不同分期的慢性肾脏病患者中血尿酸与冠状动脉狭窄程度相关性分析

目的评价肾功能损伤不同阶段高尿酸血症[SUA男性〉417μmol／L（7．0mg／m1）,女性〉357μmol／L（6．0mg／m1）1与冠状动脉狭窄程度的相关性。方法随机入选北京航天中心医院心脏中心收治的214例经选择性冠状动脉造影检查确诊的冠心病患者,根据eGFR值对慢性肾脏病（CKD）患者进行分组,分析患者的血尿酸值、临床特点、血清肌酐、炎症因子和其他一些代谢相关变量;根据简化的MDRD公式计算估算肾小球滤过率;慢性肾脏疾病定义为eGFR〈60ml／（min·1．73m2）3个月以上,有或无肾脏损伤;根据冠状动脉造影结果计算Gensini评分评价冠状动脉狭窄程度。结果CKD患者占38.3％（82例）。eGFR与冠脉狭窄程度负相关（r=-0．536,P〈0．001）;而CKD患者中血尿酸值与冠状动脉狭窄程度正相关（r=0．26,P=0．001）。CKD的独立危险因素包括：SUA水平（OR=1．22,95％CI1．09～1．37,P〈0．001）、年龄（OR=1．11,95％CI1．10～1．14,P〈0．001）、冠状动脉狭窄程度（OR=0．83,95％C10．79～0．85,P〈0．001）与高血压病史（OR=1．90,95％CI1．40～2．60,P〈0．001）。结论CKD患者中高尿酸血症是促进冠状动脉血管病变加重的重要因素,且在肾脏病的不同阶段均起作用。     

急性心肌梗死后重症多器官功能衰竭的危险因素：6674例临床分析

目的探讨急性心肌梗死（AMI）患者发生重症多器官功能衰竭（MOF）的相关危险因素,为临床早期识别高危患者提供依据。方法对解放军总医院近18年中收治的6674例[18～101岁,平均（62．94±13．63岁）]AMI患者进行回顾性分析,根据是否发生重症MOF分为两组,应用多因素logistic回归分析MOF与患者的年龄、性别、合并症、并发症等的相关性。结果83（1．24％）例发生了MOF。MOF组住院死亡率明显高于非MOF组（49．40％VS8．13％,P〈0．001）。年龄（65～74岁,OR=2．76,95％CI：1．26～6．03,P=0．011;≥75岁,OR=4．85,95％CI：2．96～7．94,P〈0．001）、肺部感染（OR=4．27,95％CI：2．68～6．82,P〈0．001）、心源性休克（OR=2．24,95％CI：1．08～4．63,P=0．030）、慢性肾功能不全（OR=2．09,95％CI：1．09～4．O1,P=0．027）是AMI后发生MOF的独立危险因素。受试者工作特征曲线（ROC）下面积为0．83（95％CI：0．75～0．89,P〈0．001）,提示模型有较高的判别MOF患者的能力。结论MOF在AMI患者中较少见,但严重危害患者预后。积极防治合并症和并发症可有效预防MOF的发生。     

ST段抬高急性心肌梗死高血糖发生的危险因素分析

目的探讨急性心肌梗死患者（acute myocardial infarction,AMI）早期出现空腹高血糖的相关危险因素,以早期识别高危患者,改善其预后。方法分析阜外医院2005年8月至2007年8月收治的初次发生ST段抬高AMI且在12h内接受急诊经皮冠状动脉介入治疗的连续276例住院患者,以空腹血糖11．1mmol／L（200mg／d1）为标准划分为高血糖组和普通血糖组,分析空腹高血糖发生的危险因素及两组患者住院期间主要不良心脏事件（major adverse cardiac events,MACE）。结果全组共53例发生高血糖（53／276,19．2％）。与普通血糖组相比,高血糖组患者的年龄偏大[（70±14）岁vs（59±11）岁,P=0．039]、女性患者较多（38％vs26％,P=0．001）、糖尿病患者较多（45％vs17％,P〈0．001）、心功能Killip分级≥Ⅱ级者较多（72％vs16％,P〈0．001）、血糖值偏高[（14．3±2．3）mmol／L vs （6．6±1．4）mmol／L,P〈0．001],心力衰竭（5％vs 1％,P=0．008）和MACE发生率增高（26％vs7％,P〈0．01）。多因素logistic回归提示高龄[OR 1．048,95％CI 1．014to1．085,P=0．006],女性[OR 2．528,95％CI 1．036 to 6．159,P=0．042],心功能Killip分级≥Ⅱ[OR 11．412,95％CI 5．144 to 25．338,P〈0．001]合并糖尿病[OR 1．024,95％CI 1．089 to 1．467,P〈0．001]是空腹高血糖发生的危险因素。276例患者中院内总病死率3．6％（10／276）;与普通血糖组相比,空腹高血糖组患者死亡率增高3．5倍（9％vs 2％,P=0．025）,MACE发生率增高2．7倍（26％vs 7％,P〈0．01）。结论高龄、女性、糖尿病史、心功能≥II级（Killip分级）是空腹高血糖发生的危险因素,入院早期高血糖提示AMI患者住院期间预后不良。     

