2011—2020年宁波市鄞州区炎症性肠病发病的流行病学研究

doi:10.19723/j.issn.1671-167X.2022.03.017

摘要/Abstract

摘要：

目的: 描述宁波市鄞州区常住居民炎症性肠病发病的分布特征，了解该地区炎症性肠病的疾病负担和发展趋势。方法: 采用回顾性队列设计，收集2010—2020年鄞州区全民健康信息平台的居民健康档案中所有常住居民的登记信息，利用电子病历随访其炎症性肠病就诊情况，设置1年洗脱期，以登记1年后首次诊断且以炎症性肠病为首要诊断的患者为新发病例。采用泊松分布估算炎症性肠病的发病密度及其95%置信区间(confidence interval, CI)。结果: 2011—2020年累计纳入鄞州区常住居民1 496 427人，其中男性729 996人(48.78%)，总随访人年8 081 030.82，中位随访人年5.41 [四分位距(interquartile range, IQR): 5.29]。研究期间共有1 217例炎症性肠病新发病例，男性(624例，51.27%)多于女性(593例，48.73%)，总发病密度为15.06/10万人年(95%CI: 14.23, 15.93)，其中溃疡性结肠炎1 106例(90.88%)，发病密度为13.69/10万人年(95%CI: 12.89, 14.52)；克罗恩病70例(5.75%)，发病密度为0.87/10万人年(95%CI: 0.68, 1.09)；未定型结肠炎41例(3.37%)，发病密度为0.51/10万人年(95%CI: 0.36, 0.69)。溃疡性结肠炎的中位发病年龄为50.82岁(IQR: 18.77)，发病年龄在45~49岁组占比最高(15.01%)；发病密度随年龄增长逐渐上升，45~49岁年龄组达到较高水平，随后略有上升，65~69岁年龄组发病密度最高，为25.44/10万人年(95%CI: 20.85, 30.75)，至75~79岁组发病密度迅速下降；克罗恩病的中位发病年龄为44.34岁(IQR: 33.41)，发病年龄在25~29岁组占比最高(12.86%)，由于克罗恩病新发病例数较少，年龄分布波动较大，青年和老年各有峰值。2011—2020年间，鄞州区炎症性肠病的发病密度在2011—2013年处于较低水平，2014—2016年呈迅速上升趋势，2016年达到峰值[24.62/10万人年(95%CI: 21.31, 28.30)]，2017—2020年略有下降。结论: 2011—2020年鄞州区炎症性肠病发病密度呈较高水平，医疗机构和卫生部门需重视其所带来的疾病负担。

关键词: 炎症性肠病, 溃疡性结肠炎, 克罗恩病, 发病密度, 队列

Abstract:

Objective: To describe the distribution characteristics of inflammatory bowel disease among permanent residents in Yinzhou District, Ningbo City, and to understand the disease burden and development trend of inflammatory bowel disease in this area. Methods: Using the retrospective cohort design, we collected the registration information of all permanent residents in the residents' health files of the Yinzhou Regional Health Information Platform from 2010 to 2020, and used electronic medical records to follow up their inflammatory bowel disease visits. A one-year wash-out period was set, and the patients who were diagnosed with the primary diagnosis for the first time after one year of registration were re-garded as new cases. The incidence density and 95% confidence interval (CI) of inflammatory bowel disease were estimated by Poisson distribution. Results: From 2011 to 2020, a total of 1 496 427 permanent residents in Yinzhou District were included, of which 729 996 were male (48.78%). The total follow-up person-years were 8 081 030.82, and the median follow-up person-years were 5.41 [interquartile range (IQR): 5.29]. During the study period, there were 1 217 new cases of inflammatory bowel disease, of which males (624 cases, 51.27%) were more than females (593 cases, 48.73%). The total incidence density was 15.06/100 000 person-years (95%CI: 14.23, 15.93). Among all new cases, there were 1 106 cases (90.88%) of ulcerative colitis, with an incidence density of 13.69 per 100 000 person-years (95%CI: 12.89, 14.52); 70 cases (5.75%) of Crohn's disease, with an incidence density of 0.87 per 100 000 person-years (95%CI: 0.68, 1.09); and 41 cases (3.37%) of indeterminate colitis, with an incidence density of 0.51 per 100 000 person-years (95%CI: 0.36, 0.69). The median age of onset of ulcerative colitis was 50.82 years old (IQR: 18.77), with the highest proportion (15.01%) in the 45-49 years group. The incidence density of ulcerative colitis gradually increased with age, reaching a relatively high level in the 45-49 years group (20.53/100 000 person-years; 95%CI: 17.63, 23.78), followed by a slight increase. And the incidence density in the 65-69 years group was the highest (25.44/100 000 person-years; 95%CI: 20.85, 30.75), with a rapid decrease in the 75-79 years group. The median age of onset of Crohn's disease was 44.34 years (IQR: 33.41), with the highest proportion (12.86%) in the 25-29 years group. Due to the small number of new cases of Crohn's disease, the age distribution fluctuated greatly, with peaks both in young and old people. From 2011 to 2020, the incidence density of inflammatory bowel disease in Yinzhou District was at a low level from 2011 to 2013, and showed a rapid upward trend from 2014 to 2016, reaching a peak of 24.62 per 100 000 person-years in 2016 (95%CI: 21.31, 28.30), and slightly decreased in 2017—2020. Conclusion: The incidence density of inflammatory bowel disease in Yinzhou District from 2011 to 2020 was at a relatively high level, and medical institutions and health departments need to pay attention to the burden of disease caused by it.

