Prolonged azathioprine treatment reduces the need for surgery in early Crohn's disease
Prolonged azathioprine treatment reduces the need for surgery in early Crohn's disease
复制标题
长期硫唑嘌呤治疗可减少早期克罗恩病的手术需求。
DOI：
10.1111/jgh.14000
复制
发表时间：
2018-03-01
影响因子：
4.1
通讯作者：
Chen, Min-Hu
中科院分区：
文献类型：
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作者：
Qiu, Yun;Chen, Bai-Li;Chen, Min-Hu
背景与目的早期使用硫唑嘌呤（AZA）是否能改变克罗恩病（CD）的自然史仍有争议。本研究的目的是评估AZA对早期CD患者疾病进展的影响。方法本纵向队列研究检查了早期CD患者，定义为疾病持续时间为18个月，根据巴黎定义以前未使用过疾病改善药物。主要终点是cd相关肠道手术的比例。采用Cox回归分析确定CD进展的潜在预测因素。结果190名早期乳糜泻患者参加了这项研究。中位随访57个月（四分位间距31.3-76.2），31例患者接受腹部手术，48例患者住院，68例患者出现临床发作。在AZA治疗5年后，cd相关的肠道手术、住院和耀斑的累积发生率分别为0.65、0.59和0.39。确定了cd相关手术的三个独立预测因素：既往肠切除术（危险比[HR]， 9.23； 95%可信区间[CI] 3.67-23.23）、吸烟者（危险比，4.0；95%可信区间[CI] 1.38-11.65）和36个月血红蛋白（危险比，0.04；95%可信区间[CI] 0.01-0.15）与cd相关手术减少相关。结论先前的肠切除术、吸烟和血红蛋白
Background and AimWhether an early use of azathioprine (AZA) can alter the natural history of Crohn's disease (CD) remains debated. The aim of this study is to evaluate the impact of AZA on disease progression in a cohort of patients with early CD.MethodsThis longitudinal cohort study examined patients with early CD defined as disease duration 18months and no previous use of disease-modifying agents according to Paris definition. The primary outcome was the proportion of CD-related intestinal surgery. Cox regression analysis was performed to identify potential predictive factors of CD progression.ResultsOne-hundred and ninety patients with early CD were enrolled in the study. After a median follow-up of 57months (interquartile range, 31.3-76.2), 31 patients underwent abdominal surgeries, 48 patients were hospitalized, and 68 patients experienced clinical flares. The cumulative rate of remaining free of CD-related bowel surgery, hospitalization, and flare at 5years on AZA treatment was 0.65, 0.59, and 0.39, respectively. Three independent predictors of CD-related operations were identified: prior bowel resection (hazard ratio [HR], 9.23; 95% confidence interval [CI] 3.67-23.23), smoker (HR, 4.0; 95% CI 1.38-11.65), and hemoglobin 36months (HR, 0.04; 95% CI 0.01-0.15) was associated with reduced CD-related operations.ConclusionPrior bowel resection, smoking, and hemoglobin