难治性克罗恩病的临床特征及影响因素分析  

Clinical characteristics and risk factors of refractory Crohn＇s disease

作　　者：徐萍萍[1] 何瑶[1] 陈白莉[1] 毛仁[1] 唐睿晗[1] 李蔓英[1] 陈芳[1] 武芸[1] 曾志荣[1] 

机构地区：[1]中山大学附属第一医院消化内科,广州510080

出　　处：《中华医学杂志》2014年第38期2982-2987,共6页National Medical Journal of China

基　　金：广东省自然科学基金（S2011010004333）;广东省科技计划项目（2010B031600044）

摘　　要：目的 分析难治性克罗恩病（CD）患者的临床特征及可能的影响因素.方法 纳入2003年1月至2013年6月于中山大学附属第一医院炎症性肠病中心随访的确诊CD患者,根据对药物治疗的反应定义难治性CD,包括激素依赖和（或）硫唑嘌呤/6-巯基嘌呤（AZA/6-MP）治疗效果欠佳,回顾性分析难治性CD的临床表现、药物治疗、实验室检查等特征,并行多因素Logistic回归分析其危险因素.结果 （1）共纳入确诊的CD患者402例,其中难治性CD发生率为33.8％ （136/402）;其中262例使用过激素,激素依赖发生率为37.0％ （97/262）;294例使用过AZA/6-MP,疗效欠佳的发生率为26.9％ （79/294）.（2）难治性CD影响因素的单因素分析显示：病变部位（回结肠型）、腹痛、腹泻、发热、腹部压痛、肛周病变、激素使用、AZA/6-MP使用、白细胞水平、血红蛋白水平、血小板计数和超敏C反应蛋白（HsCRP）水平在难治性CD组及非难治性CD组差异有统计学意义（均P＜0.05）.多因素分析显示：激素使用（OR =6.516,95％ CI：2.884～ 14.722,P=0.000）和血红蛋白低（OR=1.023,95％ CI：1.008～1.037,P=0.002）是难治性CD的独立危险因素.（3）进一步分层分析激素疗效的影响因素,单因素分析显示：血红蛋白和红细胞沉降率在激素依赖组和非激素依赖组间差异有统计学意义（均P ＜0.05）.多因素分析显示：血红蛋白低（OR=1.021,95％ CI：1.006～1.036,P=0.005）是发生激素依赖的独立危险因素.（4）进一步分层分析AZA/6-MP疗效的影响因素,单因素分析显示：病变部位（回结肠型）、肛周病变、腹痛、腹泻、发热、腹部压痛、血小板、激素使用和激素依赖在AZA/6-MP疗效欠佳组和治疗有效组间差异有统计学意义（均P＜0.05）.多因素分析显示：肛周病变（OR=2.085,95％ CI：1.007～4.039,P=0.029）、腹部压痛（OR=2.943,95％ CI：1.452～5.964,P=0.003）和激素依赖（Objective To analyze the clinical characteristics and risk factors of refractory Crohn＇s disease （CD）.Methods All clinical data of confirmed consecutive CD patients were collected from our hospital between January 2003 and June 2013.The patients＇ demographic data,clinical features,therapeutic regimens and laboratory examinations were analyzed.A multivariate Logistic regression was performed to identify the risk factors of refractory CD.Results （1） A total of 402 confirmed CD patients were recruited for analysis.The prevalence of refractory CD was 33.8% （136/402）.The rates of steroid-dependency was 37.0% （97/262） in 262 patients with a history of steroid use and the rate of thiopurines ineffectiveness was 26.9% （79/294） in 294 patients with a history of thiopurines-use; （2） Univariate analysis showed that disease location （L3 type）,abdominal pain,diarrhea,fever,abdominal tenderness,perianal lesion,steroid use,AZA/6-MP use,leucocyte,hemoglobin （Hb）,platelet level and high-sensitivity C-reactive protein （HsCRP） were significantly different between refractory and non-refractory CD patients （all P 〈0.05）.Multivariate Logistic regression showed that steroid use （OR =6.516,95% CI：2.884-14.722,P =0.000） and low Hb （OR =1.023,95% CI：1.008-1.037,P =0.002） were independent risk factors related to refractory CD; （3） Univariate analysis showed that Hb level,erythrocyte sedimentation rate （ESR） were significantly different between steroid-dependent and non-steroid-dependent groups （all P 〈0.05）.Multivariate Logistic regression showed that only low Hb level （OR =1.021,95% CI：1.006-1.036,P =0.005） was an independent risk factor related to steroid-dependency ; （4） Univariate analysis showed that disease location （L3 type）,perianal lesion,abdominal pain,diarrhea,fever,abdominal tenderness,platelet level,steroid use,steroid-dependency were significantly different between thiopurinesineffective and thiopurines-effective groups （all P 〈 0.05）.

关 键 词：CROHN病 糖皮质激素类 嘌呤类 疾病特征 危险因素 

分 类 号：R574.62[医药卫生—消化系统]