结肠型与非结肠型克罗恩病的预后及预后不良相关危险因素分析

Analysis of prognosis of colonic and non colonic Crohn's disease and its risk factors associated with poor prognosis

目的探讨结肠型与非结肠型克罗恩病(Crohn’s disease,CD)患者的预后情况及其预后不良相关危险因素。方法收集2007年1月至2016年12月中国人民解放军第211医院消化内科符合CD研究标准的280例患者,依据蒙特利尔分型标准将40例结肠型CD患者分为研究组,余240例非结肠型CD患者为对照组。制定CD患者调查表,详细登记所有患者的人口学资料、既往史、饮酒史、吸烟史、家族史、临床资料、实验室指标、内镜及组织病理学结果、影像学资料、IFX治疗者用药前及用药第30周时的上述资料等。并通过该院门诊复诊、再住院、电话、通讯软件、信函等方式对其预后情况进行至少12个月的随访。结果结肠型CD患者中女性占比42.5%,与非结肠型CD女性占比(32.9%)比较,差异无统计学意义(P>0.05)。结肠型CD平均发病年龄、平均确诊年龄、与非结肠型CD对比,差异无统计学意义(P>0.05),结肠型CD贫血发生率高于非结肠型CD(P<0.05),肠外表现发生率低于非结肠型CD(P<0.05),余临床表现对比,差异无统计学意义(P>0.05)。结肠型CD随访1年、3年、5年时预后不良率与非结肠型CD对比,差异均无统计学意义(P>0.05)。Logistic多因素回归分析显示:CD伴肛周病变、疾病行为(狭窄型、穿透型)是其预后不良的独立危险因素。结论本研究发现,结肠型CD临床上贫血发生率、血沉水平异常升高,CD伴肛周病变、疾病行为(狭窄型、穿透型)是其预后不良的独立危险因素。

Objective To investigate the prognosis of patients with colonic or non-colonic Crohn＇s disease（CD）and the risk factors associated with poor prognosis of CD. Methods Two hundred eighty patients who met the criteria of CD in the 211 st Hospital of PLA from Jan. 2007 to Dec. 2016 were enrolled in the study. According to Montreal classification criteria,40 CD patients with colonic as the research group,and the remaining non-colonic CD patients（240 cases） as the control group. For patients with CD questionnaire,with the registration of all patients＇ demographic information,medical history,drinking history,smoking history,family history,clinical data,laboratory index,endoscopic and histopathological findings,imaging data,IFX treatment before the treatment and at the 30 th week of the above information were enrolled. The prognosis of the hospital was followed-up at least 12 months through the outpatient consultation,rehospitalization,telephone,communication software,letter and so on. Results Female of colonic CD patients for42. 5%,which was higher than that in non-colonic CD group（P〈0. 05）. The average age and morbidity average age of diagnosis were both higher than those in non-colonic CD group but with no significant difference（P〈0. 05）. The incidence of anemia in colonic CD group was higher than that in non-colonic CD group（P〈0. 05）. The incidence of parenteral performance in colonic CD group was lower than that in non-colonic CD group. While the incidence of parenteral performance was lower significantly（P〈0. 05）. There were no significant differences of poor prognosis rates between colonic CD and non-colonic CD when follow-up reached 1 years,3 years and 5 years（P〈0. 05）. Logistic multifactor regression analysis showed that： CD with the presence of perianal disease,sickness behavior（narrow type and penetrating type） were the independent risk factors of poor prognosis. Conclusion In this study,we find that the incidence of anemia in the colonic CD and the level of erythrocyte sedimentation（ESR） increased abnormally. CD with presence of perianal disease and sickness behavior（narrow type and penetrating type） are independent risk factors for poor prognosis.