Long-term Disease Behavior and Surgical Intervention Analysis in Hospitalized Patients With Crohn's Disease in China: A Retrospective Cohort Study
Long-term Disease Behavior and Surgical Intervention Analysis in Hospitalized Patients With Crohn's Disease in China: A Retrospective Cohort Study
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DOI：
10.1093/ibd/izab295
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发表时间：
2022-06-02
影响因子：
4.9
通讯作者：
Qian, Jiaming
中科院分区：
文献类型：
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作者：
Bai, Xiaoyin;Zhang, Huimin;Qian, Jiaming
背景目前缺乏中国大规模队列研究中克罗恩病（CD）的疾病行为和手术治疗的真实数据。方法连续纳入2000年1月至2018年12月在我中心住院诊断为CD的患者。疾病行为进展定义为初始分类B1进展为B2或B3。收集临床特征，包括人口统计学、疾病分类和活动、药物治疗、癌症发展和死亡。结果共纳入504例患者。231例（45.8%）患者最初分类为B1;其中30例（13.0%）、71例（30.7%）和95例（41.1%）患者在1年随访、5年随访和总体时分别发生疾病进展。在行为转变之前没有位置转变的患者不太可能经历行为进展。然而，既往未暴露于皮质类固醇、免疫调节剂或生物制剂的患者发生行为进展的机会更大。当评估长期预后时，211例（41.9%）患者至少接受了1次CD相关手术;其中108例（21.4%）和120例（23.8%）患者分别在诊断前后接受了手术。初始分类为B1，无行为转变，诊断前未手术，以及随访期间既往皮质类固醇暴露与接受手术的风险较低相关。结论本研究描述了中国某中心住院CD患者的临床特征以及与行为进展和手术相关的因素。行为进展与CD相关手术的可能性较高相关，早期加强治疗是必要的，本研究基于中国三级中心CD患者的长期随访数据，描述了行为进展和手术相关的临床特征和因素。
Background There is lack of real-world data for disease behavior and surgery of Crohn's disease (CD) from large-scale Chinese cohorts. Methods Hospitalized patients diagnosed with CD in our center were consecutively included from January 2000 to December 2018. Disease behavior progression was defined as the initial classification of B1 to the progression of B2 or B3. Clinical characteristics including demographics, disease classification and activity, medical therapy, development of cancers, and death were collected. Results Overall, 504 patients were included. Two hundred thirty-one (45.8%) patients were initially classified as B1; 30 (13.0%), 71 (30.7%), and 95 (41.1%) of them had disease progression at the 1-year follow-up, 5-year follow-up, and overall, respectively. Patients without location transition before behavior transition were less likely to experience behavior progression. However, patients without previous exposure to a corticosteroid, immunomodulator, or biological agent had a greater chance of experiencing behavior progression. When the long-term prognosis was evaluated, 211 (41.9%) patients underwent at least 1 CD-related surgery; 108 (21.4%) and 120 (23.8%) of these patients underwent surgery before and after their diagnosis, respectively. An initial classification as B1, no behavior transition, no surgery prior to diagnosis, and previous corticosteroid exposure during follow-up were associated with a lower risk of undergoing surgery. Conclusions This study depicts the clinical features and factors associated with behavior progression and surgery among hospitalized CD patients in a Chinese center. Behavior progression is associated with a higher probability of CD-related surgery, and strengthened therapies are necessary for them in the early phase.This study depicts the clinical features and factors associated with behavior progression and surgery based on long-term follow-up data for CD patients in a Chinese tertiary center.