难治性远端溃疡性结肠炎的临床表现和治疗

Refractory distal ulcerative colitis:Clinical manifestations and treatment

目的:分析难治性远端溃疡性结肠炎的可能的发病原因及治疗方案.方法:收集我院2005-01/2011-12溃疡性结肠炎中145例DUC患者资料进行回顾性分析.根据对传统治疗的反应,分为有效组和难治组.比较两组患者的临床和实验室检查结果,分析难治DUC可能的原因及进一步治疗方案.结果:145例远端溃疡性结肠炎患者,其中117例符合条件纳入组,117例中有26例[22.2%(26/117)]患者难治.与有效组相比,难治组患者腹痛腹胀明显[42.3%(11/26)vs22.0%(20/91),P=0.038]、白细胞数明显增高[30.8%(8/26)vs12.1%(11/91),P=0.035],而血便、腹泻、肠外表现、C反应蛋白及血沉两组之间无明显差异(P>0.05).117例入组患者内镜下表现为直肠炎43例其中10例难治,直乙状结肠炎74例中16例难治,病变部位差异无统计学意义(P>0.05).26例难治患者仅1例行外科手术治疗,其余的通过激素静脉治疗、加用5-ASA新型剂型、适当的泻药等获得缓解.结论:远端溃疡性结肠炎患者腹泻和血便是临床最常见症状,难治组白细胞数较有效组明显增高,其有望成为评估DUC治疗转归的指标之一.难治性DUC患者可通过强化治疗、加用5-ASA的新型剂型、适当的泻药、手术等方法获得缓解.

To investigate the clinical features and treatment of distal ulcerative colitis （DUC） and to analyze probable reasons and optimal therapeutic regimens for refractory DUC. METHODS： Clinical data for 145 DUC patients who were treated at the Affiliated Yijishan Hospital of Wannan Medical College from January 2005 to December 2011 were retrospectively analyzed. Based on the response to traditional treatments, the patients were divided into either an effective group or a refractory group. The two groups were compared in clinical and laboratory examination results to analyze probable reasons and optimal therapeutic regimens for refractory DUC.RESULTS： Of 145 DUC patients, 117 were eli- gible for evaluation, and 26 of 117 patients were confirmed to have refractory DUC. The percentages of patients with abdominal distention and abdominal pain or elevated white blood cellcount differed significantly between the refractory group and effective group （42.3% vs 22.0%, P= 0.038; 30.8% vs 12.1%, P = 0.035）, while no significant differences were found in bloody stools, diarrhea, extraintestinal manifestations, C-reactive protein, blood sedimentation between the two groups （all P 〉 0.05）. Of all 117 cases, 43 were found to have rectitis （including 10 refrac- tory cases）, and 74 were found to have sigmoidiris （including 16 refractory cases）. No significant difference was found between the two groups in the location of the lesions （P 〉 0.05）. Of 26 refrac- tory cases, only 1 was treated by surgery, and the others were treated by intravenous hormone therapy, addition of new dosage form of 5-ASA, or proper laxatives to gain relief.CONCLUSION： Diarrhea and bloody stools are the most common clinical symptoms of DUC. Significantly elevated leukocyte count can be expected to be an important factor for evaluating treatment outcome of DUC. Refractory DUC can be treated by intensification therapy, addition of new dosage form of 5-ASA, proper laxatives, or surgery to gain relief.