中国致残性克罗恩病患者危险因素分析  

Risk Factors of Patients with Disabling Crohn's Disease in China

作　　者：高燕[1] 杨川华[1] 丁娟[1] 陈香[2] 杨钊斌[3] 萧树东[1] 

机构地区：[1]上海交通大学医学院附属仁济医院消化科上海市消化疾病研究所,200001 [2]上海市第八人民医院消化科 [3]福建省漳州市医院内科

出　　处：《胃肠病学》2011年第9期517-521,共5页Chinese Journal of Gastroenterology

基　　金：国家自然科学基金资助项目(No.30570829);上海市重点学科建设项目(第二期)(No.Y0205)资

摘　　要：背景:近年来免疫抑制剂和生物抗体制剂在克罗恩病(CD)的治疗中取得较大成功,随之提出疾病早期即应用免疫抑制剂和(或)生物抗体制剂的top-down治疗方案,但该方案可引起严重的不良反应如淋巴瘤或结核。目前如何选择合适的CD患者行top-down治疗已成为研究热点。目的:探讨中国致残性CD患者的危险因素,以期指导top-down治疗方案的临床应用。方法:选取1998年1月～2009年12月上海仁济医院诊断满5年或未满5年但至少符合一项致残标准的CD患者。采用Logistic回归分析筛选2年和5年致残性CD患者的危险因素。结果:共216例CD患者纳入本研究,其中2年和5年致残性CD患者分别为156例(72.2%)和177例(81.9%)。Logistic回归分析示2年和5年致残性CD患者的危险因素均为疾病活动时需糖皮质激素缓解(2年:OR=8.175,95%CI:4.102～16.294,P=0.000;5年:OR=9.703,95%CI:4.297～21.910,P=0.000)和诊断时存在肛周疾病(2年:OR=7.056,95%CI:1.959～25.423,P=0.003;5年:OR=6.734,95%CI:1.466～30.922,P=0.014),联合这两个因素预测2年和5年致残性CD的准确率分别为79.2%和81.9%。结论:中国CD患者伴有疾病活动时需糖皮质激素缓解和诊断时存在肛周疾病等致残性危险因素时,说明其适用top-down治疗。Immunosuppressors and biologic agents have been successfully used in the treatment of Crohn＇s disease （CD） in recent years, and top-down therapy was proposed to use immunosuppressors and/or biologic agents initiated in the early stage of disease. However, this strategy may have severe adverse effects such as lymphoma or tuberculosis. How to identify the patients who should be treated with top-clown therapy is a hot spot of study at present. Aims： To investigate the risk factors of patients with disabling Chinese CD for guiding the clinical use of top-down therapy. Methods： CD patients who had a history of CD ≥5 years or had CD for 〈5 years but met at least 1 criterion of disabling disease from Jan. 1998 to Dec. 2009 at Shanghai Renji Hospital were enrolled. The risk factors of patients with disabling CD for 2-year and 5-year were screened by Logistic regression analysis. Results： A total of 216 patients were enrolled, patients with disabling CD for 2-year and 5-year were 156 （72.2%） and 177 （81.9%） cases, respectively. Logistic regression analysis showed that steroids requirement for treating acute exacerbation （2-year： 0R=8.175, 95% CI： 4.102- 16.294, P-0.000; 5-year： OR=9.703, 95% CI： 4.297-21.910, P=0.000） and presence of perianal disease at diagnosis （2- year： OR=7.056, 95% CI： 1.959-25.423, P=0.003; 5-year： OR=6.734, 95% CI： 1.466-30.922, P=0.014） were the risk factors of patients with disabling CD for 2-year and 5-year. Joint use of these two factors had a 79.2% and 81.9% accuracy in predicting disabling CD for 2-year and 5-year, respectively. Conclusions： The risk factors associated with disabling course which entails the use of top-down therapy in Chinese CD patients are steroids requirement for treating acute exacerbation and presence of perianal disease at diagnosis.

关 键 词：CROHN病 致残性疾病 危险因素 糖皮质激素类 肛周疾病 top-down治疗 

分 类 号：R574.62[医药卫生—消化系统]