摘要
Background:The comparative outcomes of ulcerative colitis(UC)and Crohn’s disease(CD)in patients with primary sclerosing cholangitis(PSC)are unclear;the aim of our study was to make an objective comparison.Methods:A total of 273 patients with PSC and inflammatory bowel disease(223 with UC and 50 with CD)were included.Clinical and demographic variables were obtained.Results:The PSC risk score was similar for both groups.The median follow-up period in patients with PSC-UC was 12 years(range 0–38)and that for PSC-CD was 14 years(range 1–36).The median number of disease flares per year was higher in PSC-UC patients than in the PSC-CD group[1vs.0(ranges 0–20 and 0–9,respectively);P<0.001].More patients with UC developed colon neoplasia than CD(35.9%vs.18%;P=0.009).On proportional hazards analysis for the risk of colectomy,UC patients had a 12%higher risk for colectomy[hazard ratio(HR)=0.88;95%confidence interval(CI)0.51–1.51;P=0.64].Liver transplantation for PSC was associated with decreased risk(HR=0.57;95%CI 0.37–0.89;P=0.013),while colon neoplasia increased the risk(HR=3.83;95%CI 2.63–5.58;P<0.001)for colectomy.On proportional hazards analysis for the risk of colon neoplasia,UC patients had 56%higher risk of developing colon neoplasia than CD(HR=0.44;95%CI 0.16–1.25;P=0.12).Conclusions:PSC patients with CD appear to be associated with a lower risk of colon neoplasia and colectomy than PSC patients with UC.
背景:合并原发性硬化性胆管炎(PSC)的溃疡性结肠炎(UC)与克罗恩病(CD)的结局比较尚不清楚。本研究旨在对两者的临床结局进行客观比较。方法:273例合并PSC的炎性肠病患者(UC 223例,CD 50例)纳入研究。收集入组病例的临床及人口统计学资料。结果:两组病例PSC危险度评分相近。PSC-UC组和PSC-CD组患者的中位随访时间分别是12(0-38)年和14(1-36)年。中位疾病复发次数PSC-UC组多于PSC-CD组[1(0-20)vs.0(0-9);P<0.001]。出现结肠瘤变的患者比例PSC-UC组高于PSC-CD组(35.9%vs.18%;P=0.009)。结肠切除手术的比例风险模型分析显示,PSC-UC患者结肠切除手术风险较PSC-CD增高12%[风险比(HR)=0.88;95%可信区间(CI)0.51-1.51;P=0.64]。同时,针对PSC的肝移植可降低结肠切除手术风险(HR=0.57;95%CI 0.37-0.89;P=0.013);而结肠瘤变则增加该风险(HR=3.83;95%CI 2.63-5.58;P<0.001)。结肠瘤变的比例风险模型显示,PSC-UC患者结肠瘤变风险较PSC-CD患者增高56%(HR=0.44;95%CI 0.16-1.25;P=0.12)。结论:合并CD的PSC患者结肠瘤变和结肠切除手术的风险低于合并UC者。
