Thiopurines prevented surgical recurrence in patients with Crohn's disease after intestinal resection: Strategy based on risk stratification.
Thiopurines prevented surgical recurrence in patients with Crohn's disease after intestinal resection: Strategy based on risk stratification.
复制标题
硫嘌呤预防克罗恩病患者肠切除术后复发：基于风险分层的策略。
DOI：
10.1111/jgh.13922
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发表时间：
2018
影响因子：
4.1
通讯作者：
Chen Min-Hu
中科院分区：
文献类型：
--
作者：
Guo Jing;Chen Bai-Li;Chen Zhi-Hui;Luo Xia-Peng;Qiu Yun;Zhang Sheng-Hong;Feng Rui;He Yao;Zeng Zhi-Rong;Song Xin-Ming;Ben-Horin Shomron;Mao Ren;Chen Min-Hu
背景和目的硫嘌呤（TP）可有效减少克罗恩病（CD）术后患者的临床和内镜复发。然而，TP 是否可以预防手术复发 (SR) 仍不清楚。我们的目的是探讨 TP 是否可以预防 SR 并确定与 SR 相关的危险因素。方法这是一项对 246 名术后 CD 患者进行的回顾性队列研究。 Cox 比例风险模型用于识别 SR 的危险因素。根据是否存在危险因素对患者进行分层。结果平均随访 54.3±46.4 个月后，共有 50 名 (20.3%) 患者出现 SR。多变量分析显示，SR 的独立危险因素为穿透性疾病行为（HR 8.628；95% CI 1.573–47.341；P= 0.01）、回结肠疾病部位（HR 2.597；95% CI 1.047–6.445；P= 0.04）和孤立性上消化道疾病（UGID）部位（HR 5.082；P= 0.04）。 95% CI 1.496–17.267；P= 0.009）。然而，手术后使用 TP 显着降低了 SR 的风险（HR 0.120；95% CI 0.063–0.231；P<0.001）。根据危险因素对患者进行分层时，低风险组 (n=46) 中接受 TP 治疗或未接受 TP 治疗的患者之间的 SR 没有统计学差异 (P=0.08)。然而，在高危组 (n=200) 中，使用 TP 的患者发生 SR 的风险低于未使用 TP 的患者 (HR 0.093；95% CI 0.048–0.178；P < 0.001)。 结论 穿透性疾病行为和回结肠/孤立 (UGID) 位置与 CD 患者的 SR 相关。 TP 的使用有助于降低高危 CD 患者的 SR 风险。
Background and AimThiopurines (TPs) are effective in reducing clinical and endoscopic recurrence in postoperative patients with Crohn's disease (CD). However, whether TPs could prevent surgical recurrence (SR) remains unknown. We aimed to explore whether TPs could prevent SR and identify risk factors associated with SR.MethodsThis was a retrospective cohort study of 246 postoperative patients with CD. Cox proportional hazard model was used to identify risk factors for SR. Patients were stratified according to the presence of risk factors.ResultsA total of 50 (20.3%) patients suffered SR after a mean follow up of 54.3±46.4 months. Multivariable analysis showed independent risk factors for SR were penetrating disease behavior (HR 8.628; 95% CI 1.573–47.341;P= 0.01), ileocolonic disease location (HR 2.597; 95% CI 1.047–6.445;P= 0.04) and isolated upper gastrointestinal disease (UGID) location (HR 5.082; 95% CI 1.496–17.267;P= 0.009). However, use of TPs after surgery significantly reduced the risk of SR (HR 0.120; 95% CI 0.063–0.231;P< 0.001). When stratifying patients according to risk factors, there was no statistical difference of SR between patients treated or not by TPs (P= 0.08) in low‐risk group (n= 46). However, in high risk group (n= 200), patients with TPs use had a lower risk of SR than those without TPs (HR 0.093; 95% CI 0.048–0.178;P< 0.001).ConclusionsPenetrating disease behavior and ileocolonic/isolated (UGID) location were associated with SR in CD patients. TPs use was beneficial in decreasing risk for SR in CD patients at high risk.