重型溃疡性结肠炎临床分析及激素治疗的疗效预测因素研究

Clinical features of severe ulcerative colitis and predictive factors of its glucocorticoids treatment

目的探讨重症溃疡性结肠炎的临床特点,评价疗效及转归,分析影响激素治疗反应的可能因素。方法回顾性分析112例重症溃疡性结肠炎患者的临床资料,记录其临床表现、治疗方法及预后。根据对糖皮质激素治疗反应将患者分为有效组和难治组,分析可能影响糖皮质激素疗效的因素。结果该组病例以全结肠病变为主(79.5%),其中初发年龄大于40岁的患者占51.8%。112例患者均使用过糖皮质激素治疗,糖皮质激素控制溃疡性结肠炎急性发作有效率为58.0%,而免疫抑制剂及生物制剂可以作为拯救治疗的药物。难治组患者既往有重症发作、糖皮质激素治疗第3日便次>6次及治疗第3日仍有明显血便所占比例高于有效组(均P<0.05)。结论重症溃疡性结肠炎是一种危及生命的疾病,发病年龄较大和全结肠病变可能提示与疾病严重度有关。重症溃疡性结肠炎患者若有既往有重症发作、治疗第3日便次>6次及治疗第3日仍有明显血便,可能预示糖皮质激素治疗反应较差。

Objective To explore the clinical manifestation of severe ulcerative colitis （SUC）, evaluate the clinical outcome and find the factors influencing the reaction of glueosteroids （GCS） treatment. Methods Clinical data of 112 patients with SUC were retrospectively reviewed. Data included the clinical manifestation and processes of clinical treatment and outcome. According to the reac- tion to GCS treatment, the patients were divided into GCS effective group and intractable group for analysis of possible factors influen- cing the reaction of the hormone treatment. Results Among the all patients,79. 5% had paneolitis in which the first onset of the dis- ease mostly occurred in age older than 40 years （51.8%）. The all patients underwent GCS treatment. The effective rate of controlling a- cute ulcerative colitis was 58.0%. Immunomodulators and biological agents also were effective rescue therapy. The proportion of the in- tractable group was higher in severe attacks in past. Symptoms such as stool frequency 〉 6 and obvious rectal bleeding on third day after treatment in the intractable group were significantly higher than those in the effective group （ all P 〈 0. 05 ）. Conclusion SUC is a life- threatening disease. Older age and extensive colonic lesions at onset may be associated with severe UC. UC patients with severe attack in past, a stool frequency 〉6 and obvious rectal bleeding on the third day after treatment have relatively poor response to the GCS treat-