克罗恩病的再切除率和疾病复发--一项利用个体水平患者数据进行的人群研究。

Anja Poulsen, Julie Rasmussen, Mads Damsgaard Wewer, Esben Holm Hansen, Rie Louise Møller Nordestgaard, Hans Søe Riis Jespersen, Dagmar Christiansen, Elena Surnacheva, Viviane Annabelle Lin, Nurcan Aydemir, Kari Anne Verlo, Frederik Rønne Pachler, Pernille Dige Ovesen, Kristian Asp Fuglsang, Christopher Filtenborg Brandt, Lars Tue Sørensen, Peter-Martin Krarup, Ismail Gögenur, Johan Burisch, Jakob B Seidelin
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引用次数: 0

摘要

背景和目的:尽管克罗恩病(CD)的药物治疗取得了进展,但许多患者仍需要切除肠道,并面临复发和再次切除的风险。我们描述了当代的再切除率,并确定了疾病改变因素和再切除的风险因素:我们进行了一项以人群为基础的回顾性个体患者数据队列研究,覆盖了丹麦 47.4% 的人口,包括 2010 年至 2020 年间接受过一次原发性切除术的所有 CD 患者:结果:在631名接受初次切除术的患者中,24.5%接受了第二次切除术,5.3%接受了第三次切除术。1年、5年和10年后的再次切除率分别为12.6%、22.4%和32.2%。再次切除的原因主要是疾病活动(57%)和造口翻转(40%)。1年、5年和10年后,疾病活动导致的再次切除率分别为3.6%、10.1%和14.1%。大多数造口翻转发生在一年之内(80%)。中位复发时间为 11.0 个月。在首次切除术后一年内开始使用生物制剂对狭窄型和穿透型造口的再次切除具有保护作用。回盲部初次切除术的预防性生物制剂治疗降低了疾病复发和再次切除的风险(HR 0.58,95% CI (0.34-0.99),P=0.047)。再次切除的风险因素包括初次切除时切除肠段的位置、疾病位置、疾病行为、吸烟和肛周疾病:按疾病活动性分类的再切除率低于其他研究报告的再切除率,且与疾病表型和定位密切相关。如果在切除术后一年内开始生物治疗,某些亚组患者的病情可能会发生改变。
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Re-resection Rates and Disease Recurrence in Crohn's Disease: A Population-based Study Using Individual-level Patient Data.

Background and aims: Despite advances in the medical treatment of Crohn's disease [CD], many patients will still need bowel resections and face the subsequent risk of recurrence and re-resection. We describe contemporary re-resection rates and identify disease-modifying factors and risk factors for re-resection.

Methods: We conducted a retrospective, population-based, individual patient-level data cohort study covering 47.4% of the Danish population, including all CD patients who underwent a primary resection between 2010 and 2020.

Results: Among 631 primary resected patients, 24.5% underwent a second resection, and 5.3% a third. Re-resection rates after 1, 5, and 10 years were 12.6%, 22.4%, and 32.2%, respectively. Reasons for additional resections were mainly disease activity [57%] and stoma reversal [40%]. Disease activity-driven re-resection rates after 1, 5, and 10 years were 3.6%, 10.1%, and 14.1%, respectively. Most stoma reversals occurred within 1 year [80%]. The median time to recurrence was 11.0 months. Biologics started within 1 year of the first resection revealed protective effect against re-resection for stenotic and penetrating phenotypes. Prophylactic biologic therapy at primary ileocaecal resection reduced disease recurrence and re-resection risk (hazard ratio [HR] 0.58, 95% confidence interval [CI] [0.34-0.99], p = 0.047). Risk factors for re-resection were location of resected bowel segments at the primary resection, disease location, disease behaviour, smoking, and perianal disease.

Conclusion: Re-resection rates, categorised by disease activity, are lower than those reported in other studies and are closely associated with disease phenotype and localisation. Biologic therapy may be disease-modifying for certain subgroups when initiated within 1 year of resection.

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