溃疡性结肠炎患者类固醇激素治疗成功的影响因素分析

Analysis of influencing factors of effective steroid therapy in patients with ulcerative colitis

[目的]探讨类固醇激素治疗溃疡性结肠炎(UC)患者成功的因素,以期为临床提供诊疗依据。[方法]选取80例UC患者作为研究对象,其中40例采用口服激素法治疗(口服组),40例采用静脉注射激素治疗(静脉组),根据治疗结果将80例患者中治疗完全有效、部分有效的50例列为成功组,治疗无效的30例列为失败组,比较2组患者的临床资料,采用多因素Logistic回归法分析影响UC患者疗效的因素,并构建风险评分模型,采用X-tile软件获得评分的截断值,受试工作者特征(ROC)曲线和校准曲线评价模型的区分度和准确度。[结果]口服组和静脉组患者一般资料比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,病变范围小、治疗第3天无血便、治疗第3天排便次数少、C反应蛋白含量降低、血清白蛋白含量升高是UC患者类固醇激素治疗成功的影响因素(P<0.05)。ROC曲线显示风险评分模型的AUC为0.925(95%CI:0.851~0.978,P<0.001),校准曲线一致性指数为0.925,显示模型准确度较高。[结论]临床可以通过观察UC患者的病变范围、治疗第3天的排便次数、血便等来预测类固醇激素的治疗效果。

[Objective]To investigate the influence factors on the effective steroid therapy in patients with ulcerative colitis(UC),so as to provide evidence for clinical diagnosis and treatment.[Methods]A total of 80 UC patients were enrolled in the study.40 patients with UC were treated with oral corticosteroid therapy,and the other 40 patients were treated with intravenous corticosteroid therapy.According to the treatment results,they were divided into effective group(n=50)and failed group(n=30).The clinical data of the two groups were compared.Multivariate Logistic regression was used to analyze the factors affecting the treatment efficacy of UC patients,and a risk score model was constructed,aX-tile software was used to obtain the cut-off value of the score,and the Receiver Operating Characteristics(ROC)curve and calibration curve were used to evaluate the discrimination and accuracy of the model.[Results]There was no significant difference in general data between oral corticosteroid group and intravenous corticosteroid group(P>0.05),The results of multivariate logistic regression analysis showed that small lesion scope,no bloody stool on the third day of treatment,fewer times of defecation on the third day of treatment,decreased C-reactive protein content and increased serum albumin content were the influencing factors for the success of steroid therapy in UC patients(P<0.05).ROC curve showed that the AUC of the risk score model was 0.925(95%CI:0.851-0.978,P<0.001),and the consistency index of the calibration curve was 0.925,indicating that the accuracy of the model was high.[Conclusion]Clinical observation of the extent of UC patients,the number of defecation on the third day of treatment,blood stool can be used to predict the treatment effect of corticosteroid and take corresponding prevention and treatment measures to improve the prognosis of UC patients.