2012年河南省驻马店市HIV单阳家庭阴性配偶阳转情况及其影响因素分析

目的了解2012年河南省驻马店市艾滋病病毒（HIV）单阳家庭中,HIV阴性配偶的阳转情况及其影响因素。方法2012年7—12月,对河南省驻马店市单阳家庭进行横断面调查,收集HIV单阳家庭的基本信息、配偶间性行为信息、原阳者的治疗信息、CD4＋T淋巴细胞计数等,并对阴性配偶进行采血检测其HIV抗体阳转情况。结果共随访单阳家庭3850户,阴性配偶3850人,其中HIV抗体阳转17人,2012年驻马店市单阳家庭阴性配偶的HIV阳转率为0．44％。按原阳者性别分层,分别得到原阳者为男性的女性配偶阳转的危险因素为：近一年夫妻性生活不坚持使用安全套[比值比（OR）=31．176,95％可信区间（CI）：6．617-146．884,P〈0．0001]。原阳者为女性的男性配偶阳转的危险因素为：近一年夫妻性生活不坚持使用安全套（OR=37．859,95％CI：10．058～142．504,P〈0．0001）,近一年夫妻性生活频次〉2次／月（OR=5．875,95％CI：1．200～28．771,P=0．0289）,最近一次CD4＋T淋巴细胞计数≤350个／μL（OR=5．983,95％CI：1．213～29．503,P=0．0280）。综合来看,家庭内配偶间HIV传播的影响因素为：近一年夫妻性生活不坚持使用安全套（OR=32．557,95％CI：11．772-90．042,P〈0．0001）,近一年夫妻性生活频次〉2次／月（OR=5．630,95％CI：1．775-17．854,P=0．0033）,最近一次CD4＋T淋巴细胞计数≤350个／μL（OR=4．895,95％CI：1．536-15．606,P=0．0073）。结论驻马店市HIV单阳家庭阴性配偶阳转率较低,仍需要加强安全套的宣传以及CD4＋T淋巴细胞计数和病毒载量的检测工作。     

缺血性肠病预后的相关因素分析

目的探讨需住院的缺血性肠病患者病情严重性和病死率相关因素,并探讨复发的相关危险因素。方法回顾性分析2000年1月～2009年6月期间诊断为缺血性肠病的住院患者的临床资料,定性变量采用费希尔精准检验分析,参数变量采用斯氏t检验分析。具有统计学意义的变量纳入考克斯症状消退模型。结果研究期间,169例缺血性肠病住院患者,10例手术,8例死亡,13例重症。与病情严重程度独立相关的变量有：心血管疾病（OR：6．63,95％CI：1．59—27．61,P=0．009）、无便血（OR：4．43,95％CI：1．12～17．47,P=0．033）、腹胀（OR：6．39,95％CI：1．65～24．70,P=0．007）和肠梗阻（OR：8．76,95％CI：2．12～36．06,P=0．003）。仅弥漫性腹膜炎与病死率有关（OR：26．07,95％CI：5．67～119．93,P〈0．001）。出院后,7例（4．5％）患者复发,复发平均时间（5．31±3．67）个月,其中6例有狭窄。有缺血性肠病史（OR：13．21,95％CI：2．52～69．28,P=0．002）、服用阿司匹林（OR：6．41,95％CI：1．12～36．64,P=0．037）及降压药（OR：0．089,95％CI：0．01～0．754,P=0．027）与复发独立相关。结论合并便血、腹胀和肠梗阻的缺血性肠病患者预后较差,使用阿司匹林或降压药的患者出院后有较高的复发率,但二者之间是否存在因果关系有待进一步研究证实。     

