3100例溃疡性结肠炎住院病例回顾分析

A retrospective study of 3100 inpatients with ulcerative colitis in China

目的回顾性调查住院溃疡性结肠炎(UC)患者,探讨近年住院病例UC的特点。方法全国选取11个地区23家医院,调查1990-2003年期间住院符合UC诊断的3100例患者的诊断、治疗、逐年住院情况和同期内镜检出率,并粗略估计患病率。结果近14年UC住院例数和内镜检出例数均有逐年增加的趋势。UC粗略患病率为11．62／105。住院UC患者以轻度(35．4％)和中度(42．9％)为主。临床类型以慢性复发型(46％)和初发型(34．6％)为主,暴发型仅占2．4％。主要症状有腹泻 (75．8％)、腹痛(67．3％)、血便(63．3％)等。肠外表现(14．0％)和并发症(9．6％)少见。辅助确诊手段主要为结肠镜(95．0％)及病理(62．3％)。UC治疗上以氨基水杨酸类(66．8％)和类固醇激素(42．8％) 为主。仅2．1％患者应用免疫抑制剂。单纯内科治疗总有效率达93．6％,手术率3％,死亡19例 (0．6％)。结论 UC近年有逐渐增加的趋势,以轻中度为主,疾病类型以慢性复发型和初发型为主,暴发型少见。肠外表现及并发症较少。国内轻中度患者治疗以柳氮磺胺吡啶及类固醇激素为主,手术率、死亡率及癌变率均较国外低。

Objective To analyze the characteristics of hospitalized patients with ulcerative colitis （UC） in China. Methods The data of 3100 cases of UC were obtained from 23 hospitals in 11 regions of China from 1990 to 2003. The diagnosis, treatment, hospitalization, corresponding endoscopy detection rate as well as morbidity were reviewed. Results The hospitalized patients with UC and endoscopic di- agnosed UC increased yearly in the recent 14 years. The extrapolated prevalence of UC in China was 11.62/10^5. Most of the hospitalized UC patients revealed mild （35.4%） or moderate severity （42.9%）. In all cases, 34. 6% were first onset, 46% were chronic relapsing, 17% were chronic persistent, and only 2.4% were acute fulminant type. The major symptoms were diarrhea （75.8%）, abdominal pain （67.3%）, bloody stool （63.3%）, and mucus stool （58.4%）. About 14.8% of UC patients had extraintestinal manifestations, and 9.6 % had complications. Main diagnosis methods were endoscopy, followed by histology and radiology. The correct diagnostic rates of them were 67.8%, 49.0% and 47.1% respectively. Colonoscopy combined with biopsy was the commonest diagnosis method. The mainstay for UC treatment in China was still 5-aminosalicylate （5-ASA） agents （66. 8%） and glucocorticoids （42.8%）. Only 2.1% of the patients received immunosuppressive agents. The remission rate by medicine reached 92.5%. Only 3.0% underwent surgical intervention. The mortality was 0.6% （19 cases）. Conclusions There has been an increasing number of hospitalized UC in recent years, mostly with mild to moderate severity. The major types of UC are chronic relapsing and first onset with rare extraintestinal manifestations and complications. Sulphasalazine （SASP）/5-ASA and steroids are stills the mainstay agents used for the treatment of UC.