Risk Factors of Colorectal Stricture Associated with Developing High-Grade Dysplasia or Cancer in Ulcerative Colitis: A Multicenter Long-term Follow-up Study
Risk Factors of Colorectal Stricture Associated with Developing High-Grade Dysplasia or Cancer in Ulcerative Colitis: A Multicenter Long-term Follow-up Study
复制标题
与溃疡性结肠炎发生高度不典型增生或癌症相关的结直肠狭窄的危险因素：一项多中心长期随访研究
DOI：
10.5009/gnl19229
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发表时间：
2020-09-01
期刊：
影响因子：
3.4
通讯作者：
Du, Peng
中科院分区：
文献类型：
--
作者：
Xu, Weimin;Ding, Wenjun;Du, Peng
背景/目的溃疡性结肠炎（UC）长期癌变相关的结直肠狭窄的危险因素尚不清楚。该研究包括1986年6月至2018年7月期间从前瞻性维护的数据库中登记的所有UC患者。采用单变量分析和多变量logistic回归模型评估异型增生和狭窄患者的人口统计学数据、临床特征和结局。结果共纳入246例符合条件的患者。中位随访时间为13.0年（四分位距[IQR]，9.0 - 16.0）。结直肠狭窄35例（14.2%）。狭窄患者的临床结局较差。狭窄形成（比值比[OR]，9.350; 95%置信区间[CI]，2.842至30.762），炎性息肉（OR，5.464; 95%CI，1.692 ~ 17.638），病程> 10年（OR，3.223; 95%CI，1.040至9.985）和诊断时年龄>40岁（OR，8.499; 95%CI，1.903至37.956）与高度异型增生或结直肠癌显著相关。此外，病程超过5年（OR，3.211; 95%CI，1.168 ~ 8.881），中度贫血（OR，3.373; 95%CI，1.472至7.731），和原发性硬化性胆管炎（OR，5，842; 95%CI，1.395至24.468）是发生结直肠狭窄的促成因素。结论结直肠狭窄癌变的危险性最高。对于有狭窄危险因素的UC患者，应考虑早期启动结肠镜监测，以防止狭窄形成和进一步恶变。
Background/Aims The risk factors of colorectal stricture associated with ulcerative colitis (UC) carcinogenesis in the long-term disease duration remain unclear. Methods This study included all UC patients registered from a prospectively maintained database between June 1986 to July 2018. The demographic data, clinical features, and outcomes in patients with dysplasia and stricture were assessed using univariable analysis and multivariate logistic regression models. Results A total of 246 eligible patients were included in the analysis. The median follow-up time was 13.0 years (interquartile range [IQR], 9.0 to 16.0). There were 35 cases (14.2%) of colorectal stricture. Patients with stricture had worse clinical outcomes. Stricture formation (odds ratio [OR], 9.350; 95% confidence interval [CI], 2.842 to 30.762), inflammatory polyps (OR, 5.464; 95% CI, 1.692 to 17.638), disease duration of more than 10 years (OR, 3.223; 95% CI, 1.040 to 9.985), and age >40 years at diagnosis (OR, 8.499; 95% CI, 1.903 to 37.956) were significantly associated with high-grade dysplasia or colorectal cancer. In addition, disease duration of more than 5 years (OR, 3.211; 95% CI, 1.168 to 8.881), moderated anemia (OR, 3.373; 95% CI, 1.472 to 7.731), and primary sclerosing cholangitis (OR, 5,842; 95% CI, 1.395 to 24.468) were contributing factors for the development of colorectal stricture. Conclusions Colorectal stricture had the highest risk for malignant transformation. Earlier initiation of colonoscopic surveillance in UC patients with risk factors for stricture should be considered to prevent stricture formation and further malignant transformation.