线粒体ND2基因5178C〉A突变异质性水平与中老年人原发性高血压的关系北大核心CSCD

目的探讨线粒体ND2基因5178C〉A突变异质性水平与中老年人原发性高血压（EH）的相关性。方法2014-2015年共募集EH组患者108例和健康对照组109例,采集所有入选者的临床资料和血液样本,采用荧光实时定量聚合酶链反应法（探针法）进行mt5178C〉A异质性水平分析。结果mt5178C〉A异质性水平在EH组（42±11）％与健康对照组（54±13）％间的分布比较差异有统计学意义（P〈0．01）。将mt5178C〉A异质性水平以中位数（44．0％）为界,采用两步法的聚类分析,高异质性组EH的发病风险降低（OR=0．18,95％CI：0．10-0．31,P〈0．01）。在健康对照组中,对mt5178C〉A异质性水平与血压值进行相关性分析,异质性水平与收缩压（r=-0．38,P〈0．01）和舒张压（r=-0．49,P〈0．01）均呈现负相关。Logistic回归分析结果显示,在单因素分析中,mt5178C〉A异质性水平（OR=0．82,95％CI：0．77-0．87,P〈0．01）是EH的保护因素,而体质指数（OR=1．30,95％CI：1．12-1．45,P〈0．01）、总胆固醇（OR=2．13,95％CI：1．39-3．28,P=0．00）、三酰甘油（OR=7．62,95％CI：3．45-16．84,P〈0．01）和血尿素（OR=1．35,95％CI：1．04-1．77,P=0．03）均是EH的危险因素;在多因素分析中,mt5178C〉A异质性水平（OR=0．83,95％CI：0．78-0．89,P〈0．001）仍是EH的独立保护因素,但仅有体重指数（OR=1．23,95％CI：1．02-1．48,P=0．03）、总胆固醇（OR=2．17,95％CI：1．58-2．98,P=0．02）和低密度脂蛋白（OR=0．06,95％CI：0．01-0．83,P=0．04）表现出独立危险因素,并且P值处于0．05的临界状态。结论线粒体ND2基因5178C〉A突变异质性水平对中国中老年人群EH发病具有一定的保护作用。     

急性脑梗死早期患者血糖水平对预后的影响

目的：观察急性脑梗死早期患者血糖水平对预后的影响。方法104例发病72 h内入院的急性脑梗死患者,入院后立即行血清葡萄糖测试,采用美国国立卫生研究院卒中量表（ NIHSS）进行评分,运用改良Rankin残障量表评分（mRs）评估预后。结果104例急性脑梗死患者中,43例（41．3％）出现高血糖,高血压（OR＝3．655,95％CI：1．218～10．969,P＜0．05）、糖尿病（OR＝17．714,95％CI：3．568～87．939,P＜0．05）、NIHSS评分（OR＝2．731,95％CI：1．637～5．458,P＜0．05）为急性脑梗死后高血糖的独立危险因素。 NIHSS评分（OR＝0．322,95％CI：0．181～0．572,P＜0．05）、高血糖（OR＝6．782,95％CI：1．654～26．373,P＜0．05）为预后不良的独立危险因素。结论部分急性脑梗死患者早期血糖升高,高血糖为急性脑梗死预后不良的独立危险因素。     

颅内破裂动脉瘤患者短期预后的影响因素

目的分析影响顷内破裂动脉瘤患者预后的因素。方法回顾性分析1996年1月-2009年1月连续收治的966例（1052个动脉瘤）颅内破裂动脉瘤患者的病历资料,其中273例行显微外科手术,662例行血管内栓塞治疗,31例未经手术治疗。3个月后对预后行改良Rankin量表评分。评价性别、年龄、动脉瘤部位和大小、Fisher分级、Hunt—Hess分级、是否伴有急性重度脑积水、治疗时机、是否手术治疗、手术方式（显微外科手术或血管内治疗）、术中动脉瘤再破裂、有重度脑积水者是否术中行终板造瘘及术后是否行脑脊液持续外引流12项可能影响预后的因素进行多因素Logistics回归分析。结果①966患者中,预后良好率为72．O％（695／966）,预后不良率为23．1％（223／966）,病死率为5．0％（48／966）。②多因素Logistics回归分析显示,年龄〉60岁（OR：8．36,95％CI：2．23～11．68;P〈0．01）、Fisher分级≥Ⅲ级（OR：9．65,95％CI：3．09～13．48;P〈0．01）、Hunt—Hess分级≥Ⅳ级（OR：7．49,95％CI：1．12～13．25;P〈0．01）、未手术治疗（OR：8．23,95％CI：5．59～20．89;P〈0．01）、术中动脉瘤再破裂（OR：8．69,95％C1：5．12～19．51;P〈0．01）、非早期治疗（〉3d;OR：2．36,95％CI：1．65～12．46;P〈0．01）及术后未行脑脊液持续外引流（OR：3．08,95％C1：1．07～8．63;P〈0．01）,是影响患者预后的独立危险因素。结论年龄、Fisher分级、Hunt—Hess分级、是否手术治疗、治疗时机、术中动脉瘤再破裂及是否脑脊液持续外引流是影响患者预后的独立危险因素。     

