肠behaperet病常规治疗失败的长期预后和临床因素：日本的一项回顾性队列研究

IF 3.6 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Digestion Pub Date : 2025-09-19 DOI:10.1159/000548559

Keita Murakami, Junya Arai, Sozaburo Ihara, Yumi Tsuchida, Haruka Tsuchiya, Mayo Tsuboi, Ken Kurokawa, Nobumi Suzuki, Hiroto Kinoshita, Yoku Hayakawa, Keishi Fujio, Mitsuhiro Fujishiro

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引用次数: 0

摘要

背景：我们的目的是确定肠behet病（i-BD）患者常规治疗（CT）失败的长期结局和预测因素，包括5-氨基水杨酸、硫唑嘌呤和糖皮质激素。方法：本回顾性研究包括2005年4月至2024年7月在东京大学医院接受CT检查的63例i-BD患者。因CT失败需要使用抗肿瘤坏死因子α (TNF-α)药物的患者分为高级治疗组（AT）， CT对照者为CT组。CT失效的危险因素采用Cox比例风险回归分析，累积故障率采用Kaplan-Meier法分析。结果：28例患者（44.8%）在中位随访93个月期间需要AT。CT累计1、3、5、10年的失败率分别为22.6%、35.9%、40.0%和50.8%。多因素分析发现，最大溃疡面积≥3 cm（风险比[HR]: 2.68, 95%可信区间[CI]: 1.05-6.84, p=0.030）、联合使用质子泵抑制剂（PPI）（风险比：2.65,95%CI: 1.06-6.58, p=0.036）、c -反应蛋白(CRP)≥4 mg/dL（风险比：2.56,95%CI: 1.04-6.31, p=0.042）和尿血症（风险比：2.40,95%CI: 1.05-5.46, p=0.037）是CT失败的独立预测因素。使用所有四个因素的预测模型在预测AT需求方面显示出良好的准确性（AUC=0.877）。关于AT的疗效，22例患者（78.6%）在AT组中持续AT至少1年，大多数患者达到临床和内镜缓解。同时糖皮质激素的使用从基线时的12.7±11.7 mg/天显著下降到1年后的2.4±2.5 mg/天（结论：溃疡大、使用PPI、高CRP和便血是CT失败的危险因素）。抗tnf -α药物对CT失败患者有效，基于风险的治疗策略可能改善i-BD患者的疾病控制。

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Long-term outcomes and clinical factors associated with conventional therapy failure in intestinal Behçet's disease: A retrospective cohort study in Japan.

Background: We aimed to identify the long-term outcomes and predictive factors for failure of conventional therapy (CT), including 5-aminosalicylic acid, azathioprine, and glucocorticoid, in patients with intestinal Behçet's disease (i-BD).

Methods: This retrospective study included 63 patients with i-BD receiving CT at the University of Tokyo Hospital between April 2005 and July 2024. Patients requiring anti-tumor necrosis factor-alpha (TNF-α) agents due to CT failure were categorized into the advanced therapy (AT) group, whereas those controlled with CT were classified as the CT group. Risk factors for CT failure were analyzed using Cox proportional hazards regression, and cumulative failure rates were using the Kaplan-Meier method.

Results: Twenty-eight patients (44.8%) required AT during a median follow-up of 93 months. The cumulative 1-, 3-, 5-, and 10-year failure rates of CT were 22.6%, 35.9%, 40.0%, and 50.8%, respectively. Multivariate analysis identified maximum ulcer size ≥3 cm (hazard ratio [HR]: 2.68, 95% confidence interval [CI]: 1.05-6.84, p=0.030), concomitant proton-pump inhibitor (PPI) use (HR: 2.65, 95%CI: 1.06-6.58, p=0.036), C-reactive protein (CRP) ≥4 mg/dL (HR: 2.56, 95%CI: 1.04-6.31, p=0.042), and hematochezia (HR: 2.40, 95%CI: 1.05-5.46, p=0.037) as independent predictors of CT failure. A predictive model using all four factors demonstrated good accuracy (AUC=0.877) for predicting AT requirement. Regarding AT efficacy, 22 patients (78.6%) in the AT group continued AT for at least 1 year, with most achieving clinical and endoscopic remission. Concomitant glucocorticoid use significantly decreased from 12.7±11.7 mg/day at baseline to 2.4±2.5 mg/day at 1 year (p<0.001).

Conclusions: Large ulcer size, PPI use, high CRP, and hematochezia are risk factors for CT failure. Anti-TNF-α agents are effective in patients with CT failure, and risk-based treatment strategies may improve disease control in patients with i-BD.

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来源期刊

Digestion 医学-胃肠肝病学

CiteScore

7.90

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： ''Digestion'' concentrates on clinical research reports: in addition to editorials and reviews, the journal features sections on Stomach/Esophagus, Bowel, Neuro-Gastroenterology, Liver/Bile, Pancreas, Metabolism/Nutrition and Gastrointestinal Oncology. Papers cover physiology in humans, metabolic studies and clinical work on the etiology, diagnosis, and therapy of human diseases. It is thus especially cut out for gastroenterologists employed in hospitals and outpatient units. Moreover, the journal''s coverage of studies on the metabolism and effects of therapeutic drugs carries considerable value for clinicians and investigators beyond the immediate field of gastroenterology.