Clinical characteristics and change trend of patients with Crohn′s disease at different onset times of perianal lesions

Objective To investigate the clinical characteristics and change trend of patients with perianal lesions before or after Crohn′s disease (CD) diagnosed. Methods From January 2008 to September 2018, at The Tenth People′s Hospital Affiliated to Tongji University, the clinical data of 747 hospitalized CD patients were retrospectively collected, 293 patients were PCD patients. The clinical characteristics of PCD patients before or after CD diagnosed were analyzed and the change trend was followed. T test, Mann-Whitney U test, and Chi-square test were performed for statistical analysis. Multivariate logistic regression analysis was used to analyze factors associated with perianal lesions onset time. Spearman correlation analysis was used to analyze the change trend of clinical characteristics. Results Before CD diagnosis, 86.3% (253/293) PCD patients had perianal lesions. The median follow-up time (range) was 72 months (36 to 108 months). Compared with the patients presented with perianal lesions after CD diagnosis, the onset age of patients with perianal lesions before CD diagnosis was younger ((36.0±12.6) years vs. (24.2±10.2) years), and the rates of male (62.5%, 25/40 vs. 77.9%, 197/253), non-structuring and non-penetrating type (32.5%, 13/40 vs. 56.9%, 144/253) and perianal surgery (55.0%, 22/40 vs.76.7%, 194/253) were high, but low rate of abdominal surgery (37.5%, 15/40 vs. 13.0%, 33/253), and the differences were statistically significant (t=2.630, χ2=4.442, 8.379, 8.379 and 15.081; all P<0.05). The results of logistic multivariate analysis showed that before CD diagnosis, non-structuring and non-penetrating type was more common than structuring type (odds ratio (OR)=0.447, 95% confidence interval (CI) 0.207 to 0.962, P=0.039) and penetrating type (OR=0.264, 95%CI 0.089 to 0.780, P=0.016). The short disease duration of CD (OR=0.981, 95%CI 0.968 to 0.995, P=0.008), structuring type (OR=2.239, 95%CI 1.040 to 4.822, P=0.039) and penetrating type (OR=3.788, 95%CI 1.281 to 11.198, P=0.016) were the risk factors of perianal lesions after CD diagnosed. The number of PCD patients (r=0.964, P<0.01) and the proportion of biological agents (r=0.879, P<0.01) increased with years, while PCD duration (r=-0.828, P<0.01) and the rate of abdominal surgery significantly decreased with years (r=-0.882, P<0.01). The proportion of biological agents was negatively correlated with the rate of abdominal surgery (r=-0.770, P=0.006). Conclusions The perianal lesions should be closely monitored in adult CD patients with short disease duration, structuring type and penetrating type for early diagnosis and treatment. Biological agents can improve the clinical outcomes of PCD. Key words: Crohn disease; Perianal disease; Characteristics; Onset time; Trend