Key words: Inflammatory bowel disease, Ulcerative colitis, Crohn' s disease, Incidence density, Cohort

中图分类号:

R181.2

贺冰洁,刘志科,沈鹏,孙烨祥,陈彬,詹思延,林鸿波. 2011—2020年宁波市鄞州区炎症性肠病发病的流行病学研究[J]. 北京大学学报（医学版）, 2022, 54(3): 511-519.

Bing-jie HE,Zhi-ke LIU,Peng SHEN,Ye-xiang SUN,Bin CHEN,Si-yan ZHAN,Hong-bo LIN. Epidemiological study on the incidence of inflammatory bowel disease in Yinzhou District, Ningbo City from 2011 to 2020[J]. Journal of Peking University (Health Sciences), 2022, 54(3): 511-519.

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参考文献 35

1	葛均波, 徐永健. 内科学[M]. 8版北京: 人民卫生出版社, 2013: 385- 393.
2	中华医学会消化病学分会炎症性肠病学组. 炎症性肠病诊断与治疗的共识意见(2012年·广州)[J]. 胃肠病学, 2012, 17 (12): 763- 781. doi: 10.3969/j.issn.1008-7125.2012.12.013
3	张玉洁, 梁洁, 吴开春. 炎症性肠病诊断与治疗的共识意见(2018年, 北京)溃疡性结肠炎部分解读[J]. 中华消化杂志, 2018, 38 (5): 312- 314. doi: 10.3760/cma.j.issn.0254-1432.2018.05.003
4	Ungaro R , Mehandru S , Allen PB , et al. Ulcerative colitis[J]. Lancet, 2017, 389 (10080): 1756- 1770. doi: 10.1016/S0140-6736(16)32126-2
5	冉志华, 童锦禄. 炎症性肠病诊断与治疗的共识意见(2018年, 北京)克罗恩病部分解读[J]. 中华消化杂志, 2018, 38 (5): 315- 317. doi: 10.3760/cma.j.issn.0254-1432.2018.05.004
6	Torres J , Mehandru S , Colombel JF , et al. Crohn's disease[J]. Lancet, 2017, 389 (10080): 1741- 1755. doi: 10.1016/S0140-6736(16)31711-1
7	Alatab S , Sepanlou SG , Ikuta K , et al. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990—2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet Gastroenterol Hepatol, 2020, 5 (1): 17- 30. doi: 10.1016/S2468-1253(19)30333-4
8	李学锋, 彭霞, 周明欢. 我国炎症性肠病流行病学研究进展[J]. 现代消化及介入诊疗, 2020, 25 (9): 1265- 1267. doi: 10.3969/j.issn.1672-2159.2020.09.032
9	Qiu Y , Ren W , Liu Y , et al. Disease burden of inflammatory bowel disease in China from 1990 to 2017: findings from the Glo-bal Burden of Diseases 2017[J]. E Clin Med, 2020, 27, 100544.
10	中华医学会消化病学分会炎症性肠病学组. 炎症性肠病诊断与治疗的共识意见(2018年·北京)[J]. 中华炎性肠病杂志, 2018, 2 (3): 173- 190. doi: 10.3760/cma.j.issn.2096-367X.2018.03.005
11	Cui G , Yuan A . A systematic review of epidemiology and risk factors associated with Chinese inflammatory bowel disease[J]. Front Med, 2018, 5, 183. doi: 10.3389/fmed.2018.00183
12	Li X , Song P , Li J , et al. The disease burden and clinical characteristics of inflammatory bowel disease in the Chinese population: a systematic review and meta-analysis[J]. Int J Environ Res Public Health, 2017, 14 (3): 238. doi: 10.3390/ijerph14030238
13	Qiao Y , Ran Z . Potential influential factors on incidence and pre-valence of inflammatory bowel disease in mainland China[J]. JGH Open, 2019, 4 (1): 11- 15.
14	Huang K , Tao S , Zhou X , et al. Incidence rates of health outcomes of interest among Chinese children exposed to selected vaccines in Yinzhou Electronic Health Records: a population-based retrospective cohort study[J]. Vaccine, 2020, 38 (18): 3422- 3428. doi: 10.1016/j.vaccine.2020.03.013
15	鄞州区普查中心. 鄞州区人口普查公报数据解读[EB/OL]. (2021-05-19)[2021-11-22]. http://www.nbyz.gov.cn/art/2021/5/19/art_1229108054_59071135.html.
16	林鸿波, 刘翠丽, 沈鹏, 等. 基于鄞州区域医疗数据的利巴韦林临床使用的分析[J]. 中国药物警戒, 2018, 15 (2): 73- 77. doi: 10.3969/j.issn.1672-8629.2018.02.003
17	Yang Y , Zhou X , Gao S , et al. Evaluation of electronic healthcare databases for post-marketing drug safety surveillance and pharmacoepidemiology in China[J]. Drug Saf, 2018, 41 (1): 125- 137. doi: 10.1007/s40264-017-0589-z
18	浙江省人民政府. 浙江省人民政府关于调整宁波市部分行政区划的通知[EB/OL]. (2016-09-30)[2021-11-22]. http://www.zj.gov.cn/art/2016/9/30/art_1229017138_64597.html.
19	Keyashian K , Dehghan M , Sceats L , et al. Comparative incidence of inflammatory bowel disease in different age groups in the United States[J]. Inflamm Bowel Dis, 2019, 25 (12): 1983- 1989. doi: 10.1093/ibd/izz092
