Clin Gastroenterol Hepatol:结直肠狭窄在溃疡性结肠炎患者中的发生率及相关风险因素

2021-09-01 Nebula MedSci原创

Montreal A3级和类固醇暴露史可增加溃疡性结肠炎的结直肠狭窄风险,而美沙拉嗪的使用可降低该风险

溃疡性结肠炎 (UC) 越来越被认为是一种进行性疾病,病程长的患者可能会出现结直肠狭窄。目前,关于结直肠狭窄在 UC 中的发病率的数据很少,而且相关的危险因素也仍有待确定。

这是一项多中心回顾性队列研究,目的是在大规模 UC 患者人群中评估了结直肠狭窄的发生率和相关风险因素。纳入了于2004年1月-2019年7月期间在南锡大学医院和卢森堡 UC 中心医院接受随访的所有成年患者。

存活率

总体上,共纳入了439位 UC 患者。中位随访持续时间为 9.6 年。结直肠狭窄的发生率为 3.6%。该并发症的 5 年累积发生率为 1%,10 年累积发生率为 2.3%。确诊结直肠狭窄时的中位年龄为 47.9 岁(范围 41.0-63.0岁),从确诊 UC 到发生结直肠狭窄的中位间隔时间为 11.5 年(范围 5-15.3 年)。

Montreal A3级(年龄>40 岁;p=0.008)和类固醇使用(HR 4.1;95%CI 1.1-16.1)都是结直肠狭窄的独立风险因素;而采用美沙拉嗪治疗过的患者发生结直肠狭窄的风险较低(HR 0.3; 95%CI 0.1-0.9)。6位结直肠狭窄的患者(42.9%)存在发育异常,其中 5 位后续进展成了结直肠癌(33.3%)。

综上所述,Montreal A3级和有类固醇暴露史的 UC 患者发生结直肠狭窄的风险高于普通患者,而美沙拉嗪的使用可降低该风险。在日常临床实践中应注重评估这些因素,以预防这些患者继发结直肠狭窄。

原始出处:

Pierre-Antoine Laurain, et al. Incidence of and Risk Factors for Colorectal Strictures in Ulcerative Colitis: A Multicenter Study. Clin Gastroenterol Hepatol. September 27, 2021. https://doi.org/10.1016/j.cgh.2021.01.028

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    2022-08-03 nymo
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    2021-10-05 许安
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    2021-09-03 gwc384
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