难治性炎症性肠病临床特征分析  

Analysis of Clinical Characteristics of Refractory Inflammatory Bowel Disease

作　　者：张烁[1] 吕宾[1] 晁冠群[1] 郭赟[1] 孟立娜[1] 张璐[1] 

机构地区：[1]浙江中医药大学附属第一医院消化内科,310006

出　　处：《胃肠病学》2008年第9期544-547,共4页Chinese Journal of Gastroenterology

摘　　要：背景:近年炎症性肠病(IBD)的发病率逐渐增高,对常规治疗反应差甚至无反应的患者亦逐渐增加,如何处理难治性IBD已成为临床医师面临的一大难题。目的:探讨难治性IBD患者的临床特征,从而提高对该病的认识和诊治水平。方法:收集1998年12月～2007年12月浙江中医药大学附属第一医院确诊的229例IBD患者。根据是否使用激素及其治疗结果,将入选患者分为难治组和有效组,比较两组患者的一般情况、临床症状、内镜表现、实验室检查结果和并发症情况。结果:难治组和有效组分别纳入26例和25例IBD患者,分别占总数的11.4%和10.9%。难治组患者首次接受全身糖皮质激素治疗前的中位病程显著长于有效组(18个月对7个月,P<0.05)。两组临床症状、内镜表现和病变部位相比差异无统计学意义。起病时,难治组C反应蛋白(CRP)水平显著高于有效组[(45.5±36.8)mg/L对(19.2±15.3)mg/L,P<0.05],红细胞沉降率(ESR)水平显著高于有效组[(45.9±37.1)mm/h对(21.9±12.7)mm/h,P<0.05],血清白蛋白显著低于有效组[(24.2±10.2)g/L对(33.4±7.6)g/L,P<0.05],且并发症发生率显著高于有效组(38.5%对4.0%,P<0.05)。结论:难治性IBD临床症状和内镜表现与激素治疗有效的中-重度IBD无异,但接受激素治疗前的病程较长,起病时CRP、ESR和血清白蛋白水平与预后可能相关。Background： Recently, the incidence rate of inflammatory bowel disease （IBD） has been gradually increased, and the number of patients with poor response or non-response to conventional therapy has also been gradually increased. How to deal with refractory IBD becomes a major Challenge to clinicians. Aims： To appraise the clinical characteristics of refractory IBD in order to promote its recognition, diagnosis and management. Methods： Two hundred and twenty-nine IBD patients admitted from Dec. 1998 to Dec. 2007 in the First Affiliated Hospital of Zhejiang Chinese Medical University were enrolled, and then were divided into refractory IBD group and effective treatment group in aceordance with the efficacy of corticosteroid. The general conditions, clinical symptoms, endoscopic characteristics, laboratory examinations and complications of IBD patients in two groups were compared. Results： Twenty-six （11.4%） and 25 （10.9%） IBD patients were allocated into refractory IBD group and effective treatment group, respectively. The median course of disease before receiving glucocorticoid therapy for the first time in refractory IBD group was significantly higher than that in effective treatment group （18 months vs. 7 months, P〈0.05）. No statistically significant differences were found in clinical, endoscopic characteristics and diseased region in these two groups. At the onset of the disease, level of C reactive protein （CRP） in refractory IBD group was markedly higher than that in effective treatment group [（45.5±36.8） mg/L vs. （19.2±15.3） mg/L, P〈0.05]. Erythrocyte sedimentation rate （ESR） in refractory IBD group was obviously higher than that in effective treatment group [（45.9±37.1） mm/h vs. （21.9±12.7） mm/h, P〈0.05]. Serum albumin in refractory IBD group decreased significantly than that in effective treatment group [（24.2±10.2） g/L vs. （33.4±7.6） g/L, P〈0.05]. The incidence rate of complications in refractory IBD group was significantly higher than t

关 键 词：炎性肠疾病 难治性 糖皮质激素类 临床特征 

分 类 号：R574[医药卫生—消化系统]