初级硬化胆管炎-炎症性肠病:流行病学,死亡率和诊断序列的影响
Kristel K Leung1,2,3, Wenbin Li4, Bettina Hansen1,2,5
1The Autoimmune and Rare Liver Disease Programme, Division of Gastroenterology and Hepatology, Toronto General Hospital, Toronto, ON, Canada.
与炎症性肠道疾病 (PSC-IBD) 相关的原发性硬化性胆管炎正在增加,特别是在更高的社会经济群体中. 在PSC之前诊断IBD增加了移植和死亡风险,突出了PSC-IBD作为一个独特的疾病.
科学领域:
- 胃肠病学 胃肠病学
- 流行病学 流行病学
- 肝病学 肝病学是一种肝病学.
背景情况:
- 与炎症性肠道疾病 (IBD) 相比,原发性硬化性胆管炎 (PSC) 显著增加了发病率和死亡率.
- 大多数患有PSC的个体随着时间的推移会发展为IBD,因此需要了解PSC-IBD结合的情况.
- 在单独的PSC-IBD和IBD之间存在着不同的流行病学模式和结果.
研究的目的:
- 描述与IBD相比,PSC-IBD患者的流行病学趋势和结果.
- 分析诊断序列 (IBD之前的PSC或PSC之前的IBD) 对患者结果的影响.
- 为了确定PSC-IBD患者死亡的特定原因.
主要方法:
- 利用来自加拿大安大略省 (2002-2018) 的经过验证的卫生行政数据,用于基于人口的队列.
- 评估了PSC-IBD和IBD的发病率,流行率,移植和死亡结果.
- 检查了PSC-IBD的诊断序列作为主要暴露变量.
主要成果:
- 与IBD不同的是,PSC-IBD发病率 (0.46/100,000 PY) 和流行率 (5.53/100,000 PY) 随着时间的推移而增加.
- 更高的社会经济地位与增加的PSC-IBD发病率相关.
- 在PSC之前诊断IBD导致移植/死亡风险更高 (HR 1.34),主要是由于死亡率增加 (HR 2.73).
- 与IBD患者相比,PSC-IBD患者的移植/死亡风险是IBD患者的4.5倍.
- 与肝脏相关的疾病和恶性瘤是PSC-IBD的主要死亡原因,与IBD形成鲜明对比.
结论:
- PSC-IBD表现出明显的流行病学模式和比单独的IBD更糟糕的结果.
- 诊断的顺序显著影响结果,IBD之前的PSC与更差的预后相关.
- 这些发现支持将PSC-IBD视为独特的临床实体,并要求对早期识别策略进行进一步调查.
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