摘要
目的探讨临床缓解期或轻度活动期克罗恩病患者在长程随访中因病住院的影响因素。方法采用前瞻性队列研究设计,选择2013年8月5日至2015年1月5日就诊于北京协和医院消化内科的临床缓解期或轻度活动期克罗恩病患者123例,收集所有患者的基线资料,包括年龄和性别等一般资料,是否有(包括曾有或现有)肠外表现或并发症、糖皮质激素使用效果、超敏C反应蛋白(hsCRP)、血白蛋白等临床资料,以及炎症性肠病生命质量问卷(IBDQ)总分及其全身维度评分等。对所有患者进行长程随访直至2022年5月31日或因病住院。采用受试者操作特征曲线(ROC)分析hsCRP、血白蛋白等预测因病住院的最佳截断值。采用多因素Cox回归模型分析克罗恩病患者因病住院的影响因素。结果123例患者的中位年龄为32.0岁(25.0岁,49.0岁),女性占32.5%(40/123);71例(57.7%)患者因病住院,中位随访时间为29.2个月(9.0个月,57.9个月)。ROC分析显示,hsCRP、血白蛋白预测克罗恩病患者因病住院的最佳截断值分别为1.5 mg/L、40 g/L(均P<0.001)。多因素Cox回归模型分析结果显示,有肠外表现[HR=1.869,95%置信区间(95%CI)1.014~3.443]、有并发症(HR=2.511,95%CI 1.368~4.608)、糖皮质激素无效或依赖(HR=1.958,95%CI 1.128~3.396)、血hsCRP≥1.5 mg/L(HR=2.116,95%CI 1.111~4.029)、血白蛋白≤40 g/L(HR=3.040,95%CI 1.716~5.386)是克罗恩病患者因病住院的独立危险因素(P=0.045、0.003、0.017、0.023、<0.001),IBDQ全身维度评分(HR=0.873,95%CI 0.805~0.948)是因病住院的独立保护因素(P=0.001)。结论有肠外表现、有并发症、糖皮质激素无效或依赖、血hsCRP≥1.5 mg/L、血白蛋白≤40 g/L的临床缓解期或轻度活动期克罗恩病患者是因病住院的高风险人群,需给予更积极的治疗和紧密随访。IBDQ全身维度评分更高的克罗恩病患者病情更稳定。
Objective To explore the influencing factors of hospitalization in patients with mild active Crohn′s disease or in clinical remission during long-term follow-up.Methods This was a prospective cohort study.From August 5,2013 to January 5,2015,123 patients with mild active Crohn′s disease or in clinical remission visited the Department of Gastroenterology,Peking Union Medical College Hospital were selected.The baseline information of all the patients were collected,including the general data such as age and gender,clinical data such as extra-intestinal manifestations,complications,efficacy of glucocorticoid usage,serum hypersensitive C-reactive protein(hsCRP),serum albumin,and the total score and the subscore in systemic symptoms of inflammatory bowel disease questionnaire(IBDQ).All the patients were followed up for a long time till May 31,2022 or the date of hospitalization due to the disease.Receiver operating characteristic curve(ROC)was used to define the optimal cut-off values of hsCRP and serum albumin for hospitalization prediction.Multivariate Cox regression model was used to analyze the influencing factors of hospitalization.Results The median age of 123 patients was 32.0 years old(25.0 years old,49.0 years old),32.5%(40/123)were female,and 71 cases(57.7%)were hospitalized because of disease,and the median follow-up time was 29.2 months(9.0 months,57.9 months).ROC analysis showed that the optimal cut-off value of hsCRP and serum albumin in predicting hospitalization because of disease in patients with Crohn′s disease was 1.5 mg/L and 40 g/L(both P<0.001),respectively.Multivariate Cox regression model showed that the extra-intestinal manifestations(HR=1.869,95%confidence interval(95%CI)1.014 to 3.443),complications(HR=2.511,95%CI 1.368 to 4.608),glucocorticoid dependence or refractory(HR=1.958,95%CI 1.128 to 3.396),serum hsCRP≥1.5 mg/L(HR=2.116,95%CI 1.111 to 4.029)and serum albumin≤40 g/L(HR=3.040,95%CI 1.716 to 5.386)were independent risk factors of hospitalization because of disease in patients with Crohn′s disease(P=0.045,0.003,0.017,0.023,and<0.001).However,IBDQ subscore in systemic symptoms(HR=0.873,95%CI 0.805 to 0.948)was an independent protective factor of hospitalization because of disease(P=0.001).Conclusions Patients with Crohn′s disease at remission stage or mild activity stage who have extra-intestinal manifestations,complications,glucocorticoid dependence or refractory,serum hsCRP≥1.5 mg/L or serum albumin≤40 g/L are at high risk of hospitalization because of disease,and should be given more active treatments and more frequent follow-up.Patients with higher IBDQ subscore in systemic symptoms are more likely to gain a long-term stable condition.
作者
罗涵青
李玥
孙园园
吕红
胜利
王丽
钱家鸣
Luo Hanqing;Li Yue;Sun Yuanyuan;Lyu Hong;Sheng Li;Wang Li;Qian Jiaming(Department of Health Care,Peking Union Medical College Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100730,China;Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100730,China;Department of Epidemiology and Biostatistics,Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences,School of Basic Medicine Peking Union Medical College,Beijing 100005,China;Department of Psychiatry,Beijing United Family Hospital,Beijing 100015,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2022年第12期828-836,共9页
Chinese Journal of Digestion
基金
卫生行业科研专项(201002020)
中国医学科学院医学与健康科技创新工程(2016-I2M-3-001)。
关键词
克罗恩病
缓解期
住院
预后
危险因素
Crohn′s disease
Remission
Hospitalization
Prognosis
Risk factors
