Divergent patterns of total and cancer mortality in ulcerative colitis and Crohn's disease patients: the Florence IBD study 1978-2001
Divergent patterns of total and cancer mortality in ulcerative colitis and Crohn's disease patients: the Florence IBD study 1978-2001
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DOI：
10.1136/gut.2003.031476
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发表时间：
2004-09-01
期刊：
影响因子：
24.5
通讯作者：
Palli, D
中科院分区：
文献类型：
--
作者：
Masala, G;Bagnoli, S;Palli, D
背景和目标：先前在意大利佛罗伦萨进行的一项基于人群的研究表明，溃疡性结肠炎和克罗恩病患者中吸烟相关疾病的死亡率存在两种不同的模式。长期随访（中位数15年）完成重新评估死亡率在这个地中海cohol.Patients和方法：总体而言，920例炎症性肠病患者进行了随访，直到2001年12月或死亡，7例（0.8%）失访。共有14 040人年可用于分析;观察到118例死亡（溃疡性结肠炎81/689例，克罗恩病37/231例）。使用年龄、性别和日历特定的国家和地方死亡率估计预期死亡;计算标准化死亡率比（SMR）和95%置信区间（CI）。在克罗恩病患者中，胃肠道疾病的死亡率显著增加（SMR 4.49（95% CI 1.80-9.25））、所有癌症（SMR 2.10（95% CI 1.22-3.36））和肺癌（SMR 4.00（95% CI 1.60-8.24）），导致总死亡率显著超出50%。溃疡性结肠炎患者的总死亡率显著降低，因为心血管（SMR 0.67（95% CI 0.45-0.95））和肺癌（SMR 0.32（95% CI 0.07-0.95））死亡率较低。没有显着过剩的结直肠癌的死亡率是显而易见的，在这个延长following.Conclusions：这些明显不同的死亡率模式与克罗恩病和溃疡性结肠炎患者之间的吸烟习惯的差异。家庭医生和胃肠病学家应将戒烟视为克罗恩病患者的一个具体优先事项;后者应免费参加结构化戒烟计划，以降低吸烟相关的超额死亡率。总的来说，没有证据表明大肠癌的死亡率增加。
Background and aims: Two divergent patterns of mortality for smoking related diseases in ulcerative colitis and Crohn's disease patients were suggested in a previous population based study in Florence, Italy. Long term follow up (median 15 years) was completed to re-evaluate mortality in this Mediterranean cohort.Patients and methods: Overall, 920 patients with inflammatory bowel disease were followed until December 2001 or death, with seven patients (0.8%) lost to follow up. A total of 14 040 person years were available for analysis; 118 deaths were observed (81/689 in ulcerative colitis and 37/231 in Crohn's disease). Expected deaths were estimated using age, sex, and calendar specific national and local mortality rates; standardised mortality ratios (SMR) and 95% confidence interval (CI) were calculated.Results: Among Crohn's disease patients, mortality was strongly increased for gastrointestinal diseases (SMR 4.49 (95% CI 1.80-9.25)), all cancers (SMR 2.10 (95% CI 1.22-3.36)), and lung cancer (SMR 4.00 (95% CI 1.60-8.24)), leading to a significant 50% excess total mortality. Ulcerative colitis patients showed a significantly reduced total mortality because of lower cardiovascular (SMR 0.67 (95% CI 0.45-0.95)) and lung cancer (SMR 0.32 (95% CI 0.07-0.95)) mortality. No significant excess for colorectal cancer mortality was evident in this extended follow up.Conclusions: These clearly divergent patterns of mortality correlate with documented differences in smoking habits between Crohn's disease and ulcerative colitis patients. Family doctors and gastroenterologists should consider stopping cigarette smoking a specific priority for Crohn's disease patients; the latter should be offered free participation in structured programmes for smoking cessation, with the aim of reducing smoking related excess mortality. Overall, no evidence of an increased mortality for large bowel cancer emerged in this series.