Risk of early surgery for Crohn's disease: Implications for early treatment strategies
Risk of early surgery for Crohn's disease: Implications for early treatment strategies
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DOI：
10.1016/s0002-9270(03)01707-6
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发表时间：
2003-12-01
影响因子：
9.8
通讯作者：
Zawacki, JK
中科院分区：
文献类型：
--
作者：
Sands, BE;Arsenault, JE;Zawacki, JK
目标：在这项研究中，我们的目的是确定克罗恩病的早期手术率，并确定与早期手术相关的风险因素，作为克罗恩病早期干预的后续研究的基础。我们对1991年至1997年间诊断出克罗恩病的患者进行了回顾性队列研究，并随访了至少3年，他们在新英格兰的16个社区和教会中被发现。对每例患者进行病历审查。记录基线人口统计学和疾病特征的详细信息。还记录了手术史，包括手术日期、适应症和手术。通过单因素分析确定早期手术的危险因素（定义为诊断后3年内因克罗恩病接受大手术，不包括诊断时的大手术）。多元Logistic回归分析，以确定独立的风险factors.Results：345名合格的患者，69（20.1%）需要手术3年内诊断，排除14例（4.1%）谁在诊断时进行了大手术。总的来说，诊断和手术之间的时间间隔很短;一半需要手术的患者在诊断后6个月内接受了手术。通过单变量分析确定的与早期手术显著相关的风险因素包括：吸烟;不累及结肠的小肠疾病;恶心、呕吐或腹痛;中性粒细胞计数;以及前6个月使用类固醇。仅局限于结肠的疾病、便血、使用5-氨基水杨酸盐和淋巴细胞计数与早期手术风险呈负相关。Logistic回归分析证实了独立的关联，吸烟作为一个积极的危险因素和参与结肠，小肠作为一个消极的危险因素，早期surgics.CONCLUSIONS：手术率高，在第一个3年后诊断克罗恩病，特别是在第一个6个月。这些结果表明，需要改进的危险分层和快速起效的有效治疗来改变克罗恩病的自然史。
OBJECTIVES: In this study we aimed to define the rate of early surgery for Crohn's disease and to identify risk factors associated with early surgery as a basis for subsequent studies of early intervention in Crohn's disease.METHODS: We assembled a retrospective cohort of patients with Crohn's disease diagnosed between 1991 and 1997 and followed for at least 3 yr, who were identified in 16 community and referral-based practices in New England. Chart review was performed for each patient. Details of baseline demographic and disease features were recorded. Surgical history including date of surgery, indication, and procedure were also noted. Risk factors for early surgery (defined as major surgery for Crohn's disease within 3 yr of diagnosis, exclusive of major surgery at time of diagnosis) were identified by univariate analysis. Multiple logistic regression was used to identify independent risk factors.RESULTS: Of 345 eligible patients, 69 (20.1%) required surgery within 3 yr of diagnosis, excluding the 14 patients (4.1%) who had major surgery at the time of diagnosis. Overall, the interval between diagnosis and surgery was short; one half of all patients who required surgery underwent operation within 6 months of diagnosis. Risk factors identified by univariate analysis as significantly associated with early surgery included the following: smoking; disease of small bowel without colonic involvement; nausea and vomiting or abdominal pain on presentation; neutrophil count; and steroid use in the first 6 months. Disease localized to the colon only, blood in the stool, use of 5-aminosalicylate, and lymphocyte count were inversely associated with risk of early surgery. Logistic regression confirmed independent associations with smoking as a positive risk factor and involvement of colon without small bowel as a negative risk factor for early surgery.CONCLUSIONS: The rate of surgery is high in the first 3 yr after diagnosis of Crohn's disease, particularly in the first 6 months. These results suggest that improved risk stratification and potent therapies with rapid onset of action are needed to modify the natural history of Crohn's disease.