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基于风险概况的真实世界手术和内镜复发和在术后克罗恩病的预防利用
Ravi S Shah1, Salam Bachour2, Abel Joseph3
1Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio.
概括
临床风险因素预测克罗恩氏病 (CD) 患者在大结节切除后的手术复发. 预防性生物治疗可以减少手术和内镜复发,无论患者的风险分层如何.
科学领域:
- 胃肠病学 胃肠病学
- 炎症性肠道疾病研究研究
- 外科手术的结果
背景情况:
- 术前风险分层对于指导克罗恩病 (CD) 预防性生物使用至关重要,以防止术后复发.
- 关于验证临床风险因素和生物预防在现实世界CD队列中的影响的数据有限.
研究的目的:
- 为了探索经历了大结肠切除 (ICR) 的CD患者的术前临床风险概况.
- 量化与术后复发相关的个体风险因素.
- 在现实环境中评估生物预防对复发风险的影响.
主要方法:
- 1404名接受ICR (2009-2020) 的成年CD患者的多中心回顾性分析.
- 患者分为高风险 (活跃吸烟者,前2次以上的手术,透/周围部疾病) 和低风险组.
- 评估内镜 (鲁特吉尔特评分≥i2b) 和基于分层和术后生物预防 (≤90天) 的手术复发风险.
主要成果:
- 多种高风险因素 (≥2 ICR,活跃吸烟,透性疾病,围疾病) 与手术复发有关 (ORs 1.41-1.99).
- 在接受预防的高风险患者中,手术复发明显较低 (10.2%对16.7%,P=.02).
- 通过所有风险层的预防,内镜复发率较低 (高风险:28.1%与37.4%,P=.03;低风险:21.1%与38.3%,P=.002).
结论:
- 临床风险因素有效地识别了患有CD手术复发风险的患者.
- 这些因素对内镜复发的预测价值有限.
- 生物预防似乎有利于预防复发,无论手术前风险分层如何.
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