重度溃疡性结肠炎糖皮质激素治疗反应及其影响因素分析

Analysis of therapeutic effect and the correlative influencing factors of glucocorticoids treatment in patients with severe ulcerative colitis

目的分析重度溃疡性结肠炎（ SUC）糖皮质激素治疗反应及其可能的影响因素。方法收集113例SUC患者的病例资料,根据SUC患者对糖皮质激素治疗的反应,将患者分为完全缓解组、部分缓解组和无效组。比较3组患者一般资料、病变部位、临床表现、实验室检查结果、内镜形态学特征及治疗转归,分析SUC糖皮质激素治疗反应及其可能的影响因素。结果在113例SUC患者中,85%（96/113）的患者使用静脉糖皮质激素治疗,治疗第5-7天进行评估,完全缓解组、部分缓解组及无效组各占32.3%、26.0%、41.7%。部分缓解组和无效组患者一部分可通过延长糖皮质激素治疗的时间获得缓解,但转换治疗和手术风险增加。与完全缓解组比较,部分缓解组入院时腹泻次数≥10次/d、既往有重症发作、激素治疗第3天仍有明显血便所占比例较高,差异有统计学意义（ P〈0.05）。无效组入院时腹泻次数≥10次/d、既往有重症发作、治疗第3天大便次数〉6次、激素治疗第3天仍有明显血便、严重低白蛋白血症（〈25 g/L）＆amp;nbsp；所占比例及激素治疗前3d大便次数明显高于完全缓解组,差异有统计学意义（ P〈0.05）。与完全缓解组比较,部分缓解组及无效组内镜下严重病变发生率高,其中深凿样溃疡所占比例差异有统计学意义（ P〈0.05）。结论部分缓解组和无效组患者部分可通过延长糖皮质激素治疗时间获得缓解,但将增加转换治疗和手术风险；结合临床、实验室、内镜形态学指标,可早期预测静脉糖皮质激素治疗反应。

Objective To analyze therapeutic effect and the possible influencing factors of glucocorticoids treatment in patients with severe ulcerative colitis （ SUC） . Methods Medical records of 113 SUC in-patients from January 2001 to February 2013 in The First Affiliated Hospital of Anhui Medical University were collected. According to the reaction to glucocorticoids treatment, SUC patients were divided into complete remission group, partial remission group and non-response group. The general data, lesion, clinical symptoms, laboratory findings, endoscopic mor-phological features and treatment outcome of these three groups were compared. The possible influencing factors of glucocorticoids treatment in patients with SUC were analyzed. Results Totally 113 SUC patients were enrolled, of which 85%（ 96/113 ） patients received glucocorticoids treatment. Assess the therapeutic effect of glucocorticoids treatment at day 5-7, complete remission group, partial remission group and non-response group took up 32.3%, 26.0%, 41.7% respectively. Part of partial remission group patients and non-response group patients could have remission through extending the period of glucocorticoids treatment, but with an increased risk of rescue therapies and surgical treatment. Compared with complete remission group, the proportion of partial remission group was higher in stool frequency ≥10/day on admission, previous severe attack, blood in stools at day 3, with statistical significant difference（P〈0.05）. The proportion of non-response group was higher in stool frequency≥10/day on admission, previous severe attack, stool frequency 〉6 /day at day 3, blood in stools at day 3,severe hypoalbumin-emia（ 〈25 g/L）and the number of stool frequency at day 1-3, with statistical significant difference（P〈0.05）. In addition, compared with complete remission group, severe lesions were found with high frequency in the partial remission group and non-response group, especially punched out ulcer, with statistical significant difference be-tween the two groups（P=0. 044）. Conclusion Part of partial remission group and non-response group patients could have remission phrough extending the period of glucocorticoids treatment, but with an increased risk of rescue therapies and surgical treatment;rapid response to glucocorticoids treatment can be predicted by combing clinical symptoms, laboratory findings, and endoscopic morphological parameters.