克罗恩病初次手术危险因素分析

Clinical presentation and risk factors for surgery in Crohn＇s disease

目的探讨克罗恩病患者需手术治疗的危险因素。方法回顾性分析中山大学附属第二医院2010--2014年间收治、并能获得研究终点（接受肠切除手术或末次随访距首发症状至少5年）的173例克罗恩病患者的临床资料，采用蒙特利尔分型对病变部位和疾病行为进行评价。采用Logistic回归模型对初次手术的危险因素进行分析。结果自首发症状出现后5年内，有85例（49．1％）患者接受了肠切除手术。单因素分析显示，诊断年龄在40岁以上、男性、病变累及上消化道、狭窄型和穿透型病变者需要手术治疗的概率较高（均P〈0.05）。多因素分析结果显示，诊断年龄大于40岁（OR=2．34，95％CI：1．05—5．22）和男性患者（OR=2．02，95％CI：1．04～3．92）为需手术治疗的独立高危因素，单纯结肠病变（OR=O．35，95％CI：0．13～0．97）为需手术治疗的独立保护因素。结论克罗恩病临床表现呈现多样化；高龄及男性患者是手术治疗的高危人群，而病变局限于结肠者需手术治疗的概率较低。

Objective To investigate the risk factors on initial surgery in Crohn＇s disease. Methods The clinical data of 173 patients with Crohn＇s disease who were treated during 2010 and 2014 years in the Second Affiliated Hospital of Sun Yat-Sen University, were analyzed retrospectively. The patients who had received intestinal resection or whose initial symptoms occurred at least 5 years at the end of the follow-up were recruited. Montreal classification was used to evaluate lesion location and disease behavior. The risk factors of the initial surgery were analyzed by using Logistic regression model. Results Eighty-five patients（49.1%）received intestinal resection in 5 years after the onset of symptoms. The result of univariate analysis showed that the probability of surgical treatment is high in patients who were male and those older than 40 years at diagnosis（P〈0.05）. Lesions involving upper digestive tract, stenosis and penetrating lesions were also the risk factors on initial surgery in Crohn＇s disease （P〈0.05）. The result of multivariate analysis showed the relative risk of initial surgery was increased in male gender（OR=2.02, 95%CI： 1.04-3.92） and in those who were older than 40 years at diagnosis （OR=2.34,95%CI： 1.05-5.22）. However, in patients with Crohn＇s disease involving colon alone, the relative risk of initial surgery was decreased （OR=0.35, 95%CI：0.13-0.97）. Conclusion Abdominal pain is the most common clinical presentation in Crohn＇s disease. Disease behavior and operation is closely related. Older than 40 years at diagnosis and male gender is high risk factor for surgery while colonic lesion alone is protective factor.