溃疡性结肠炎治疗后黏膜愈合程度与预后的关系的研究

目的探讨溃疡性结肠炎（UC）治疗后黏膜愈合程度与预后的关系。方法确诊为UC并经治疗后获得缓解的患者82例,根据治疗效果评价,分为黏膜愈合组（A组：DAI,0—1分;Geboes,0～1级）、黏膜未愈合组（B组：DAI,0～1分;Geboes,2～5级）。随访2年,内容包括患者的基线资料及0、12、24个月（或）复发时组织学参数、血清学指标（白蛋白、ESR、CRP、ANCA、IL-18、IL-6、IL-15）,及再入院、结肠手术、结肠癌发生情况等,评估UC治疗后黏膜愈合程度与预后的关系。结果A、B组复发率及复发时间组间比较差异无统计学意义（P〉0．05）,经多因素COX回归分析发现性别（女性）、既往复发、pANCA、基底部浆细胞增多是UC复发的独立危险因素（P〈0．05）。A、B组再入院率[分别为27．5％和44．1％,P=0．018,OR=2．24,95％CI（1．11—3．98）]、结肠切除术发生率[分别为0％和17．6％,P=0．035,OR=5．43,95％CI（2．14—7．64）],组间差异明显,而癌变率[分别为0％和2．7％,P=0．643,OR=3．43,95％CI（0．14—7．64）]组间差异无统计学意义。结论UC治疗后黏膜愈合程度与其预后存在明显的相关性。     

老年StandfordB型主动脉夹层患者冠状动脉造影的临床意义

目的探讨老年StandfordB型主动脉夹层患者中冠状动脉粥样硬化性心脏病（冠心病）的检出率及其相关危险因素。方法回顾性分析134例50岁以上同时进行主动脉造影和冠状动脉造影的StandfordB型主动脉夹层患者的临床资料及影像学资料．对数据进行统计分析。结果134例患者中,冠心病的检出率为26．1％（35例）,其中单支病变22例（16．4％）,2支病变9例（6．7％）,左主干或3支病变4例（3．0％）。多因素Logistic回归分析显示．男性（OR=6．682,95％CI1．01—44．13,P=0．049）及吸烟（OR=3．513,95％CI1．05-11．70,P=0．041）是StandfordB型主动脉夹层合并冠心病的预测因素。结论50岁以上StandfordB型主动脉夹层患者共患冠心病的比例较高,在主动脉造影时有必要常规进行冠状动脉造影检查,以免漏诊。     

Evolution of disease phenotype in adult and pediatric onset Crohn’s disease in a population-based cohort

