Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study)
Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study)
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DOI：
10.1080/00365520802600961
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发表时间：
2009-01-01
影响因子：
1.9
通讯作者：
Moum, Bjorn
中科院分区：
文献类型：
--
作者：
Solberg, Inger Camilla;Lygren, Idar;Moum, Bjorn
目标。未选择和新诊断患者的队列研究对于更好地了解溃疡性结肠炎（UC）的预后至关重要。本研究的目的是在以人群为基础的初始队列中评估前10年UC的病程，并根据诊断时收集的信息确定预后危险因素。材料和方法。从1990年到1994年，在挪威东南部招募了843名炎症性肠病患者。该队列在诊断后1年、5年和10年进行系统随访。结果。519例UC患者中，423例完成了10年随访，53例死亡，43例失访。与普通人群相比，死亡风险没有增加。10年后累计结肠切除术率为9.8% （95% CI: 7.4-12.4%）。最初表现为广泛结肠炎，红细胞沉降率（ESR）为30 mm/h与诊断时的风险比（HR）增加（3.57,95% CI: 1.60-7.96）和50岁相关，随后的结肠切除术的风险比（HR）降低（0.28,95% CI: 0.12-0.65）。有83%的患者复发，但有一半（48%）的患者在过去5年内没有复发。五分之一（69/288）的直肠炎或左侧结肠炎患者进展为广泛性结肠炎。结论。UC在前10年的预后通常很好。结肠切除术率低，大部分患者随着时间的推移而缓解。最初广泛结肠炎和ESR升高的患者可以从早期有效的药物治疗策略中获益。
Objective. Cohort studies of unselected and newly diagnosed patients are essential for a better understanding of the prognosis in ulcerative colitis (UC). The aim of this study was to evaluate the course of UC in a population-based inception cohort during the first 10 years, and to identify prognostic risk factors based on information gathered at diagnosis. Material and methods. From 1990 to 1994, a population-based cohort of 843 patients with inflammatory bowel disease was enrolled in South-Eastern Norway. The cohort was systematically followed-up at 1, 5 and 10 years after diagnosis. Results. Of 519 patients with UC, 423 completed the 10-year follow-up, 53 died and 43 were lost to follow-up. The mortality risk was not increased compared with that in the general population. The cumulative colectomy rate after 10 years was 9.8% (95% CI: 7.4-12.4%). Initial presentation with extensive colitis and erythrocyte sedimentation rate (ESR) 30 mm/h was associated with an increased hazard ratio (HR) (3.57, 95% CI: 1.60-7.96) and age 50 years at diagnosis, with reduced HR (0.28, 95% CI: 0.12-0.65) for subsequent colectomy. Relapsing disease was noted in 83%, but half (48%) of the patients were relapse free during the last 5 years. One-fifth (69/288) of patients with proctitis or left-sided colitis had progressed to extensive colitis. Conclusions. The prognosis for UC during the first 10 years was generally good. The colectomy rate was low, and a large proportion of patients were in remission as time progressed. Patients with initially extensive colitis and elevated ESR could benefit from an early potent medical treatment strategy.