Natural History of Adult Ulcerative Colitis in Population-based Cohorts: A Systematic Review.
Natural History of Adult Ulcerative Colitis in Population-based Cohorts: A Systematic Review.
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DOI：
10.1016/j.cgh.2017.06.016
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Sandborn WJ
中科院分区：
文献类型：
--
作者：
Fumery M;Singh S;Dulai PS;Gower-Rousseau C;Peyrin-Biroulet L;Sandborn WJ
对UC自然史的全面了解有助于了解疾病演变，识别不良预后标志物和治疗策略的影响，并促进共同决策。我们系统回顾了长期随访的成人人群队列研究中UC的自然史。通过对截至2016年3月31日的MEDLINE进行系统性文献综述，我们确定了在17个基于人群的初始队列中进行的60项研究，这些研究报告了成人发病UC的长期病程和结局（n= 15，316例UC患者）。左侧结肠炎是最常见的部位，在10-30%的患者中观察到疾病扩展。大多数患者的病程为轻度至中度，诊断时最活跃，然后处于不同的缓解期或轻度活动期;约10-15%的患者经历了侵袭性病程，10年时复发的累积风险为70-80%。几乎50%的患者需要UC相关的住院治疗，5年内再次住院的风险约为50%。结肠切除术的5年和10年累积风险为10-15%;实现粘膜愈合与结肠切除术的低风险相关。约50%的患者接受皮质类固醇，尽管这一比例随着时间的推移而下降，免疫调节剂（20%）和抗TNF（5-10%）的使用相应增加。虽然UC与死亡风险增加无关，但其与高发病率和工作残疾相关，与克罗恩病相当。随着时间的推移，UC是一种致残性疾病。需要前瞻性队列研究来评价近期采用免疫调节剂和生物制剂早期使用疾病缓解疗法和靶向治疗方法的策略的影响。还需要对低发病率地区进行长期研究。
A comprehensive knowledge of the natural history of UC helps understand disease evolution, identify poor prognostic markers and impact of treatment strategies and facilitates shared decision-making. We systematically reviewed the natural history of UC in adult population-based cohort studies with long-term follow-up. Through a systematic literature review of MEDLINE through March 31, 2016, we identified 60 studies performed in 17 population-based inception cohorts reporting the long-term course and outcomes of adult-onset UC (n=15,316 UC patients). Left-sided colitis is the most frequent location and disease extension is observed in 10–30% patients. Majority of patients have a mild-moderate course, most active at diagnosis and then in varying periods of remission or mild activity; about 10–15% patients experience an aggressive course, and the cumulative risk of relapse is 70–80% at 10 years. Almost 50% patients require UC-related hospitalization, and 5-year risk of re-hospitalization is ~50%. The 5- and 10-year cumulative risk of colectomy is 10–15%; achieving mucosal healing is associated with lower risk of colectomy. About 50% patients receive corticosteroids, though this proportion has decreased over time, with a corresponding increasing in the use of immunomodulators (20%) and anti-TNF (5–10%). While UC is not associated with an increased risk of mortality, it is associated with high morbidity and work disability, comparable to Crohn’s disease. UC is a disabling condition over time. Prospective cohorts are needed to evaluate the impact of recent strategies of early use of disease-modifying therapies and treat-to-target approach, with immunomodulators and biologics. Long-term studies from low-incidence areas are also needed.
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