AIM:To investigate the evolution of disease phenotypein adult and pediatric onset Crohn’s disease(CD) populations,diagnosed between 1977 and 2008.METHODS:Data of 506 incident CD patients were analyzed(age at diagnosis:28.5 years,interquartile range:22-38 years).Both in-and outpatient records were collected prospectively with a complete clinical follow-up and comprehensively reviewed in the population-based Veszprem province database,which included incident patients diagnosed between January 1,1977 and December 31,2008 in adult and pediatric onset CD populations.Disease phenotype according to the Montreal classification and long-term disease course was analysed according to the age at onset in time-dependent univariate and multivariate analysis.RESULTS:Among this population-based cohort,seventy-four(12.8%) pediatric-onset CD patients were identified(diagnosed ≤ 17 years of age).There was no significant difference in the distribution of disease behavior between pediatric(B1:62%,B2:15%,B3:23%) and adult-onset CD patients(B1:56%,B2:21%,B3:23%) at diagnosis,or during follow-up.Overall,the probability of developing complicated disease behaviour was 49.7% and 61.3% in the pediatric and 55.1% and 62.4% in the adult onset patients after 5-and 10-years of follow-up.Similarly,time to change in disease behaviour from non stricturing,non penetrating(B1) to complicated,stricturing or penetrating(B2/B3) disease was not significantly different between pediatric and adult onset CD in a Kaplan-Meier analysis.Calendar year of diagnosis(P = 0.04),ileal location(P < 0.001),perianal disease(P < 0.001),smoking(P = 0.038) and need for steroids(P < 0.001) were associated with presence of,or progression to,complicated disease behavior at diagnosis and during follow-up.A change in disease location was observed in 8.9% of patients and it was associated with smoking status(P = 0.01),but not with age at diagnosis.CONCLUSION:Long-term evolution of disease behavior was not different in pediatric-and adult-onset CD patients in this     

Inflammatory bowel disease characteristics among African Americans, Hispanics, and non-Hispanic Whites: characterization of a large North American cohort

OBJECTIVES: Inflammatory bowel disease (IBD), comprising primarily of Crohn's disease (CD) and ulcerative colitis (UC), is increasingly prevalent in racial and ethnic minorities. This study was undertaken to characterize racial differences in disease phenotype in a predominantly adult population. METHODS: Phenotype data on 830 non-Hispanic white, 127 non-Hispanic African American, and 169 Hispanic IBD patients, recruited from six academic centers, were abstracted from medical records and compiled in the NIDDK-IBD Genetics Consortium repository. We characterized racial differences in family history, disease location and behavior, surgical history, and extraintestinal manifestations (EIMs) using standardized definitions. RESULTS: African American CD patients were more likely than whites to develop esophagogastroduodenal CD (OR = 2.8; 95% CI: 1.4-5.5), colorectal disease (OR = 1.9; 95% CI: 1.1-3.4), perianal disease (OR = 1.7; 95% CI: 1.03-2.8), but less likely to have ileal involvement (OR = 0.55; 95% CI: 0.32-0.96). They were also at higher risk for uveitis (OR = 5.5; 95% CI: 2.3-13.0) and sacroiliitis (OR = 4.0; 95% CI: 1.55-10.1). Hispanics had higher prevalence of perianal CD (OR = 2.9; 95% CI: 1.8-4.6) and erythema nodosum (3.3; 95% CI: 1.7-6.4). Among UC patients, Hispanics had more proximal disease extent. Both African American and Hispanic CD patients, but not UC patients, had lower prevalences of family history of IBD than their white counterparts. CONCLUSIONS: There are racial differences in IBD family history, disease location, and EIMs that may reflect underlying genetic variations and have important implications for diagnosis and management of disease. These findings underscore the need for further studies in minority populations.     

The familial Mediterranean fever (MEVF) gene as a modifier of Crohn's disease

OBJECTIVES: Crohn's disease (CD) has been reported to be more frequent among non-Ashkenazi Jewish patients suffering from familial Mediterranean fever (FMF). Interestingly, functional similarities between the CD susceptibility gene (NOD2/CARD15) and the FMF gene (MEFV) have been described: both belong to the death domain containing protein family, important in the regulation of apoptosis, cytokine processing and inflammation. AIMS: To investigate the prevalence of MEFV mutations in Jewish non-Ashkenazi CD patients and its putative effect on CD presentation. METHODS: Germline DNA of 105 Israeli CD patients of non-Ashkenazi and mixed Ashkenazi-non-Ashkenazi ethnic background was analyzed for three most common MEFV mutations: M694V, V726A, and E148Q. Five patients (4.7%) with a clinical diagnosis of FMF were included. Data obtained from each patient included: age of onset, disease location, and behavior, the presence of extraintestinal manifestations of CD and therapeutic regimens. RESULTS: The overall prevalence of mutation carriers among non-FMF-CD patients was 13% (13/100). A stricturing disease pattern was observed in 56% (10/18) of all carriers, FMF-CD, and non-FMF-CD patients, and in 25% (22/87) of noncarriers (OR: 3.7, 95% CI: 1.3-10.5, p= 0.015). The prevalence of fistulas was comparable in both groups. Extraintestinal manifestations were significantly more frequent among carriers than noncarriers (65%vs 32%, OR 3.9, 95% CI = 1.3-11.5, p= 0.015). No differences were observed in disease location and disease severity. CONCLUSIONS: MEFV mutations are not associated with CD susceptibility, yet the presence of these mutations appears to be associated with a stricturing disease pattern and extraintestinal disease manifestations of CD.     

