克罗恩病预后不良预测因素的研究

克罗恩病（CD）的临床过程差异较大，甄别高危患者并给予积极内科治疗可能具有重要的l临床意义。目的：分析我国CD确诊时的l临床特征并探讨CD预后的预测因素。方法：以2003年1月。2010年12月我院首次确诊并完整随访的275例连续CD患者为研究对象．回顾性分析临床特征．估算预后不良率，采用单因素和多因素分析探讨影响预后的危险因素。结果：本组患者男女比为1．8：1，中位确诊年龄为28岁．呈单峰分布；病变部位主要为回结肠型（L3型）和回肠末端型（L1型），分别占58．9％、21．1％；疾病行为以非狭窄非穿透型（B1型）为主（78．9％），22．5％的患者伴随肛周病变。共99例患者预后不良，预后不良率为30-3％～83．7％。单因素和多因素分析结果显示：确诊年龄A3型（OR=6．743，95％CI：1．293。35．156，P=0．024）、疾病行为狭窄型（B2型）（OR=9．761，95％CI：2．831．33．653．P〈0．001）或穿透型（B3型）（OR=44．387，95％CI：8．266～238．343，P〈0．001）、伴随肛周病变（OR=3．645，95％CI：1．645～8．081，P=0．001）以及初洽时需应用系统作用糖皮质激素（OR=5．775，95％CI：2．741～12．169，P〈0．001）可能是C19预后不良的预测因素。结论：我国CD患者男性多于女性，确诊年龄呈单峰分布；病变部位以L3型为主，L2型相对较少。确诊年龄A3型、疾病行为B2型或B3型、伴随肛周病变以及初治时需应用系统作用糖皮质激素可能是CD患者3年内预后不良的预测因素。

Predictors for Crohn's Disease with Poor Prognosis

Background: Crohn’s disease(CD) is a disease with highly varied clinical course and outcome.It may be important to identify the high risk patients who could benefit from aggressive medical therapy.Aims: To investigate the clinical characteristics at diagnosis and analyze the predictors for prognosis of CD in China.Methods: A total of 275 consecutive CD patients with complete data from Jan.2003 to Dec.2010 were enrolled.Clinical characteristics were analyzed retrospectively.The rate of poor prognosis was calculated.Predictors for prognosis were studied by univariate and multivariate analyses.Results: The ratio of male to female was 1.8∶1.Diagnosis was established at a median age of 28 years with one peak distribution.Most lesions were located in ileocolon(L3)(58.9%) and terminal ileum(L1)(21.1%).Behavior of disease was predominantly presented by nonstricturing and nonpenetrating(B1)(78.9%),and 22.5% of patients were concomitant with perianal disease.Ninety-nine patients were categorized as having poor prognosis.The rate of CD with poor prognosis was 30.3%-83.7%.Univariate and multivariate analyses showed that A3 subtype diagnosis age(OR=6.743,95% CI: 1.293-35.156,P=0.024),stricturing behavior(OR=9.761,95% CI: 2.831-33.653,P<0.001) or penetrating behavior(OR=44.387,95% CI: 8.266-238.343,P<0.001),associated with perianal disease(OR=3.645,95% CI: 1.645-8.081,P=0.001) and need of systemic steroids for initially treating the first flare(OR=5.775,95% CI: 2.741-12.169,P<0.001) were the predictors for poor diagnosis of CD.Conclusions: CD patients in China are male in predominance,with one peak age distribution at diagnosis,mostly involving ileocolon and less being isolated at terminal ileum.Predictors for poor prognosis are A3 subtype diagnosis age,stricturing behavior or penetrating behavior,the presence of perianal disease,and need of systemic steroids for initial treatment.