Crohn's disease patients carrying Nod2/CARD15 gene variants have an increased and early need for first surgery due to stricturing disease and higher rate of surgical recurrence
Crohn's disease patients carrying Nod2/CARD15 gene variants have an increased and early need for first surgery due to stricturing disease and higher rate of surgical recurrence
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DOI：
10.1097/01.sla.0000186173.14696.ea
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发表时间：
2005-11-01
影响因子：
9
通讯作者：
Panés, J
中科院分区：
文献类型：
--
作者：
Alvarez-Lobos, M;Arostegui, JI;Panés, J
目标：研究Nod 2/CARD 15基因变异沿着疾病表型特征对克罗恩病（CD）初次手术需求和手术复发的预测价值。基因型-表型关系的研究表明，这些变异与肠狭窄的发展有关。初步报告分析这些变异之间的关联和需要sihave产生不一致的results.Methods：共170 CD患者前瞻性纳入研究，并定期随访7.4 +/- 6.1年。记录CD的临床特征、手术时间和指征以及复发情况。结果：在单因素分析中，Nod 2/CARD 15基因变异患者的狭窄性疾病手术率明显高于其他患者（OR = 3.63，95%可信区间CI = 1.42-9.27），且需要手术的时间较早（P = 0.004）。在多变量分析中，只有Nod 2/CARD 15变异（OR，3.58; 95% CI，1.21-10.5）和CD诊断时的狭窄表型（OR，9.34; 95% CI，2.56-33.3）是狭窄病变初次手术的独立预测因素。在70例需要手术的患者中，在单变量和多变量分析中，Nod 2/CARD 15变异患者的术后复发率也更高（OR，3.29; 95%CI，1.13-9.56），再次手术时间早结论：Nod 2/CARD 15变异与克罗恩病狭窄早期手术及手术复发相关。这些变异的患者可以从预防和/或早期治疗策略中获益。
Objective: To study the predictive value of Nod2/CARD15 gene variants along with disease phenotypic characteristics for requirement of initial surgery and for surgical recurrence in Crohn's disease (CD).Summary Background Data: Nod2/CARD15 gene variants play an important role in the susceptibility to CD. Studies of genotype-phenotype relationship suggest that these variants are associated with development of intestinal strictures. Preliminary reports analyzing the association between these variants and need for si have produced inconsistent results.Methods: A total of 170 CD patients were included prospectively in the study and followed up regularly for a rnean of 7.4 +/- 6.1 years. Clinical characteristics of CD, time and indication for surgery, and recurrence were registered. Nod2/CARD15 gene variants were determined by DNA sequencing analysis.Results: Surgery for stricturing disease was significantly more frequent in patients with Nod2/CARD15 variants in the univariate analysis (odds ratio [OR], 3.63; 95% confidence interval [CI], 1.42-9.27), and it was required at an earlier time (P = 0.004). Only Nod2/CARD15 variants (OR, 3.58; 95% Cl, 1.21-10.5) and stricturing phenotype at diagnosis of CD (OR, 9.34; 95% Cl, 2.56-33.3) were independent predictive factors of initial Surgery for stricturing lesions in the multivariate analysis. Among 70 patients that required surgery, postoperative recurrence was also more frequent in patients with Nod2/CARD15 variants in the univariate and multivariate analysis (OR, 3.29; 95% Cl, 1.13-9.56), and reoperation was needed at ail earlier time (P = 0.03).Conclusion: Nod2/CARD15 variants are associated with early initial surgery due to stenosis and with surgical recurrence in Crohn's disease. Patients with these variants could benefit from preventive and/or early therapeutic strategies.