Intestinal permeability and its association with the patient and disease characteristics in Crohn＇s disease

AIM：To assess the intestinal permeability （IP） in patients with Crohn＇s disease （CD） and study the association of IP with the patient and disease characteristics.
METHODS： One hundred and twenty five consecutive patients of CD （Males： 66） were diagnosed on the basis of a combination of standard clinical, endoscopic, imaging and histological features. CD activity index （CDAI） was used to calculate the activity of the disease while the behavior of the disease was assessed by the modified Montreal classification. IP was measured by the ratio of the percentage excretion of ingested doses of lactulose and mannitol in urine （LMR）. The upper limit of normality of LMR （0.037） was derived from 22 healthy controls.
RESULTS： Thirty six percent of patients with CD had increased IP. There was no significant difference in mannitol excretion （patients vs controls = 12.5% vs 14.2%, P = 0.4652）, but lactulose excretion was significantly higher in patients compared to healthy controls （patients vs controls = 0.326% vs 0.293%, P = 0.0391）. The mean LMR was also significantly higher in the patients as compared to healthy controls [0.027 （0.0029-0.278） vs 0.0164 （0.0018-0.0548）, P = 0.0044]. Male patients had a higher LMR compared to females [0.036 （95% CI 0.029, 0.046） vs 0.022 （95% CI 0.0178, 0.028） （P = 0.0024）, though there was no difference in the number of patients with abnormal IP in boththe sexes. Patients with an ileo-colonic disease had a higher LMR than those with only colonic disease [0.045 （95% CI 0.033, 0.06） vs 0.021 （95% CI 0.017, 0.025） （P 〈 0.001）]. Of patients with ileo-colonic disease, 57.8% had an abnormal IP, compared to 26.7% with colonic and 15.6% with small intestinal disease. Patients with a stricturing disease had significantly higher LMR compared to non-fistulising non-stricturing disease [0.043 （95% CI 0.032, 0.058） vs 0.024 （95% CI 0.019, 0.029） （P = 0.0062）]. There was no correlation of IP with age, disease activ     

Disease location, anti-Saccharomyces cerevisiae antibody, and NOD2/CARD15 genotype influence the progression of disease behavior in Crohn's disease

BACKGROUND: Crohn's disease (CD) is characterized by heterogeneity of phenotype. The Vienna classification can be used to classify CD, and recent data illustrate that behavior evolves over the course of the disease. Clinical and biological influences on disease progression remain unclear. We examined the associations of CD disease progression at diagnosis and for up to 20 years of follow-up. METHODS: Two hundred thirty-one well-characterized CD patients were studied. Demographic, clinical, and NOD2/CARD15 data were collected. Disease behavior according to the Vienna classification was assessed at diagnosis and for up to 20 years following diagnosis. RESULTS: At diagnosis, 70% of patients had inflammatory disease, 9% stricturing, and 21% penetrating. Early age at diagnosis was associated with ileocolonic and upper GI disease (p = 0.015), and positive anti-Saccharomyces cerevisiae antibody (ASCA) was associated with ileal involvement (p = 0.008). Smoking was relatively protective against colonic, rather than ileal involvement at diagnosis (p < 0.02). At 20 years, 92% had progressed to a more severe disease type. Patients who progress to a more severe disease type require more frequent surgery (p < 0.00001). Multivariate analysis found disease progression to be associated with ileal disease location (p = 0.001) and positive ASCA (p = 0.003). Variant NOD2/CARD15 alleles were protective against rapid progression of disease phenotype (p = 0.04). The presence of perianal disease was independent of intestinal penetrating disease. CONCLUSIONS: The progression of disease type in CD is associated with the need for more frequent surgery. Rapid progression is associated with ileal disease and positive ASCA, and delayed progression is associated with variant NOD2/CARD15 alleles. Consideration should be given to a separate Vienna classification for perianal disease.     

