Upper Gastrointestinal Tract Phenotype of Crohn's Disease Is Associated with Early Surgery and Further Hospitalization
Upper Gastrointestinal Tract Phenotype of Crohn's Disease Is Associated with Early Surgery and Further Hospitalization
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DOI：
10.1002/ibd.20804
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发表时间：
2009-04-01
影响因子：
4.9
通讯作者：
Chan, Francis K. L.
中科院分区：
文献类型：
--
作者：
Chow, Dorothy K. L.;Sung, Joseph J. Y.;Chan, Francis K. L.
背景资料：根据蒙特利尔分类，上消化道表型L4在患有克罗恩病（CD）的白人患者中不常见，但具有过度的复发风险。我们研究了CID在中国患者的临床过程中提出的L4表型和预测其发生的因素后纵向follow-up.Methods：这项前瞻性队列研究包括132中国CD患者（中位年龄诊断，30.0），汽车，范围：14.0-77.0岁），随访770人年。收集人口统计学数据，包括疾病行为和位置，手术细节和住院情况。Kaplan-Meier方法用于估计进一步住院和大手术的概率，然后通过考克斯比例风险回归来确定临床变量是否独立预测endpoints.Results：L4表型在30例（22.7%）患者中发现。L4组狭窄（46.7%对18.6%）和穿透（30.0%对3.9%）表型明显多于非L4组（P < 0.0001）。L4组进一步住院的3年累积概率为86.9%（95%置信区间[CI]：73.8%-100.0%），而非L4组为49.3%（95% CI：39.3%-59.3%）（对数秩检验）。P < 0.0001）。L4表型独立预测进一步住院治疗（校正风险比[HR]：2.1：95% CI：1.3-3.5）。L4组的大手术累积概率显著高于非L4组（P < 0.0001）。18例（17.6%）患者在随访时出现L4表型，狭窄表型可预测其发生（校正HR：5.5：95%CI：2.2-14.0）。结论：中国CD患者更常出现L4表型，这可预测后续住院的需要。
Background: According to the Montreal Classification, upper gastrointestinal tract phenotype L4 is uncommon in Caucasian patients with Crohn's disease (CD) but carries excess risk of recurrence. We Studied the clinical Course of CID in Chinese patients presenting with the L4 phenotype and factors predicting its Occurrence upon longitudinal follow-up.Methods: This prospective cohort Study included 132 Chinese CD patients (median age at diagnosis, 30.0),cars, range: 14.0-77.0 years) who were followed for 770 person-years. Demographic data including disease behavior and location, details Of Surgery, and hospitalization were collected. The Kaplan-Meier method was used to estimate the probabilities Of further hospitalization and major surgery followed by Cox proportional hazards regression to determine if clinical variables independently predicted the endpoints.Results: The L4 phenotype was found in 30 (22.7%) patients at presentation. There were significantly more stricturing (46.7% versus 18.6%) and penetrating (30.0% Versus 3.9%) phenotypes in the L4 group than in the non-L4 group (P < 0.0001). The 3-year cumulative probability of further hospitalization was 86.9% (95% confidence interval [CI]: 73.8%-100.0%) in the L4 group as compared with 49.3% (95% Cl: 39.3%-59.3%) in the non-L4 group (log-rank test. P < 0.0001). The L4 phenotype independently predicted further hospitalization (adjusted hazards ratio [HR]: 2.1: 95% Cl: 1.3-3.5). The cumulative probability of major Surgery was significantly higher in the L4 than in the non-L4 group (P < 0.0001). Eighteen (17.6%) patients developed the L4 phenotype on follow-up and the stricturing, phenotype predicted its Occurrence (adjusted HR: 5.5: 95% Cl: 2.2-14.0).Conclusions: Chinese CD patients more often had the L4 phenotype, which predicted the need of subsequent hospitalization.