Family history and serology predict Crohn's disease after ileal pouch-anal anastomosis for ulcerative colitis
Family history and serology predict Crohn's disease after ileal pouch-anal anastomosis for ulcerative colitis
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DOI：
10.1007/s10350-007-9158-3
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发表时间：
2008-01-01
影响因子：
3.9
通讯作者：
Targan, Stephan R.
中科院分区：
文献类型：
--
作者：
Melmed, Gil Y.;Fleshner, Phillip R.;Targan, Stephan R.
目的：在确诊为溃疡性结肠炎的行回肠袋-肛管吻合术的患者中，约有5%至10%的患者随后被诊断为克罗恩病。术前预测克罗恩病回肠膀胱术后肛门吻合术的因素尚未明确。方法：共238例连续接受回肠膀胱术后肛门吻合术的溃疡性结肠炎或不明原因结肠炎患者被前瞻性纳入纵向数据库。围手术期对临床因素进行评估。采用酶联免疫吸附试验检测术前血清中抗酿酒酵母、抗外膜Pporin-C、抗CBir1和核周抗中性粒细胞胞浆抗体。克罗恩病的定义是回肠袋附近的小肠炎或回肠造口闭合后至少三个月发现的肛周瘘。结果：16例患者(7%)被诊断为克罗恩病；克罗恩病的中位发病时间为19(范围1-41)个月。回肠膀胱术后克罗恩病家族史(危险比，8.4；95%可信区间，2.96-24.1；P
PURPOSE: Approximately 5 to 10 percent of patients undergoing ileal pouch-anal anastomosis with a diagnosis of ulcerative colitis are subsequently diagnosed with Crohn's disease. Preoperative predictors for Crohn's disease post-ileal pouch-anal anastomosis have not been prospectively defined.METHODS: A total of 238 consecutive patients with ulcerative colitis or indeterminate colitis undergoing ileal pouch-anal anastomosis were prospectively enrolled into a longitudinal database. Clinical factors were assessed perioperatively. Serum drawn preoperatively was assayed for anti-Saccharomyces cerevisiae, antiouter membrane porin-C, anti-CBir1, and perinuclear antineutrophil cytoplasmic antibody using enzyme-linked immunosorbent assay. Crohn's disease was defined by small bowel inflammation proximal to the ileal pouch or a perianal fistula identified at least three months after ileostomy closure. Predictors were assessed in a multivariate Cox proportional hazards model to predict the rate of Crohn's disease after ileostomy closure.RESULTS: Sixteen patients (7 percent) were diagnosed with Crohn's disease; median time to Crohn's disease was 19 (range, 1-41) months. Significant factors for postoperative Crohn's disease after ileal pouch-anal anastomosis included family history of Crohn's disease (hazard ratio, 8.4; 95 percent confidence interval, 2.96-24.1; P