The Natural History of Pediatric Ulcerative Colitis: A Population-Based Cohort Study
The Natural History of Pediatric Ulcerative Colitis: A Population-Based Cohort Study
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DOI：
10.1038/ajg.2009.177
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发表时间：
2009-08-01
影响因子：
9.8
通讯作者：
Colombel, Jean-Frederic
中科院分区：
文献类型：
--
作者：
Gower-Rousseau, Corinne;Dauchet, Luc;Colombel, Jean-Frederic
目的：溃疡性结肠炎(UC)的自然病史在儿童中的描述一直很差。方法：在1988年至2002年诊断的一个地理来源的发病队列中，我们确定了113名UC患者(确诊时年龄0-17岁)，并进行了至少2年的随访。用Kaplan-Meier方法估计结肠切除的累积风险。用Logistic回归模型评估疾病扩展的危险因素，用COX风险比例模型评估结肠切除术的危险因素。结果：中位随访时间为77个月(46-125)。确诊时，28%的患者患有直肠炎，35%的患者患有左侧结肠炎，37%的患者患有广泛性结肠炎。49%的患者病程以疾病扩展为特征。诊断延迟6个月以上和炎症性肠病家族史与疾病扩展的风险增加相关，优势比分别为5.0(1.2~2 1.5)和11.8(1.3~111.3)。1年、3年和5年的累积结肠切除率分别为8%、15%和20%。确诊时出现肠外表现(EIMS)与结肠切除的风险增加相关(危险比(HR)=3.5(1.2-10.5))。在确诊时有局限性疾病的患者中，经历疾病扩展的患者行结肠切除术的风险高于未经历疾病扩展的患者(HR=13.31.7~101.7)。结论：儿童UC具有诊断时定位广泛、疾病扩展率高的特点。20%的儿童在5年后切除了结肠。结肠切除率受疾病范围的影响，并与诊断时EIMS的存在有关。
OBJECTIVES: The natural history of ulcerative colitis (UC) has been poorly described in children.METHODS: In a geographically derived incidence cohort diagnosed from 1988 to 2002, we identified 113 UC patients (age 0-17 years at diagnosis) with a follow-up of at least 2 years. The cumulative risk of colectomy was estimated by the Kaplan-Meier method. Risk factors for disease extension were assessed with logistic regression models, and risk factors for colectomy with Cox hazards proportional models.RESULTS: Median follow-up time was 77 months (46-125). At diagnosis, 28% of patients had proctitis, 35% left-sided colitis, and 37% extensive colitis. Disease course was characterized by disease extension in 49% of patients. A delay in diagnosis of more than 6 months and a family history of inflammatory bowel disease were associated with an increased risk of disease extension, with odds ratios of 5.0 (1.2-21.5) and 11.8 (1.3-111.3), respectively. The cumulative rate of colectomy was 8% at 1 year, 15% at 3 years, and 20% at 5 years. The presence of extra-intestinal manifestations (EIMS) at diagnosis was associated with an increased risk of colectomy (hazard ratio (HR) = 3.5 (1.2-10.5)). Among the patients with limited disease at diagnosis, the risk of colectomy was higher in those who experienced disease extension than in those who did not (HR = 13.3 1.7-101.7).CONCLUSIONS: Pediatric UC was characterized by widespread localization at diagnosis and a high rate of disease extension. Twenty percent of children had their colon removed after 5 years. The colectomy rate was influenced by disease extension and was associated with the presence of EIMS at diagnosis.