Early Thiopurines Versus Conventional Step-Care Therapy for Modifying the Disease Course of Early Crohn's Disease: A Tertiary Referral Center Cohort Study.
Early Thiopurines Versus Conventional Step-Care Therapy for Modifying the Disease Course of Early Crohn's Disease: A Tertiary Referral Center Cohort Study.
复制标题
早期硫嘌呤与传统的逐步护理疗法改变早期克罗恩病的病程：一项三级转诊中心队列研究。
DOI：
10.1097/md.0000000000001148
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发表时间：
2015-08
期刊：
影响因子：
1.6
通讯作者：
Chen MH
中科院分区：
文献类型：
--
作者：
Qiu Y;Chen BL;Mao R;Zhang SH;He Y;Zeng ZR;Chen MH
硫嘌呤（TP）对早期克罗恩病（CD）长期预后的影响仍有争议。本研究旨在比较传统的阶梯护理替代治疗模式的疾病进展。这项纵向队列研究检查了来自大学炎症性肠病转诊中心的确诊CD患者。根据TP治疗开始的时间，比较了粘膜愈合（MH）、CD相关手术或住院治疗以及临床缓解的结局。采用Kaplan-Meier法估计事件的累积发生率。纳入190例早期CD患者。中位随访57个月（四分位距，31.3-76.2）后，29例患者接受腹部手术，48例患者住院，68例患者发生临床发作。第36个月时，自上而下（TD）组达到MH的患者累积比例高于加速递增（AC）组和常规管理（CM）组（分别为78.8% vs 39.9%和42.2%; P = 0.001）。 在第60个月时，TD组中无CD相关肠道手术的患者比例有增加的趋势，尽管不显著（P = 0.16）。 然而，在次要结局中，与CM策略相比，早期TP为基础的AC或TD策略与60个月时临床缓解率的改善无关（P = 0.79）。 在早期TP和CM之间，MH、CD相关肠道手术或住院率以及临床缓解率无显著差异。AC和CM策略对疾病改善的效果最低。TD策略有可能实现更高的MH率。我们的研究结果支持TD策略在早期CD患者的致残过程中的风险。
The impact of thiopurines (TP) on the long-term outcome of early Crohn disease (CD) is still controversial. The present study designed as a comparison of conventional step-care to alternative treatment paradigms for disease progression. This longitudinal cohort study examined the established CD patients from a university-based inflammatory bowel disease referral center. Outcomes of mucosal healing (MH), CD-related surgery or hospitalization, and clinical remission were compared based on timing of initiation of TP therapy. The cumulative incidence of events was estimated by Kaplan–Meier method. One-hundred ninety patients with early CD were included. After a median follow-up of 57 months (interquartile range, 31.3–76.2), 29 patients undergone abdominal surgeries, 48 patients hospitalized, and 68 patients experienced clinical flares. A higher cumulative proportion of patients in the top-down (TD) group achieving MH than both the accelerated step-up (AC) group and conventional management (CM) group at month 36 (78.8% vs 39.9% and 42.2%, respectively; P = 0.001). There was a trend, albeit not significant, for an increased proportion of patients free of CD-related intestinal surgery in the TD group at month 60 (P = 0.16). However, among secondary outcomes, an early TP-based AC or TD strategy was not associated with improvement in clinical remission rates compared with a CM strategy at month 60 (P = 0.79). No significant difference was observed between early TP and CM for rates of MH, CD-related intestinal surgery or hospitalization, and clinical remission. Both AC and CM strategy were minimally effective for disease modification. TD strategy has the potential of achieving higher rates MH. Our results support the TD strategy in patients with early CD at risk for a disabling course.