Low colectomy rates in ulcerative colitis in an unselected European cohort followed for 10 years
Low colectomy rates in ulcerative colitis in an unselected European cohort followed for 10 years
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DOI：
10.1053/j.gastro.2006.11.015
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发表时间：
2007-02-01
期刊：
影响因子：
29.4
通讯作者：
Moum, Bjorn
中科院分区：
文献类型：
--
作者：
Hoie, Ole;Wolters, Frank L.;Moum, Bjorn
背景和目的：溃疡性结肠炎（UC）的结肠切除率与发病率和病程期间的治疗决策有关。本研究的目的是确定诊断后头十年内 UC 的结肠切除术风险，并确定可能影响手术治疗选择的因素。方法：1991-1993 年，来自北欧、南欧 7 个国家以及以色列 9 个中心的 781 名 UC 患者被纳入一项前瞻性初始队列研究。经过10年的随访，617例患者有完整的病历，73例死亡，91例失访。结果：随访 10 年的患者和失访患者在诊断时的年龄、性别或疾病程度没有显着差异。结肠切除术的 10 年累积风险为 8.7%：北欧中心为 10.4%，南欧中心为 3.9% (P < .001)。广泛性结肠炎比直肠炎更有可能进行结肠切除术，调整后的风险比 (HR) 为 4.1 (95% CI: 2.0-8.4)。与南部中心相比，荷兰和挪威的调整后 HR 为 2.7（95% CI：1.3-5.6），丹麦为 8.2（95% CI：3.6-18.6）。诊断时的年龄、性别和诊断时的吸烟状况对结肠切除率没有统计学上的显着影响。结论：结肠切除率低于以前的出版物，但北欧和南欧之间存在差异。结肠切除术与广泛性结肠炎相关，但无法解释地理差异。
Background & Aims: The colectomy rate in ulcerative colitis (UC) is related to morbidity and to treatment decisions made during disease course. The aims of this study were to determine the colectomy risk in UC in the first decade after diagnosis and to identify factors that may influence the choice of surgical treatment. Methods: In 1991-1993, 781 UC patients from 9 centers located in 7 countries in northern and southern Europe and in Israel were included in a prospective inception cohort study. After 10 years of follow-up, 617 patients had complete medical records, 73 had died, and 91 had been lost to follow-up. Results: There were no significant differences in age, sex, or disease extent at diagnosis between patients followed for 10 years and those lost to follow-up. The 10-year cumulative risk of colectomy was 8.7%: 10.4% in the northern and 3.9% in the southern European centers (P < .001). Colectomy was more likely in extensive colitis than in proctitis, with an adjusted hazard ratio (HR) of 4.1 (95% CI: 2.0-8.4). Compared with the southern centers, the adjusted HR was 2.7 (95% CI: 1.3-5.6) for The Netherlands and Norway together and 8.2 (95% CI: 3.6-18.6) for Denmark. Age at diagnosis, sex, and smoking status at diagnosis had no statistically significant influence on colectomy rates. Conclusions: The colectomy rate was found to be lower than that in previous publications, but there was a difference between northern and southern Europe. Colectomy was associated with extensive colitis, but the geographic variations could not be explained.