Clinical course in Crohn's disease: Results of a five-year population-based follow-up study (the IBSEN study)
Clinical course in Crohn's disease: Results of a five-year population-based follow-up study (the IBSEN study)
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DOI：
10.1080/00365520601076124
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发表时间：
2007-01-01
影响因子：
1.9
通讯作者：
Moum, Bjorn
中科院分区：
文献类型：
--
作者：
Henriksen, Magne;Jahnsen, Jorgen;Moum, Bjorn
背景。关于克罗恩病 (CD) 患者临床病程的基于人群的前瞻性研究很少。目的。延长基于人群的前瞻性研究（IBSEN 研究）的观察期，以了解有关 CD 患者最初 5 年临床病程的更多信息，并将研究结果与维也纳分类联系起来。方法。对 1990 年至 1993 年 4 年间挪威东南部所有诊断为炎症性肠病 (IBD) 的患者进行了前瞻性随访。患者被邀请在纳入研究后 1 年和 5 年到当地医院进行系统随访。这些访问包括结构化访谈、临床检查和结肠镜检查。结果。在 843 名最初诊断为 IBD 的患者中，200 名确诊为 CD 的患者仍然活着，并且在诊断 5 年后有足够的数据进行分析。分别在 27 名 (13.5%) 和 35 名患者 (17.5%) 中观察到与维也纳分类相关的疾病定位和行为变化。观察期间，56名患者（28%）接受了肠切除手术，其中一半的疾病局限于回肠末端。在为期 5 年的访问中，口服柳氮磺吡啶和 5-氨基水杨酸 (5-ASA) 是最常用的药物（54% 的患者），而口服糖皮质激素和硫唑嘌呤分别有 25% 和 13% 的患者使用。 72% 的患者在 5 年期间的某个时间服用过口服糖皮质激素。大多数患者在 5 岁时出现肠道症状，但只有 16% 的患者出现干扰日常活动的症状。 14% 的患者经历了 5 年无复发病程；然而，复发与最初的维也纳分类无关。当患者描述临床病程时，44% 的患者报告在随访期间症状有所改善。结论：未经选择的 CD 患者队列的 5 年临床病程大多为轻度。手术频率低于其他研究中观察到的频率，并且只有少数患者在初次诊断 5 年后出现干扰日常活动的症状。维也纳分类预测了手术风险，但没有预测 5 年时的症状、观察期间的复发或患者描述的病程。
Background. There are few population-based, prospective studies on the clinical course in patients with Crohn's disease (CD). Aim. To extend the observation period in a population-based prospective study (the IBSEN study) to find out more about the initial 5-year clinical course in CD patients and to relate the findings to the Vienna classification. Methods. All patients diagnosed with inflammatory bowel disease (IBD) in southeastern Norway in the 4 years 1990 - 1993 were followed prospectively. The patients were invited to a systematic follow-up visit at their local hospital 1 and 5 years after inclusion in the study. The visits included a structured interview, a clinical examination and colonoscopy. Results. Out of 843 patients initially diagnosed with IBD, 200 patients with definite CD were alive and had sufficient data for analysis 5 years after diagnosis. Changes in disease localization and behaviour in relation to the Vienna classification were observed in 27 (13.5%) and 35 patients (17.5%), respectively. During the observation period, 56 patients (28%) underwent surgery with intestinal resection, and half of these had disease localized in the terminal ileum. At the time of the 5-year visit, oral sulfasalazin and 5-aminosalicylic acid (5-ASA) were the most frequently used medications (by 54% of the patients), while oral glucocorticosteroids and azathioprine were being used by 25% and 13%, respectively. Seventy-two percent of the patients had taken oral glucocorticosteroids at some time in the course of the 5-year period. The majority of the patients had intestinal symptoms at 5 years, but only 16% had symptoms that interfered with everyday activities. Fourteen percent of the patients had had a relapse-free 5-year course; however, relapse was not related to the initial Vienna classification. When the patients described the clinical course, 44% reported an improvement in symptoms during the follow-up period. Conclusions: The 5-year clinical course in an unselected cohort of CD patients was mostly mild. The frequency of surgery was lower than that observed in other studies and only a minority of the patients had symptoms that interfered with everyday activities 5 years after the initial diagnosis. The Vienna classification predicted the risk of surgery, but did not predict symptoms at 5 years, relapses during the observation period or the course of disease as described by the patients.