Risk factors for surgery and postoperative recurrence: analysis of a south China cohort with Crohn's disease
Risk factors for surgery and postoperative recurrence: analysis of a south China cohort with Crohn's disease
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DOI：
10.3109/00365521.2012.668931
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发表时间：
2012-10-01
影响因子：
1.9
通讯作者：
Hu, Pin-Jin
中科院分区：
文献类型：
--
作者：
Gao, Xiang;Yang, Rong-Ping;Hu, Pin-Jin
背景和目标。探讨中国克罗恩病（CD）患者队列中初次手术和术后复发的危险因素。方法.回顾了2003年至2010年连续诊断患者的病历。招募了57名完成定期随访的术后患者进行术后复发分析。结果该队列的323例患者中有111例（34.4%）接受了初次手术。发病后1、5、10和30年的累积切除率分别为16.6%、35.4%、53%和94.5%。男性（或：1.994; 95%可信区间：1.291 - 3.078，p = 0.002）、狭窄（OR：4.832; 95% CI：3.064 - 7.621，p = 0.000）或穿透性（OR：4.923; 95% CI：3.060 - 7.919，p = 0.000）与初次手术风险增加相关，而早期使用免疫调节剂（OR：0.438; 95%可信区间：0.218 - 0.880，p = 0.020）与风险降低相关。57例（21.1%）患者被诊断为术后临床复发，1年、2年和3年的累积复发率分别为6.1%、17.1%和36.8%。肛周疾病与临床复发风险增加相关（OR：5.606; 95% CI：1.59 - 19.766，p = 0.007）。结论. CD中的操作频率较高。男性、穿透性和狭窄性疾病与初次手术风险增加相关，而早期使用免疫调节剂与风险降低相关。术后复发率也很高。肛周疾病患者临床复发的风险较高。
Background and aims. To investigate the risk factors for primary surgery and postoperative recurrence in a cohort of Chinese Crohn's disease (CD) patients. Methods. Medical notes of consecutive diagnosed patients from 2003 until 2010 were reviewed. Fifty-seven postoperative patients - finished regular follow-up - were recruited for postoperative recurrence analysis. Results. One hundred eleven of 323 (34.4%) patients of this cohort underwent primary surgery. The cumulative frequency of resection was 16.6%, 35.4%, 53%, and 94.5% for 1, 5, 10, and 30 years, respectively, after onset of disease. Male (OR: 1.994; 95% CI: 1.291-3.078, p = 0.002), stricture (OR: 4.832; 95% CI: 3.064-7.621, p = 0.000), or penetrating (OR: 4.923; 95% CI: 3.060-7.919, p = 0.000) were associated with an increased risk for primary surgery, while early use of immunomodulators was (OR: 0.438; 95% CI: 0.218-0.880, p = 0.020) associated with a decreased risk. Fifty-seven (21.1%) patients were diagnosed as postoperative clinical recurrence and the cumulative recurrence rates were 6.1%, 17.1%, and 36.8% for 1, 2, and 3 years, respectively. Perianal disease was associated with an increased risk for clinical recurrence (OR: 5.606; 95% CI: 1.59-19.766, p = 0.007). Conclusions. The operation frequency is high in CD. Male, penetrating, and stricture diseases are associated with an increased risk for primary surgery while early use of immunomodulators is associated with a decreased risk. The postoperative recurrence rate is also high. Patients with perianal disease are at higher risk for clinical recurrence.