Predictors of Crohn's disease
Predictors of Crohn's disease
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DOI：
10.1053/j.gastro.2005.12.019
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发表时间：
2006-03-01
期刊：
影响因子：
29.4
通讯作者：
Cosnes, J
中科院分区：
文献类型：
--
作者：
Beaugerie, L;Seksik, P;Cosnes, J
背景和目的：克罗恩病的早期强化治疗仅适用于患有致残性疾病的患者。我们研究的目的是确定预测随后 5 年致残病程的诊断因素。方法：在我们科室1985年至1998年间诊断的1526名克罗恩病患者中，我们排除了在疾病第一个月内接受手术的患者、数据不足的患者以及患有严重慢性非消化性疾病的患者。在剩下的 1188 名患者中，当至少存在一项常规预定义的临床严重程度标准时，克罗恩病在疾病最初 5 年内的病程被归类为致残。结果：在1123名随访数据允许完整5年病程分类的患者中，致残性疾病率为85.2%。诊断时存在且与随后 5 年失能显着相关的独立因素是最初需要使用类固醇 (OR 3.1 [95% Cl: 2.2-4.4])、年龄低于 40 岁 (OR 2.1 [95% Cl: 1.3-3.6]) 和存在肛周疾病 (OR 1.8 [95% Cl: 1.2-2.8])。具有2个和3个致残疾病预测因素的患者的致残疾病阳性预测值分别为0.91和0.93。当对 1998 年以来在我们机构就诊的 302 名连续患者组成的独立组进行前瞻性测试时，这些值分别为 0.84 和 0.91。结论：在转诊中心诊断克罗恩病时，预测随后 5 年致残病程的因素包括年龄低于 40 岁、存在肛周疾病以及最初需要类固醇。
Background & Aims: Early intensive therapy in Crohn's disease should be considered only in patients with disabling disease. The aim of our study was to identify at diagnosis factors predictive of a subsequent 5-year disabling course. Methods: Among the 1526 patients seen at our unit with Crohn's disease diagnosed between :1985 and 1998, we excluded patients operated on within the first month of the disease, patients with inadequate data, and patients with severe chronic nondigestive disease. In the 1188 remaining patients, Crohn's disease course within the first 5 years of the disease was categorized as disabling when at least 1 of the criteria of clinical severity, conventionally predefined, was present. Results: Among the 1123 patients with follow-up data allowing full 5-year course classification, the rate of disabling disease was 85.2%. Independent factors present at diagnosis and significantly associated with subsequent 5-year disabling were the initial requirement for steroid use (OR 3.1 [95% Cl: 2.2-4.4]), an age below 40 years (OR 2.1 [95% Cl: 1.3-3.6]), and the presence of perianal disease (OR 1.8 [95% Cl: 1.2-2.8]). The positive predictive value of disabling disease in patients with 2 and 3 predictive factors of disabling disease was 0.91 and 0.93, respectively. These values were 0.84 and 0.91, respectively, when tested prospectively in an independent group of 302 consecutive patients seen at our institution from 1998. Conclusions: At diagnosis of Crohn's disease in a referral center, factors predictive of subsequent 5-year disabling course are an age below 40 years, the presence of perianal disease, and the initial requirement for steroids.