235例炎症性肠病患者首次接受糖皮质激素治疗的临床疗效分析

The natural history of first course of corticosteroid therapy for 235 patients with inflammatory bowel disease

目的探讨炎症性肠病(IBD)患者首次接受糖皮质激素(激素)治疗的疗效及疾病转归。方法收集2002年1月-2010年12月我院收治的首次使用激素治疗的IBD患者890例,对激素治疗30 d及随访1年的临床疗效进行回顾性分析。结果 890例IBD患者中,溃疡性结肠炎(UC)患者401例,克罗恩病(CD)患者489例,其中共有81例(81/401,20.2%)UC及154例(154/489,31.5%)CD患者使用口服或静脉滴注激素,激素治疗30 d时,UC患者完全缓解57例(57/81,70.4%),部分缓解22例(22/81,27.2%),无效2例(2/81,2.5%);CD患者完全缓解94例(94/154,61.0%),部分缓解45例(45/154,29.2%),无效15例(15/154,9.7%)。随访1年末,UC患者持续应答53例(53/79,67.1%),激素依赖26例(26/79,32.9%);CD患者持续应答102例(102/151,67.5%),激素依赖26例(26/15,17.2%),手术23例(23/15,15.2%)。激素短期及远期疗效的风险因素回归分析显示合用硫唑嘌呤/6-巯基嘌呤(AZA/6-MP)与CD患者激素治疗的远期疗效相关(P=0.03)。结论大部分IBD患者对激素治疗有效,UC患者激素治疗总有效率优于CD,随访1年32.9%UC及17.2%CD患者呈激素依赖,15.2%CD患者需手术切除病变肠段。

Objective To assess the response to the first course of corticosteroids in inflammatory bowel disease patients and their outcomes. Methods 890 patients in our hospital, diagnosed with inflammatory bowel disease from Jan.2002 to Dec. 2010 who were treated with the first course of corticosteroids were identified. Immediate outcome （30 days） and 1-year outcome after the first course of corticosteroids were determined retrospectively. Results A total of 890 IBD patients （401 UC, 489 CD） were observed retrospectively. 81 （81/401, 20.2% ） cases in UC group and 154 （154/489, 31.5% ） cases in CD group were treated with oral or intravenous cortieosteroids. Immediate outcomes （30 days） for ulcerative colitis were complete remission in 57 （57/81, 70. 4% ）, partial remission in 22 （22/81, 27.2% ） , and no response in 2 （2/81, 2.5% ）. Immediate outcomes for Crohn＇ s disease were complete remission in 94 （94/154, 61.0%）, partial remission in 45 （45/154, 29.2%）, and no response in 15 （15/154, 9.7%）. 1-year outcomes for ulcerative colitis were prolonged response in 53 （53/79, 67.1% ） , cortieosteroid dependence in 26 （26/79, 32.9% ）. 1-year outcomes for Crohn＇ s disease were prolonged response in 102 （ 102/151, 67.5% ） , corticosteroid dependence in 26 （26/151,17.2% ） and operation in 23 （23/151,15.2% ）. Logistic regression analysis of each potential risk factor for immediate and 1-year outcomes showed 1-year outcomes associated with the combination of azathioprine and 6-mercaptopurine in Crohn＇ s disease （P = 0. 03）. Conclusion Most patients with inflammatory bowel disease initially respond to eorticosteroids. Ulcerative colitis patients responded better than Crohn＇ s disease cases. At 1- year, 32. 9% of patients with ulcerative colitis and 17. 2% Crohn＇ s disease were corticosteroid dependence, and 15.2% Crohn＇ s disease required surgical resection.