缺血性结肠炎溃疡形成的危险因素及临床特点分析

An analysis of clinical characteristics and risk factors for ulceration in ischemic colitis

目的 探讨缺血性结肠炎（IC）溃疡形成的危险因素及临床特点.方法 对解放军总医院2002年6月至2012年6月确诊为IC且资料详实的63例患者进行回顾性分析.根据结肠镜检查病变部位有无溃疡,分为溃疡组（23例）和非溃疡组（40例）.分析两组患者的临床特点的差异,并以logistic回归分析IC患者发生溃疡性病变的危险因素.结果 男50例,女13例,平均年龄70岁.临床表现为腹痛54例（85.7％）,腹泻34例（54.0％）,血便26例（41.3％）.溃疡组慢性便秘发生率[34.8％ （8/23）]明显高于非溃疡组[12.5％ （5/40）]（P=0.03）,阿司匹林肠溶片应用比例[52.2％（12/23）]明显高于非溃疡组[25.0％（10/40）]（P=0.03）,腹部压痛发生率[82.6％ （19/23）]明显高于非溃疡组[52.5％ （21/40）] （P =0.02）.Logistic回归分析显示慢性便秘、服用阿司匹林肠溶片是IC患者溃疡形成的独立危险因素（OR =3.38,P=0.04;OR =5.91,P=0.03）;存在腹部压痛的IC患者合并溃疡性病变的可能性更大（OR=3.12,P=0.04）.IC多发生于左半结肠[69.8％（44/63）],且溃疡组和非溃疡组的病变分布范围的差异无统计学意义（P =0.066）.增强CT显示溃疡组伴腹部动脉粥样硬化的比例[88.2％ （15/17）]明显高于非溃疡组[58.3％ （14/24）] （P =0.038）.溃疡组住院时间[（14.3±7.1）d]明显长于非溃疡组[（6.2±4.1）d]（P＜0.01）.溃疡组入院时血WBC显著高于非溃疡组[（10.17±3.32）×109/L比（7.25±3.15）×109/L,P=0.018],Hb显著低于非溃疡组[（98±27）g/L比（126±35） g/L,P=0.041].结论 慢性便秘、服用阿司匹林肠溶片及腹部动脉粥样硬化是IC患者溃疡形成的危险因素;出现腹部压痛、血WBC升高、Hb降低则提示IC患者肠道溃疡形成.

Objective To investigate the clinical manifestations and risk factors related to ulcer in patients with ischemic colitis（IC）.Methods Clinical data of sixty-three IC patients with definite diagnosis from June 2002 to June 2012 in the PLA General Hospital were retrospectively analyzed.All patients were classified into ulcer group （23 cases） and non-ulcer group （40 cases） according to the presence of ulcer or not.Clinical manifestations and risk factors related to ulcer lesions were compared in the two groups.Logistic regression model was used for statistical analysis.Results There were 50 men and 13 women enrolled,with an average age of 70 years old.The main clinical manifestations included abdominal pain [85.7％ （54/63）],diarrhea [54.0％ （34/63）],hematochezia [41.3％ （26/63）].In comparison with non-ulcer group,the ulcer group showed higher incidences of chronic constipation[34.8％ （8/23）vs 12.5％ （5/40）,P =0.03],enteric-coated aspirin intake [52.2％ （12/23） vs 25.0％ （10/40）,P =0.03] and abdomen tenderness[82.6％ （19/23） vs 52.5％ （21/40）,P =0.02].Chronic constipation and entericcoated aspirin intake were independent risk factors related to ulcer lesions （OR =3.38,P =0.04 ; OR =5.91,P =0.03）.Patients with abdomen tenderness had higher incidence of ulcer lesion（OR =3.12,P =0.04）.The most common location of IC was left colon[69.8％ （44/63）].No difference of site distribution was found in ulcer and non-ulcer group（P =0.066）.Splanchnic atherosclerosis in the ulcer group was more common than in non-ulcer group [88.2％ （15/17） vs 58.3％ （14/24）,P =0.038].The duration of hospitalization was significantly longer in ulcer group [（14.3 ± 7.1） d vs （6.2 ± 4.1） d,P ＜ 0.01].Higher white blood cell （WBC） count and lower hemoglobin （Hb） were seen in ulcer group than those in non-ulcer group [（10.17 ±3.32） × 109/L vs （7.25 ±3.15） × 109/L,P =0.018; （98 ±27）g/L vs （126 ±35）g/L,P=0.041].Conclusions Chronic constipation,enteric-coated aspirin intake and splanchnic atherosclerosis are risk factors related to ulcer in IC patients.Abdomen tenderness,high WBC and low Hb strongly indicate possible IC with ulcer.