缺血性结肠炎所致溃疡的危险因素及临床特征分析

Related factors and clinical features of ulcer in patients with ischemic colitis

目的探讨缺血性结肠炎(IC)患者溃疡发生的危险因素及其临床特点。方法选取我院2009年2月至2014年5月收治的60例IC患者作为研究对象,根据是否发生溃疡分为溃疡组(25例)和非溃疡组(35例),对两组患者的临床资料进行比较,采用单因素方差分析及多因素Logistic回归分析分别对缺血性结肠炎患者发生溃疡的临床特征及危险因素进行分析。结果 (1)溃疡组患者平均年龄比非溃疡组明显增加(P<0.05),且出现腹部压痛及长期服用阿司匹林肠溶片的患者人数明显增加,而出现腹泻的人数明显减少,组间比较差异均具有统计学意义(P<0.05);经多因素Logistic回归分析显示,长期服用阿司匹林肠溶片以及出现腹部压痛是IC患者发生溃疡的独立危险因素(P<0.05);(2)溃疡组患者镜下主要表现为肠黏膜溃疡,而非溃疡组患者镜下则主要以肠黏膜充血、水肿、糜烂、瘀斑血泡以及活动性渗血为特点,而CT下溃疡组患者腹部血管病变人数比非溃疡组患者明显增加,差异具有统计学意义(P<0.05)。结论长期服用阿司匹林肠溶片是影响IC患者发生溃疡的独立危险因素;腹部动脉病变会显著增加溃疡发生的风险,而IC患者临床症见腹部压痛则可能提示伴有溃疡形成。

Objective To study the risk factors and clinical characteristics of ulcer in patients with ischemic colitis. Methods Sixty patients with ischemic colitis treated in our hospital from February 2009 to May 2014 were selected as research objects, which were divided into ulcer group（25 cases） and non-ulcer group（35 cases） according to whether with ulcer. The clinical data of two groups were compared. The risk factors and clinical features of ischemic colitis patients with ulcer were analyzed by univariate analysis and multivariate logistic regression analysis. Results（1） The average age of patients in ulcer group was significantly higher than that of patients in non-ulcer group（P〈0.05）. The number of patients with abdominal tenderness and long-term use of aspirin enteric-coated metformin hydrochloride in ulcer group was significantly increased, and the number of patients with diarrhea was significantly reduced（P〈0.05）. Multivariate logistic regression analysis showed that long-term treatment of aspirin enteric-coated metformin hydrochloride and abdominal tenderness were the independent risk factors for the development of ulcers in patients with ischemic colitis（P〈0.05）.（2） The patients of ulcer group showed intestinal mucosa ulcer under microscope, while the patients of non-ulcer group showed characteristics of intestinal mucosal hyperemia, edema, erosion, ecchymosis and bleeding blister, and active bleeding. The number of patients with abdominal vascular lesions showed under the CT were significantly increased in the ulcer group than the non-ulcer group（P〈0.05）. Conclusion Long-term aspirin treatment is an independent risk factor for ulcers in patients with ischemic colitis. Abdominal artery lesions can significantly increase the risk of ulcer, and abdominal tenderness may indicate ulceration in patients with ischemic colitis.