克罗恩病病程中病变部位是否会发生变化?——一项系统综述和Meta分析

Did the lesion location change during the course of Crohn′s disease?A Meta-analysis and systematic review

目的探讨克罗恩病(Crohn′s disease,CD)自然史中病变范围变化及病变肠段切除术后的复发部位。方法检索The Cochrane Library、PubMed、中国知网、维普和万方数据库,搜集CD自然病程病变范围变化情况及术后复发情况的病例报告、临床研究,检索时限均为建库至2021年2月1日。提取基本信息、病变部位变化率及相关情况、术后复发率及部位等资料,并进行荟萃回归分析、敏感性分析及描述性总结。结果纳入5篇CD自然病程中部位变化相关文献,共1670例患者,年龄(33.28±19.41)岁,随访时间(5.90±2.20)年,病变部位变化率为14.4%(95%CI:10.1%~18.6%),其中18.9%(8.5%~29.3%)的L_(1)型、15.1%(13.5%~16.8%)的L_(2)型会扩展为L_(3);11.1%(2.6%~19.6%)的L_(1)型、2.7%(0~5.5%)的L_(2)型会扩展为L_(4)型;5.5%(3.0%~8.0%)的L_(3)型会扩展为L_(4)型。7篇文章仅纳入儿童(≤17岁)患者,其疾病部位变化率为21.3%(13.9%~28.7%)。纳入研究术后复发的文献81篇,含20382例CD患者,术后随访时间为(5.97±4.72)年。46.85%(1546/3300)的患者于术后1年左右出现内镜或影像学复发,39.82%(1070/2687)于术后3年出现临床症状复发,19.52%(3028/15510)于术后4年需要再次手术。49篇文献描述了手术后复发部位,共16567例术后患者,3888例复发,其中82.33%位于吻合口(包括造瘘口)及附近肠段。结论CD自然病程中病变范围相对稳定,CD术后复发多发生于吻合口(或造口)及附近肠段,另外,术后内镜或影像学复发先于临床症状复发,因此,术后早期(6~12个月)内镜和影像学检查是合适的,无论有无症状复发。

Objective To investigate the stability of disease location over the course and postoperative recurrence site of Crohn′s disease(CD).Methods The Cochrane Library,PubMed,CNKI,VIP and WanFang from database inception up until Feb 1st,2021 were searched.Case reports and clinical studies of changes in the location of natural disease course and postoperative recurrence of CD were included.Basic information,related conditions of location,postoperative recurrence rate and site were extracted,and Meta-analysis,sensitivity analysis and descriptive summary were performed.Results Of include studies(n=12)about the stability of its location over the course of CD,5 enrolled patients of all ages and 7 only focus on the children(≤17 years old).The rate of location change was 14.4%(95%CI:10.1%-18.6%,I2=86.0%)and 21.3%(95%CI:13.9%-28.7%,I2=93.0%)respectively.Eighty-one studies on postoperative recurrence with 20382 patients were included.Of all patients observed after surgery,46.85%(1546/3300)developed endoscopic or imaging recurrence about 1 year later,39.82%(1070/2687)developed clinical recurrence about 3 years later,and 19.52%(3028/15510)needed reoperation about 4 years later.There were 82.33%(3201/3888)patients recurred at the anastomosis(including the stoma)and the adjacent intestinal segment.Conclusion The location of CD is relatively stable in the natural course of CD.Postoperative recurrence sites of CD are common in anastomosis(or stoma)and adjacent intestinal segments,and endoscopic or imaging recurrence is prior to clinical symptom recurrence.Therefore,endoscopic and imaging examination is appropriate in the early postoperative period(6-12 months),regardless of whether there is symptomatic recurrence.