克罗恩病患者L4亚型临床结局的差异研究  

Study on the differences in clinical outcomes of L4 subtypes in patients with Crohn′s disease

作　　者：祝晓 张瑜[2] 曹倩[2] 吕杨波 徐建光 Zhu Xiao;Zhang Yu;Cao Qian;Lyu Yangbo;Xu Jianguang(Department of Gastroenterology,The Quzhou Affiliated Hospital of Wenzhou University,Quzhou People′s Hospital,Quzhou 324000,China;Department of Gastroenterology,Sir Run Run Shaw Hospital,College of Medicine Zhejiang University,Hangzhou 310000,China;Department of Colorectal Surgery,The Quzhou Affiliated Hospital of Wenzhou University,Quzhou People′s Hospital,Quzhou 324000,China)

机构地区：[1]温州医科大学附属衢州医院(衢州市人民医院)消化内科,衢州324000 [2]浙江大学医学院附属邵逸夫医院消化内科,杭州310000 [3]温州医科大学附属衢州医院(衢州市人民医院)肛肠外科,衢州324000

出　　处：《中国医师杂志》2024年第9期1333-1337,1342,共6页Journal of Chinese Physician

基　　金：浙江省自然科学基金(LQ21H030010)。

摘　　要：目的研究克罗恩病(CD)L4亚型患者疾病结局是否存在差异。方法收集2017年1月至2019年12月衢州市人民医院及浙江大学医学院附属邵逸夫医院初诊的488例CD患者,根据疾病部位分型分为L4a、L4b和非L4(non-L4)组,比较三组间肠道并发症及首次腹部手术率的差异。结果纳入研究的488例CD患者中L4型196例(40.2%),且以L4b型(28.3%,138/488)为主。通过时间依赖的受试者工作特征(ROC)曲线确认,疾病部位可以预测CD患者随访中的手术率。与non-L4型相比,L4b型随访期手术率更高[59.4%(76/128)vs 27.4%(80/292),P<0.001],而L4a型却更低[10.3%(6/58)vs 27.4%(80/292),P=0.0096]。同时,L4b型患者随访中再发肠梗阻率也明显高于L4a型和non-L4型[46.9%(60/128)vs 6.9%(4/58),P<0.001;46.9%(60/128)vs 11.6%(34/292),P=0.007]。生物制剂的使用可以降低L4b型患者的手术率(HR:1.93,95%CI:1.03~3.63,P=0.0406)。结论初诊的CD患者中,L4b型发病率较高,且L4b型是CD不良预后的高危因素,建议早期使用生物制剂。精准的疾病部位分型可以指导临床个体化治疗。Objective To investigate whether there are differences in disease outcomes among patients with Crohn′s disease(CD)L4 subtype.Methods A total of 488 CD patients who were initially diagnosed at the Quzhou People′s Hospital and the Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from January 2017 to December 2019 were collected.They were divided into L4a,L4b,and non-L4 groups based on disease site classification,and the differences in intestinal complications and first abdominal surgery rates among the three groups were compared.Results Among the 488 CD patients included in the study,196(40.2%)were classified as L4 type,with L4b type being the predominant type(28.3%,138/488).By confirming the time-dependent receiver operating characteristic(ROC)curve,the disease site can predict the surgical rate during follow-up of CD patients.Compared with non-L4 patients,L4b patients had a higher follow-up surgery rate[59.4%(76/128)vs 27.4%(80/292),P<0.001],while L4a patients had a lower rate[10.3%(6/58)vs 27.4%(80/292),P=0.0096].At the same time,the recurrence rate of intestinal obstruction in L4b patients during follow-up was significantly higher than that in L4a and non-L4 patients[46.9%(60/128)vs 6.9%(4/58),P<0.001;46.9%(60/128)vs 11.6%(34/292),P=0.007].The use of biologics can reduce the surgery rate in L4b patients(HR:1.93,95%CI:1.03-3.63,P=0.0406).Conclusions The incidence rate of L4b is high in newly diagnosed CD patients,and L4b is a high risk factor for poor prognosis of CD,so early use of biological agents is recommended.Accurate classification of disease sites can guide individualized clinical treatment.

关 键 词：克罗恩病 疾病部位分型 治疗结果 

分 类 号：R574[医药卫生—消化系统]