20	Jung YS , Han M , Kim WH , et al. Incidence and clinical outcomes of inflammatory bowel disease in South Korea, 2011—2014: a nationwide population-based study[J]. Dig Dis Sci, 2017, 62 (8): 2102- 2112. doi: 10.1007/s10620-017-4640-9
21	Kaplan GG , Windsor JW . The four epidemiological stages in the global evolution of inflammatory bowel disease[J]. Nat Rev Gastroenterol Hepatol, 2021, 18 (1): 56- 66. doi: 10.1038/s41575-020-00360-x
22	Zeng Z , Zhu Z , Yang Y , et al. Incidence and clinical characteristics of inflammatory bowel disease in a developed region of Guangdong Province, China: a prospective population-based study[J]. J Gastroenterol Hepatol, 2013, 28 (7): 1148- 1153. doi: 10.1111/jgh.12164
23	Yang H , Li Y , Wu W , et al. The incidence of inflammatory bowel disease in Northern China: a prospective population-based study[J]. PLoS One, 2014, 9 (7): e101296. doi: 10.1371/journal.pone.0101296
24	Zhao J , Ng SC , Lei Y , et al. First prospective, population-based inflammatory bowel disease incidence study in mainland of China: the emergence of "Western" disease[J]. Inflamm Bowel Dis, 2013, 19 (9): 1839- 1845.
25	Ng SC , Tang W , Ching JY , et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn' s and colitis epidemiology study[J]. Gastroenterology, 2013, 145 (1): 158- 165. doi: 10.1053/j.gastro.2013.04.007
26	缪佳蓉. 云南省炎症性肠病流行病学特征、环境及复发因素的研究[D]. 云南: 昆明医科大学, 2015.
27	Shivashankar R , Tremaine WJ , Harmsen WS , et al. Incidence and prevalence of Crohn's disease and ulcerative colitis in Olms-ted County, Minnesota from 1970 through 2010[J]. Clin Gastroenterol Hepatol, 2017, 15 (6): 857- 863. doi: 10.1016/j.cgh.2016.10.039
28	Kotze PG , Underwood FE , Damião A , et al. Progression of inflammatory bowel diseases throughout Latin America and the Caribbean: a systematic review[J]. Clin Gastroenterol Hepatol, 2020, 18 (2): 304- 312. doi: 10.1016/j.cgh.2019.06.030
29	Burisch J , Munkholm P . The epidemiology of inflammatory bowel disease[J]. Scand J Gastroenterol, 2015, 50 (8): 942- 951. doi: 10.3109/00365521.2015.1014407
30	Mak WY , Zhao M , Ng SC , et al. The epidemiology of inflammatory bowel disease: east meets west[J]. J Gastroenterol Hepatol, 2020, 35 (3): 380- 389. doi: 10.1111/jgh.14872
31	Loftus EV Jr. , Silverstein MD , Sandborn WJ , et al. Ulcerative colitis in Olmsted County, Minnesota, 1940—1993: incidence, prevalence, and survival[J]. Gut, 2000, 46 (3): 336- 343. doi: 10.1136/gut.46.3.336
32	浙江统计数据库. 鄞州区地区生产总值统计[EB/OL]. (2021-02-22)[2021-10-22]. http://data.tjj.zj.gov.cn/page/dataquery.simpleMacro/newQuery/newQuery.jsp?getData=nianduData&ddiUrn=urn:ddi:ZJJCKSTAT:a463a4d9-806b-4fcc-8fc9-b43a8ee4298c:1&dataClassific=yandu&sjztId=urn:ddi:ZJJCKSTAT:8c1a842d-cf0b-40b5-b355-ec4c8d90c506:1&sjztB-gq=N&orgCode=330212&proDemo=zj.
33	浙江统计数据库. 鄞州区人均生产总值统计[EB/OL]. (2021-02-22)[2021-10-22]. http://data.tjj.zj.gov.cn/page/dataquery.simpleMacro/newQuery/newQuery.jsp?getData=nianduData&ddiUrn=urn:ddi:ZJJCKSTAT:a463a4d9-806b-4fcc-8fc9-b43a8ee4298c:1&dataClassific=yandu&sjztId=urn:ddi:ZJJCKSTAT:8c1a842d-cf0b-40b5-b355-ec4c8d90c506:1&sjztB-gq=N&orgCode=330212&proDemo=zj.
34	Chen Y . Perspectives of IBD China: is Crohn's and colitis foundation model a solution to health care issues for the country?[J]. Inflamm Bowel Dis, 2018, 24 (5): 925- 929. doi: 10.1093/ibd/izy056
35	Ng SC , Shi HY , Hamidi N , et al. Worldwide incidence and pre-valence of inflammatory bowel disease in the 21st century: a syste-matic review of population-based studies[J]. Lancet, 2017, 390 (10114): 2769- 2778. doi: 10.1016/S0140-6736(17)32448-0

