急性重度溃疡性结肠炎近期和远期结局分析  

Analysis on short-and long-term outcomes of acute severe ulcerative colitis

作　　者：王伟[1] 曹倩[2] 王玉芳[3] 林朗 王梦雨 温忠慧[3] 胡品津[1] 高翔[1] Wang Wei;Cao Qian;Wang Yufang;Lin Lang;Wang Mengyu;Wen Zhonghui;Hu Pinjin;Gao Xiang(Department of Gastroenterology,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,china;Department of Gastroenterology,run run shaw Hospital,Zhejiang University,Hangzhou 310016,china;Department of Gastroenterology,West China Hospital,Sichuan University,Chengdu 610041,china)

机构地区：[1]中山大学附属第六医院消化内科,广州510655 [2]浙江大学邵逸夫医院消化内科,杭州310016 [3]四川大学华西医院消化内科,成都610041

出　　处：《中华炎性肠病杂志（中英文）》2018年第1期27-32,共6页Chinese Journal of Inflammatory Bowel Diseases

基　　金：国家自然科学基金青年项目(81600418);广东省自然科学基金(2017A030313695).

摘　　要：目的 分析急性重度溃疡性结肠炎(ASUC)患者的近期及远期结局.方法 采用Trulove&Witts纳入标准收集2010年1月至2016年10月期间首次重度发作并住院治疗的UC患者,3家医院共纳入69例ASUC患者.采用Travis方法评价静脉激素治疗3、7 d后应答状态(完全应答,complete responders,CR3,CR7;不完全应答,incomplete responders,IR3,IR7;无应答,non-responders,NR3,IR7),并分析其与ASUC患者近期手术率、远期手术率、再住院率关系.结果 69例ASUC患者首次重度发作住院期间,28例患者接受转换治疗,其中26例患者接受了药物补救治疗,2例接受了急诊手术治疗.69例中,共11例(15.9%)患者接受了手术治疗.NR3患者近期手术率(30.8%,8/26)显著高于静脉激素应答患者(CR3和IR3)(7.0%,3/40) (P = 0.01).在回访时间3~84个月内(中位23个月),58例未接受外科手术的出院患者中共有17例(29.3%)最终接受手术治疗.IR7组远期手术率(40.5%, 15/37)显著高于CR7组(9.5%,2/21)(P=0.022).CR7组累计手术率显著低于IR7组:0.0%比27.0%(12个月)、4.8%比32.4%(23个月)(P=0.023).回访期内共有33例患者(56.9%)因疾病复发至少再住院治疗1次.IR7组再住院率(67.6%,25/37)显著高于CR7组(38.1%,8/21) (P =0.032).CR7组累计再住院率显著低于IR7组:19.0%比29.7% (12个月)、28.6%比51.4%(23个月)(P = 0.024).住院期及回访期无死亡病例.结论 本组ASUC患者首次住院期间手术率为15.9%,未手术病例在回访期内手术率为29.3%.以静脉激素治疗3d无应答和7 d不完全应答为高危指标,有助于分别预测ASUC近期及远期手术风险.Objective To analyze the short-and long-term outcomes of Chinese patients with acute severe ulcerative colitis(ASUC).Methods Clinical data of 69 ASUC patients according to enrolled criteria of Trulove&Witts.who were admitted to hospital for the first onset of severe illness.between January 2010 and October 2016 from 3 domestic hospitals were retrospectively analyzed.Response status to intravenous steroids was stratified by Travis method on day 3 and 7.including complete responders.CR3.CR7;incomplete responders.IR3.IR7;and non-responders.NR3.IR7.The short-term outcome parameter was the colectomy rate during hospitalization.and the long-term outcome parameters were rates of colectomy and re-hospitalization after discharge.Association of response status with short-term colectomy rate.long-term colectomy rate and re-hospitalization rate were examined.Results Twenty-eight of 69 patients(40.6%)received rescue therapy during hospitalization.in whom 2 patients underwent urgent colectomy and 26(37.7%)patients received rescue medical therapy.Among 69 patients.11(15.9%)patients underwent colectomy during hospitalization.Short-term colectomy rate of NR3 patients(30.8%.8/26)was significantly higher than 7.0%(3/40)of CR3 plus IR3 patients(P=0.01)during hospitalization.Among 58 patients who did not undergo colectomy within hospitalization.17(29.3%)patients underwent colectomy finally during the follow-up period of 3 to 84 months(medium 23 months).The long-term colectomy rate of IR7 patients was 40.5%(15/37).which was significantly higher than 9.5%(2/21)of CR7 patients(P=0.022).The cumulative colectomy rate of CR7 patients was significantly lower as compared to IR7 patients:0.0%vs.27.0%(12 months).4.8%vs.32.4%(23 months)(P=0.023).During follow-up.33(56.9%)patients required re-hospitalizaion for once at least due to recurrence.The re-hospitalization rate of IR7 patients was 67.6%(25/37).which was significant higher than 38.1%(8/21)of CR7 patients(P=0.032).The cumulative re-hospitalization rate of CR7 patients was significantly lo

关 键 词：急性重度溃疡性结肠炎 结肠切除术 再住院率 结局 

分 类 号：R73[医药卫生—肿瘤]