Diagnostic delay in inflammatory bowel disease increases the risk of intestinal surgery

AIM To investigate the factors affecting diagnostic delay and outcomes of diagnostic delay in inflammatory bowel disease(IBD) METHODS We retrospectively studied 165 patients with Crohn's disease(CD) and 130 patients with ulcerative colitis(UC) who were diagnosed and had follow up durations 6 mo at Korea University Ansan Hospital from January 2000 to December 2015. A diagnostic delay was defined as the time interval between the first symptom onset and IBD diagnosis in which the 76~(th) to 100~(th) percentiles of patients were diagnosed.RESULTS The median diagnostic time interval was 6.2 and 2.4 mo in the patients with CD and UC, respectively. Among the initial symptoms, perianal discomfort before diagnosis(OR = 10.2, 95%CI: 1.93-54.3, P = 0.006) was associated with diagnostic delays in patients with CD; however, no clinical factor was associated with diagnostic delays in patients with UC. Diagnostic delays, stricturing type, and penetrating type were associated with increased intestinal surgery risks in CD(OR = 2.54, 95%CI: 1.06-6.09; OR = 4.44, 95%CI: 1.67-11.8; OR = 3.79, 95%CI: 1.14-12.6, respectively). In UC, a diagnostic delay was the only factor associated increased intestinal surgery risks(OR = 6.81, 95%CI: 1.12-41.4).CONCLUSION A diagnostic delay was associated with poor outcomes, such as increased intestinal surgery risks in patients with CD and UC.     

Does cigarette smoking influence the phenotype of Crohn's disease? Analysis using the Montreal classification

OBJECTIVES: The clinical subclassification of Crohn's disease by phenotype has recently been reevaluated. We have investigated the relationships between smoking habit, age at diagnosis, disease location, and progression to stricturing or penetrating complications using the Montreal classification. METHODS: 408 patients (157 male, median age 29.4 yr) were assessed. Data were collected on smoking habit, age at diagnosis, anatomical distribution, and disease behavior. Follow-up data were available on all patients (median 10 yr). RESULTS: At diagnosis, ex-smokers (N = 53) were older than nonsmokers (N = 177) or current smokers (N = 178, medians 43.2 vs 28.3 or 28.9 yr, respectively, P < 0.001). Disease location differed according to smoking habit at diagnosis (chi(2)= 24.1, P= 0.02) as current smokers had less colonic (L2) disease than nonsmokers or ex-smokers (30%vs 45%, 50%, respectively). In univariate Kaplan-Meier survival analysis, smoking habit at diagnosis was not associated with time to development of stricturing disease, internal penetrating disease, perianal penetrating disease, or time to first surgery. Patients with isolated colonic (L2) disease were slower to develop strictures (P < 0.001) or internal penetrating disease (P= 0.001) and to require surgery (P < 0.001). Cox models with smoking habit as time-dependent covariates showed that, relative to ileal (L1) location of disease, progression to stricturing disease was less rapid for patients with colonic (L2) disease (HR 0.140, P < 0.001), but not independently affected by smoking habit. Progression to surgery was also slower for colonic (L2) than ileal (L1) disease location (HR 0.273, P < 0.001), but was independent of smoking habit. CONCLUSIONS: Smoking habit was associated with age at diagnosis and disease location in Crohn's disease, while disease location was associated with the rate of development of stricturing complications and requirement for surgery. The pathogenic basis of these observations needs to be explained.     

Racial differences in disease phenotypes in patients with Crohn's disease

BACKGROUND: Our objectives were to assess the differences in perforating disease behavior, disease severity, and extraintestinal manifestations (EIM) in patients with Crohn's disease (CD) by race. MATERIALS AND METHODS: We identified outpatients with CD evaluated at the University of Maryland Gastroenterology Faculty Practice office or the Baltimore Veterans Affairs Maryland Health Care System, from 1997 to 2005. We assessed age at diagnosis, disease behavior, disease location, need for surgery and EIM. RESULTS: Race was not associated with perforating disease behavior (relative risk [RR] 0.79, 95% confidence interval [CI] 0.46-1.35), need for surgery (RR 0.89, 95% CI 0.56-1.12), and EIM of CD (RR 0.77, 95% CI 0.46-1.27). White patients were significantly more likely to have ileal disease, whereas African American patients were significantly more likely to have ileocolonic and colonic disease. Age at diagnosis younger than 40 years (odds ratio [OR] 4.41, 95% CI 1.84-10.56) and ileocolonic disease (OR 2.39, 95% CI 1.24-4.63) were independent risk factors for perforating disease behavior. Similarly, age at diagnosis younger than 40 (OR 2.79, 95% CI 1.45-5.33), ileal disease (OR 3.76, 95% CI 1.66-8.48), and ileocolonic disease (OR 2.57, 95% CI1.21-5.46) were associated with the need for surgery. Female gender (OR 4.23, 95% CI 1.87-9.58) and a positive family history of CD (OR 3.45, 95% CI 1.49-8.0) were associated with joint manifestations of CD. DISCUSSION: We did not detect differences in disease behavior, severity, or joint EIM by race. Although African American patients were more likely to have ileocolonic or colonic disease, these factors did not affect disease behavior or severity.     

