氨基水杨酸联合泼尼松治疗重度溃疡性结肠炎无效的影响因素分析

Analysis of Influencing Factors for the Ineffectiveness of Aminosalicylic Acid Combined with Prednisone in the Treatment of Severe Ulcerative Colitis

目的分析探讨氨基水杨酸联合泼尼松治疗重度溃疡性结肠炎(UC)无效的影响因素。方法选取2019年7月至2022年7月河南大学第一附属医院收治的288例重度UC患者作为研究对象,所有患者均行氨基水杨酸联合泼尼松治疗,收集患者性别、年龄、病程、体重指数、病变部位、是否补充维生素D、临床疗效以及白蛋白、C反应蛋白水平等资料,并根据治疗是否有效(含完全缓解、显效、有效)将其分为有效组与无效组,多因素Logistic回归分析氨基水杨酸联合泼尼松治疗重度UC无效的影响因素。结果氨基水杨酸联合泼尼松治疗5 d后,288例重度UC患者完全缓解58例、显效95例、有效43例、无效92例,根据治疗是否有效将其分为有效组196例(68.06%)与无效组92例(31.94%)。单因素分析结果显示,无效组病变部位为右半结肠、未补充维生素D的患者比例均明显高于有效组(χ^(2)=10.191、13.034,P=0.006、P<0.001),白蛋白水平明显低于有效组(t=30.264,P<0.001);多因素Logistic回归分析结果显示,病变部位为右半结肠、未补充维生素D及白蛋白水平低是氨基水杨酸联合泼尼松治疗重度UC无效的独立危险因素(95%CI为1.367~3.798、1.521~4.236、0.674~0.824,P=0.002、P<0.001、P<0.001)。结论氨基水杨酸联合泼尼松治疗重度UC无效与病变部位为右半结肠、未补充维生素D及白蛋白水平低密切相关,临床应根据患者具体情况及时进行针对性干预,以提高其治疗效果。

Objective To analyze the influencing factors for the ineffectiveness of aminosalicylic acid combined with prednisone in the treatment of severe ulcerative colitis(UC).Methods 288 patients with severe UC,admitted to The First Affiliated Hospital of Henan University from July 2019 to July 2022,were selected as research subjects.All patients received aminosalicylic acid combined with prednisone treatment.Patients’data,including sex,age,disease-duration,body mass index,lesion location,with vitamin D supplementation or not,clinical efficacy and the levels of albumin and C-reactive protein were collected.The patients were divided into the effective group and the ineffective group according to whether the treatment was effective(including complete relief,markedly effective,and effective)or not.Multivariate Logistic regression analysis was conducted to analyze the influencing factors for the ineffectiveness of aminosalicylic acid combined with prednisone in the treatment of severe UC.Results After 5 days of treatment with aminosalicylic acid combined with prednisone,of the 288 patients with severe UC,58 cases showed their symptoms completely relieved,95 cases showed markedly effectiveness,43 cases showed treatment effectiveness,and 92 cases showed treatment ineffective-ness.The patients were divided into the effective group 196 cases(68.06%)and the ineffective group 92 cases(31.94%)according to whether the treatment was effective or not.The results of the univariate analysis showed that the proportions of patients with lesions in the right colon and without vitamin D supplementation were significantly higher in the ineffective group compared with the effective group(χ^(2)=10.191 and 13.034,P=0.006,P<0.001),and the albumin level was significantly lower in the ineffective group(t=30.264,P<0.001).Multivariate Logistic regression analysis showed that lesions in the right colon,without vitamin D supplementation and low albumin level were independent risk factors for the ineffectiveness of aminosalicylic acid combined with prednisone in the treatment of severe UC(95%CI:1.367-3.798,1.521-4.236,0.674-0.824,P=0.002,P<0.001,P<0.001).Conclusion The ineffectiveness of aminosalicylic acid combined with prednisone in the treatment of severe UC is closely related to such factors as lesions in the right colon,without vitamin D supplementation and low albumin level of patients.Targeted interventions should be taken in clinical practice based on patients’condition in a timely fashion to improve the therapeutic effect.