Risk factors for colorectal neoplasia in inflammatory bowel disease: A nested case-control study from copenhagen county, denmark and olmsted county, minnesota
Risk factors for colorectal neoplasia in inflammatory bowel disease: A nested case-control study from copenhagen county, denmark and olmsted county, minnesota
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DOI：
10.1111/j.1572-0241.2007.01070.x
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发表时间：
2007-04-01
影响因子：
9.8
通讯作者：
Sandborn, William J.
中科院分区：
文献类型：
--
作者：
Jess, Tine;Loftus, Edward V., Jr.;Sandborn, William J.
目的：基于人群的炎症性肠病（IBD）患者结直肠发育不良和癌症的危险因素和保护因素的数据很少。我们在丹麦哥本哈根县和明尼苏达州奥姆斯特德县的两个描述良好的IBD队列中对这些因素进行了巢式病例对照研究。方法：43例肿瘤患者按6项标准与1-3例对照（N = 102）进行匹配。对医疗记录进行了详细的人口统计和临床数据检查。对于每个变量，使用条件逻辑回归估计肿瘤发生的几率。结果：原发性硬化性胆管炎（PSC）（优势比[OR] 6.9, 95%可信区间[CI] 1.2-40）、病程中临床活动性疾病的百分比（OR[每增加5%]1.2,95% CI 0.996-1.4）和>= 1年的持续症状（OR 3.2, 95% CI 1.2-8.6）与肿瘤相关，而与小肠x线片中位数（OR 1.3, 95% CI 0.96-1.6）存在临界相关性。我们没有观察到就诊频率（OR 1.4, 95% CI 0.96-2.0）、结肠镜检查次数（OR 1.4, 95% CI 1.0-2.1）、磺胺嘧啶累积剂量（OR[每1,000 g] 1.1, 95% CI 1.0-1.3）和美沙拉胺（OR[每1,000 g] 1.3, 95% CI 0.9-1.9）或部分肠切除术（OR 1.5, 95% CI 0.3-7.1）的保护作用。结论：IBD患者的亚组- PSC，严重长期疾病和x射线暴露的患者-结直肠肿瘤的风险更高。密切随访、结肠镜检查和5-氨基水杨酸盐治疗的保护作用值得怀疑。
OBJECTIVES: Population-based data on risk factors and protective factors for colorectal dysplasia and cancer in patients with inflammatory bowel disease (IBD) are sparse. We conducted a nested case-control study of such factors in two well-described IBD cohorts from Copenhagen County, Denmark and Olmsted County, Minnesota.METHODS: Forty-three neoplasia cases were matched on six criteria to 1-3 controls (N = 102). Medical records were scrutinized for demographic and clinical data. For each variable, the odds of neoplasia were estimated using conditional logistic regression.RESULTS: Primary sclerosing cholangitis (PSC) (odds ratio [OR] 6.9, 95% confidence interval [CI] 1.2-40), percentage of disease course with clinically active disease (OR [per 5% increase] 1.2, 95% CI 0.996-1.4), and >= 1 yr of continuous symptoms (OR 3.2, 95% CI 1.2-8.6) were associated with neoplasia, whereas a borderline association with median number of small-bowel x-rays (OR 1.3, 95% CI 0.96-1.6) was observed. We did not observe a protective effect of frequency of physician visits ( OR 1.4, 95% CI 0.96-2.0), number of colonoscopies (OR 1.4, 95% CI 1.0-2.1), cumulative dose of sulfasalazine (OR [per 1,000 g] 1.1, 95% CI 1.0-1.3) and mesalamine (OR [per 1,000 g] 1.3, 95% CI 0.9-1.9), or partial intestinal resections (OR 1.5, 95% CI 0.3-7.1).CONCLUSIONS: Subgroups of IBD patients-those with PSC, severe long-standing disease, and exposure to x-ray-were at greater risk of colorectal neoplasia. The protective effect of close follow-up, colonoscopy, and treatment with 5-aminosalicylates was questionable.