Clinical prognostic factors for disabling Crohn’s disease: A systematic review and meta-analysis

AIM: To identify demographic and clinical factors asso-ciated with disabling Crohn’s disease (CD). METHODS: A systematic review and meta-analysisof observational studies, focusing on the factors that can predict the prognosis of different outcomes of CD was undertaken. PubMed, ISI Web of Knowledge and Scopus were searched to identify studies investigat-ing the above mentioned factors in adult patients with CD. Studies were eligible for inclusion if they describe prognostic factors in CD, with inclusion and exclusion criteria defined as follows. Studies with adult patients and CD, written in English and studying association between clinical factors and at least one prognosis out-come were included. Meta-analysis of effects was un-dertaken for the disabling disease outcome, using odds ratio (OR) to assess the effect of the different factors in the outcome. The statistical method used was Mantel-Haenszel for fixed effects. The 16-item quality assess-ment tool (QATSDD) was used to assess the quality of the studies (range: 0-42). RESULTS: Of the 913 papers initially selected, sixty studies were reviewed and three were included in the systematic review and meta-analysis. The global QA-TSDD scores of papers were 18, 21 and 22. Of a total of 1961 patients enrolled, 1332 (78%) were classified with disabling disease five years after diagnosis. In two studies, age at diagnosis was a factor associated with disabling disease five years after diagnosis. Individu-als under 40 years old had a higher risk of developing disabling disease. In two studies, patients who were treated with corticosteroids on the first flare developed disabling disease five years after diagnosis. Further, perianal disease was found to be relevant in all of the studies at two and five years after diagnosis. Finally, one study showed localization as a factor associated with disabling disease five years after diagnosis, with L3 being a higher risk factor. This meta-analysis showed a significantly higher risk of developing disabling dis-ease at five year     

Imbalances in dietary consumption of fatty acids, vegetables, and fruits are associated with risk for Crohn's disease in children

BACKGROUND AND OBJECTIVES: The role of dietary factors in the etiology of Crohn's disease (CD) is inconsistent largely due to difficulties in acquiring valid information on consumption habits. We examined the impact of diet on new onset CD in children using a validated food-frequency questionnaire (FFQ). METHODOLOGY: A case-control study was carried out. Children < or =20 yr, newly diagnosed with CD, were recruited from 3 pediatric gastroenterology clinics across Canada. Population or hospital controls were selected matched to cases for time of diagnosis (+/-6 months) and area of residence. Dietary consumption 1 yr prior to disease diagnosis was evaluated using a validated FFQ, administered within 1 month of diagnosis. Conditional logistic regression analysis adjusting for potential confounding variables (energy intake, age, gender, body mass index) was carried out. RESULTS: A total of 130 CD patients and 202 controls were studied. Mean age at diagnosis (+/-SD) was 14.2 (2.7). There were more male patients (59%). Comparing the highest to the lowest levels of consumption, higher amounts of vegetables (OR 0.69, 95% CI 0.33-1.44, P= 0.03), fruits (OR 0.49, 95% CI 0.25-0.96, P= 0.02), fish (OR 0.46, 95% CI 0.20-1.06, P= 0.02), and dietary fiber (OR 0.12, 95% CI 0.04-0.37, P < 0.001) protected from CD. Consumption of long-chain omega-3 fatty acids (LCN-omega-3) was negatively associated with CD (OR 0.44, 95% CI 0.19-1.00, P < 0.001). A higher ratio of LCN-omega-3/omega-6 fatty acids was significantly associated with lower risks for CD (OR 0.32, 95% CI 0.14-0.71, P= 0.02). CONCLUSIONS: Our findings indicate that an imbalance in consumption of fatty acids, vegetables, and fruits is associated with increased risks for CD among Canadian children.