234例难治性溃疡性结肠炎患者临床特征及治疗分析

The analysis of clinical characteristics and treatment of 234 patients with intractable ulcerative colitis

目的凋查难治性溃疡性结肠炎（IUC）患者临床特征及治疗现状。方法利用炎症性肠病数据库，对1999年1月至2009年12月浙江大学医学院附属邵逸夫医院住院的溃疡性结肠炎（UC）患者资料进行回顾性分析。根据对糖皮质激素（GCS）治疗的反应，分为有效组和难治组，比较两组患者一般资料、病变部位、临床表现及实验室检查结果，分析难治组进一步的治疗方案及效果。结果共收集234例UC患者，其中37．6％（88／234）的患者使用过GCS，难治组和有效组各占23．9％（21／88）和76．1％（67／88）。难治组和有效组患者病变部位差异无统计学意义（P〉0．05）。与有效组比较，难治组患者中中重度腹痛[38．1％（8／21）比13．4％（9／67）]、贫血E61．9％（13／21）比32．8％（22／67）]、血小板增多E57．1％（12／21）比29．9％（20／67）]、低白蛋白血症E38．1％（8／21）比11．9％（8／67）]者的比例较高（P值分别=0．012、0．018、0．023、0．007，OR分别=3．97、3．32、3．13、4．54，95%CI分别为1．29～12．23、1．20～9．20、1．14～8．61、1．44～14．32）。一部分难治组患者可通过延长GCS使用时间、加用免疫调节剂、生物制剂、切除肠段等方法而获缓解。结论UC患者起病时若存在中重度腹痛、贫血、血小板增多和（或）低白蛋白血症，则可能预示GCS治疗的反应相对较差。IUC患者可通过免疫调节剂、生物制剂、手术等方法进行进一步治疗。

Objective To investigate the clinical characteristics and currently treatment status of intractable ulcerative colitis （IUC）. Methods A retrospective analysis was conducted on the data of inflammatory bowel disease patients, who were hospitalized in Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, from January 1999 to December 2009. According to the reaction to glueosteroids （GCS） treatment, they were divided into GCS effective group and intractable group. The general data, lesion, clinical symptoms and laboratory findings of these two groups were compared. Further treatments and the results of intractable group were analyzed. Results Totally 234 UC patients were enrolled, of which 37.60/oo （88/234） patients received GCS treatment, intractable group and effective group took up 23.9% （21/88） and 76.1% （67/88） respectively. There was no significant difference of lesion between two groups （P〉0.05）. Compared with effective group, the proportion of intractable group was higher in moderately severe bellyache [38. 1%（8/21） vs 13. 4%（9/67）, P=0.012, OR=3.97, 95%CI：1.29-12.23]. anemia [61.9%（13/21） vs 32.8%（22/67）, P=0.018, OR 3.32, 95%CI：1.20-9.20], tbrombocytosis [37. 1%（12/21） vs 29. 9% （20/67）, P=0. 023, OR=3. 13, 95%CI：1. 11-8. 61] and hypoalbuminemia [38. 1%（8/21） vs 11. 9%（8/67）, P=0. 007, OR=4. 54, 95%CI： 1. 44 - 14. 32]. Some patients of intractable group could be remission through extending period of GCS treatment, adding lhe immunomodulators or biological agents and intestinal segment excision. Conlusion UC patients with moderately severe bellyache, anemia, tbrombocytosis, bypoalburnlnemia at the onset of disease, which may indicate relatively poor response to GCS treatment. Immunomodulators, biological agents and surgery are the further treatment for IUC patients.