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Items	UC (n=1 106)	CD (n=70)	IC (n=41)	P value	IBD (n=1 217)
Age onset/years, M(IQR)	50.82(18.77)	44.34(33.41)	46.41(28.10)	< 0.001	50.50(19.94)
Age group onset/years, n(%)				< 0.001
0-19	3(0.27)	7(10.00)	3(7.32)		13(1.07)
20-24	17(1.54)	2(2.86)	2(4.88)		21(1.73)
25-29	46(4.16)	9(12.86)	2(4.88)		57(4.68)
30-34	71(6.42)	7(10.00)	7(17.07)		85(6.98)
35-39	88(7.96)	7(10.00)	2(4.88)		97(9.97)
40-44	129(11.66)	4(5.71)	4(9.76)		137(11.26)
45-49	166(15.01)	6(8.57)	6(14.63)		178(14.63)
50-54	151(13.65)	4(5.71)	2(4.88)		157(12.90)
55-59	125(11.30)	3(4.29)	1(2.44)		129(10.60)
60-64	124(11.21)	8(11.43)	4(9.76)		136(11.18)
65-69	99(8.95)	7(10.00)	1(2.44)		107(8.79)
70-74	53(4.79)	4(5.71)	1(2.44)		58(4.77)
75-79	15(1.36)	2(2.86)	1(2.44)		18(1.48)
80-84	13(1.18)	0(0.00)	3(7.32)		16(1.31)
≥85	6(0.54)	0(0.00)	2(4.88)		8(0.66)
Gender, n(%)				0.132
Male	557(50.36)	42(60.00)	25(60.98)		624(51.27)
Female	549(49.64)	28(40.00)	16(39.02)		593(48.73)
Calendar year onset, n(%)				< 0.001
2011	20(1.81)	1(1.43)	2(4.88)		23(1.89)
2012	6(0.54)	1(1.43)	0(0.00)		7(0.58)
2013	19(1.72)	2(2.86)	0(0.00)		21(1.73)
2014	96(8.68)	1(1.43)	1(2.44)		98(8.05)
2015	144(13.02)	8(11.43)	14(34.15)		166(13.64)
2016	184(16.64)	3(4.29)	11(26.83)		198(16.27)
2017	134(12.12)	10(14.29)	2(4.88)		146(12.00)
2018	176(15.91)	10(14.29)	2(4.88)		188(15.45)
2019	181(16.37)	20(28.57)	3(7.32)		204(16.76)
2020	146(13.20)	14(20.00)	6(14.63)		166(13.64)

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