Perianal Crohn Disease in a Large Multicenter Pediatric Collaborative
Perianal Crohn Disease in a Large Multicenter Pediatric Collaborative
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DOI：
10.1097/mpg.0000000000001447
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发表时间：
2017-05-01
影响因子：
2.9
通讯作者：
Dombkowski, Kevin J.
中科院分区：
文献类型：
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作者：
Adler, Jeremy;Dong, Shiming;Dombkowski, Kevin J.
背景：尽管克罗恩病(CD)的肛周并发症在临床上很常见，但对儿童人群中的肛周并发症的流行病学了解甚少。方法：我们从一个前瞻性观察队列中进行了回顾性分析，该队列是一个多中心的儿科炎症性肠病质量改进协作组，名为ImproveCareNow Network(2006年5月至2014年10月)。临床医生在门诊时前瞻性地记录了体检和表型分类。肛周检查结果和伴随的表型变化被用来证实新发肛周疾病的时间。结果按年龄、性别和种族分层，并用Logistic回归进行跨组比较。累积发病率使用Kaplan-Meier分析进行估计，并使用Cox比例风险回归模型进行组间比较。结果：登记的CD患者7076人(41%为女孩)。缺失/冲突的条目导致397例(6%)患者被排除。其余6679例中，1399例(21%)发展为肛周疾病。肛周疾病在男孩(22%)中比女孩(20%；P=0.013)中更常见，并且在较晚而不是较早发病的患者中在确诊后较早发展(P<；0.001)。与白人(20%；P=0.017)相比，肛周疾病在黑人(26%)中也更常见。起病较晚的亚洲人在病程较早时出现肛周疾病(P=0.01)。确诊时的疾病部位或营养状况与肛周疾病的发展没有相关性。结论：在这项大型多中心合作中，我们发现CD儿童的肛周疾病比以前认识到的更常见。在不同种族和其他亚组中，发现肛周疾病的发生存在差异。需要采取治疗策略来防止肛周疾病的发展。
Background: Although perianal complications of Crohn disease (CD) are commonly encountered in clinical practice, the epidemiology of perianal CD among populations of children is poorly understood. We sought to characterize the prevalence of perianal disease in a large and diverse population of pediatric patients with CD.Methods: We conducted retrospective analyses from a prospective observational cohort, the ImproveCareNow Network (May 2006-October 2014), a multicenter pediatric inflammatory bowel disease quality improvement collaborative. Clinicians prospectively documented physical examination and phenotype classification at outpatient visits. Perianal examination findings and concomitant phenotype change were used to corroborate time of new-onset perianal disease. Results were stratified by age, sex, and race and compared across groups with logistic regression. Cumulative incidence was estimated using Kaplan-Meier analyses and compared between groups with Cox proportional hazard regression models.Results: The registry included 7076 patients with CD (41% girls). Missing/ conflicting entries resulted in 397 (6%) patient exclusions. Among the remaining 6679 cases, 1399 (21%) developed perianal disease. Perianal disease was more common among boys (22%) than girls (20%; P = 0.013) and developed sooner after diagnosis among those with later rather than early onset disease (P< 0.001). Perianal disease was also more common among blacks (26%) compared with whites (20%; P = 0.017). Asians with later onset CD developed perianal disease earlier in their disease course (P = 0.01). There was no association between disease location or nutritional status at diagnosis and later development of perianal disease.Conclusions: In this large multicenter collaborative, we found that perianal disease is more common among children with CD than previously recognized. Differences in the development of perianal disease were found across racial and other subgroups. Treatment strategies are needed to prevent perianal disease development.