背景:克罗恩病(CD)是一种慢性疾病,其特征是手术后复发率高,严重影响患者的生活质量。许多研究探讨了CD术后复发的危险因素,缺乏将内镜术后复发(ePOR)作为临床结局的荟萃分析.因此,本文旨在通过系统评价和荟萃分析来确定CD患者ePOR的危险因素。
方法:PubMed,Embase,科克伦图书馆,从开始到2023年10月17日,搜索了WebofScience数据库的相关文献。两名研究者独立筛选文献并提取信息。使用Stata18.0进行数据分析。
结果:包括23篇论文,5个病例对照研究和18个队列研究。美国国立卫生研究院质量评估工具将17项研究评为良好,将6项研究评为公平。23项研究的样本量从40到346不等,ePOR患者的数量从23到169不等。多变量荟萃分析结果显示,吸烟[OR=2.06,95%CI(1.65,2.57),P=0.0001],既往回肠结肠切除术[OR=1.71,95%CI(1.23,2.38),P=0.002],回肠结肠切除术时的疾病定位[OR=2.68,95%CI(1.38,5.22),P=0.004],肛周疾病[OR=1.47,95%CI(1.07,2.03),P=0.017],吻合口散见性溃疡[OR=3.39,95%CI(1.83,6.28),P=0.001是CD患者ePOR的危险因素。术后预防性用药[OR=0.53,95%CI(0.38,0.75),P=0.0001]是CD患者ePOR的保护因素。
结论:本系统评价确定了CD患者ePOR的多种因素,也是一个保护因素。然而,包含的文章数量有限。需要更多高质量的临床研究来进一步验证结论。
背景:本研究已在国际前瞻性系统审查注册(PROSPERO)(CRD42023483671)中注册。
BACKGROUND: Crohn\'s disease (CD) is a chronic condition characterized by a high recurrence rate after surgery, which seriously affects the quality of life of patients. Many studies have explored the risk factors for the recurrence of CD after surgery, there is a lack of meta-analysis focusing on endoscopic postoperative recurrence (ePOR) as a clinical outcome. Therefore, this paper aims to identify the risk factors for ePOR in CD patients through systematic
review and meta-analysis.
METHODS: PubMed, Embase, Cochrane Library, and Web of Science databases were searched for related literature from inception to 17th October 2023. Two researchers independently screened the literature and extracted information. Data analysis was performed using Stata18.0.
RESULTS: Twenty-three papers were included, with 5 case-control studies and 18 cohort studies. The National Institutes of Health quality assessment tool rated 17 studies as good and 6 studies as fair. The sample size of the 23 studies ranged from 40 to 346, and the number of patients with ePOR ranged from 23 to 169. The results of multivariate meta-analysis showed that smoking [OR = 2.06, 95% CI (1.65, 2.57), P = 0.0001], previous ileocolonic resection [OR = 1.71, 95% CI (1.23, 2.38), P = 0.002], disease localization at ileocolic resection [OR = 2.68, 95% CI (1.38, 5.22), P = 0.004], perianal disease [OR = 1.47, 95% CI (1.07, 2.03), P = 0.017], and anastomotic scattered ulcer [OR = 3.39, 95% CI (1.83, 6.28), P = 0.001] were risk factors for ePOR in CD patients. Postoperative prophylactic medication [OR = 0.53, 95% CI (0.38,0.75), P = 0.0001] was a protective factor for ePOR in CD patients.
CONCLUSIONS: This systematic
review identified multiple factors for ePOR in CD patients, as well as a protective factor. However, the number of articles included was limited. More high-quality clinical studies are required to further validate the conclusions.
BACKGROUND: This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023483671).