医学
危险系数
四分位间距
内科学
胃肠病学
克罗恩病
置信区间
肿瘤坏死因子α
磁共振成像
英夫利昔单抗
结肠镜检查
外科
疾病
结直肠癌
癌症
放射科
作者
Kyunghwan Oh,Eui Geum Oh,Soo Min Noh,Seong Ho Park,Nayoung Kim,Sung Wook Hwang,Sang Hyoung Park,Dan Yang,Jeong‐Sik Byeon,Seung‐Jae Myung,Suk‐Kyun Yang,Byong Duk Ye
标识
DOI:10.14309/ctg.0000000000000442
摘要
INTRODUCTION: Although endoscopic healing (EH) is recommended as the therapeutic goal in patients with Crohn's disease (CD), combined EH and radiologic healing (RH) could be a more ideal therapeutic goal considering the transmural nature of CD. We compared the prognosis of patients with CD who achieved EH, RH, both EH and RH (deep healing; DH), or no healing under treatment with anti-tumor necrosis factor (TNF) agents. METHODS: We analyzed 392 patients with CD who received anti-TNF treatment for more than 1 year and evaluated with CT enterography or magnetic resonance enterography together with colonoscopy within 3 months between July 2017 and December 2018. Major outcomes (anti-TNF dose intensification, switch to other biologics, CD-related bowel resection, and hospitalization) were compared according to the EH and RH status. RESULTS: During the follow-up (median 18 months; interquartile range, 15–21), the DH group showed a better rate of major outcome-free survival compared with other groups ( P < 0.001). In multivariable analysis, elevated C-reactive protein (adjusted hazard ratio [aHR], 2.166; 95% confidence interval [CI], 1.508–3.110; P < 0.001), EH-only (aHR, 3.903; 95% CI, 1.635–9.315; P = 0.002), RH-only (aHR, 3.843; 95% CI, 1.545–9.558; P = 0.004), and no healing (aHR, 8.844; 95% CI, 4.268–18.323; P < 0.001) were associated with increased risks of major outcomes. DISCUSSION: Patients with CD who achieved DH under anti-TNF therapy showed a better prognosis compared with those who only achieved EH. The possibility of DH being used as a new therapeutic target for patients with CD should be investigated in further studies.
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