糖皮质激素治疗儿童中重度溃疡性结肠炎的疗效影响因素分析

Analysis of the factors influencing the efficacy of glucocorticoids in the treatment of moderate to severe pediatric ulcerative colitis

目的探讨糖皮质激素(简称激素)治疗儿童中重度溃疡性结肠炎(UC)疗效的影响因素。方法采用回顾性病例对照研究方法,分析2016年1月至2021年12月在首都医科大学附属北京儿童医院诊治的38例应用激素治疗的中重度UC患儿的临床资料。根据对激素治疗的反应分为激素难治组和激素有效组,采用Kaplan-Meier方法计算累积复发率,单因素分析两组的临床资料差异,应用Logistic回归分析激素难治的危险因素。结果共纳入38例中重度UC患儿,男22例,女16例;发病年龄10.7(8.5,12.7)岁,病程4.3(1.1,13.6)个月。38例UC患儿应用激素治疗后3个月、6个月、1年、2年的累积复发率分别为26.3%、52.6%、63.7%和69.5%。激素有效组17例(44.7%),激素难治组21例(55.3%),其中激素依赖16例(42.1%)、激素抵抗5例(13.2%)。激素难治组患儿基线、激素治疗第3天和第5天儿童溃疡性结肠炎活动指数(PUCAI)评分[65.0(50.0,70.0)分比50.0(37.5,60.0)分,25.0(10.0,37.5)分比10.0(10.0,20.0)分,25.0(10.0,37.5)分比10.0(5.0,12.5)分]、早期复发率(85.7%比35.3%)均高于激素有效组,复发时间[4.0(2.0,5.0)个月比19.0(7.5,46.5)个月]短于激素有效组,基线白蛋白水平[(33.3±5.5)g/L比(37.6±5.9)g/L]低于激素有效组,差异均具有统计学意义(均P<0.05)。多因素Logistic回归分析显示基线PUCAI评分是激素难治的独立危险因素(OR=1.070,95%CI:1.011~1.132,P=0.020)。结论中重度UC患儿激素依赖率和激素抵抗率较高,激素难治患儿疾病复发时间更早、早期复发率更高、基线白蛋白水平更低。基线PUCAI评分较高的中重度UC患儿更易发生激素依赖和激素抵抗。

Objective To explore the influencing factors of efficacy of glucocorticoids in the treatment of moderate to severe ulcerative colitis(UC)in children.Methods A retrospective case-control study was conducted.The clinical data of 38 children with moderate to severe UC treated with glucocorticoids in Beijing Children's Hospital of Capital Medical University from January 2016 to December 2021 were analyzed.According to the response to glucocorticoids therapy,the patients were divided into steroid-intractable group and steroid-effective group.Kaplan-Meier method was used to calculate the cumulative recurrence rate.Univariate analysis was performed to analyze the differences of clinical data between the two groups,and Logistic regression was used to analyze the risk factors of steroid-intractable UC in children.Results A total of 38 children with moderate to severe UC were enrolled,including 22 males and 16 females.The median onset age was 10.7(8.5,12.7)years old,and the median disease duration was 4.3(1.1,13.6)months.The cumulative recurrence rates of 38 UC patients at 3 months,6 months,1 year and 2 years after glucocorticoids treatment were 26.3%,52.6%,63.7%and 69.5%,respectively.There were 17 patients(44.7%)in steroid-effective group.There were 21 patients(55.3%)in steroid-intractable group,including 16(42.1%)of steroid dependence and 5(13.2%)of steroid resistance.In the steroid-intractable group,the PUCAI scores at baseline,on the 3rd day and 5th day of glucocorticoids treatment[65.0(50.0,70.0)points vs.50.0(37.5,60.0)points,25.0(10.0,37.5)points vs.10.0(10.0,20.0)points,25.0(10.0,37.5)points vs.10.0(5.0,12.5)points]and early recurrence rate(85.7%vs.35.3%)were higher than those in steroid-effective group,the recurrence time[4.0(2.0,5.0)months vs.19.0(7.5,46.5)months]was shorter than that in steroid-effective group,albumin level at baseline[(33.3±5.5)g/L vs.(37.6±5.9)g/L]was lower than that in steroid-effective group,and the differences were statistically significant(all P<0.05).Multivariate Logistic regression analysis showed that the PUCAI score at baseline was an independent risk factor for steroid-intractable UC(OR=1.070,95%CI:1.011-1.132,P=0.020).Conclusions The rates of steroid dependence and the steroid resistance are high in moderate to severe UC children.Children in the steroid-intractable group have an earlier recurrence time,a higher rate of early recurrence,and a lower albumin level at baseline.The steroid dependence and resistance are more likely to occur in children with moderate to severe UC when PUCAI score at baseline is high.