预测重度溃疡性结肠炎患者需手术治疗的临床指标  

Clinical parameters of predicting the need of colectomy in patients with severe ulcerative colitis

作　　者：魏娟[1,2] 金鑫鑫 袁柏思[1,2] 刘炯 路又可[1,2] 王少东 汪芳裕[1,2] 

机构地区：[1]中国人民解放军南京军区南京总医院 [2]南京大学医学院附属金陵医院消化内科,江苏南京210002

出　　处：《胃肠病学和肝病学杂志》2015年第9期1083-1087,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家自然科学基金资助项目(81270453)

摘　　要：目的探讨预测重度溃疡性结肠炎(ulcerative cditis,UC)患者对静脉激素治疗的反应及需手术治疗的临床指征。方法回顾性分析重度UC 62例,根据患者最终是否接受结肠切除手术分为手术组(24例)和非手术组(38例)。收集患者入院第1天和激素治疗第3天的临床资料,利用单因素回归分析法,找出重度UC需手术治疗的危险因素,并比较4种预测指数(Oxford指数、Swedish指数、Edinburgh指数、Seo指数)的准确性。结果 (1)手术组与非手术组激素治疗第3天的大便次数、C-反应蛋白(CRP)、白蛋白、粪便钙卫蛋白水平比较,差异有统计学意义(P<0.05);两组间肠外营养、抗生素及中药灌肠3项治疗比较,差异有统计学意义(P<0.05)。(2)Oxford指数敏感度65.5%,特异度91.4%;Swedish指数敏感度58.6%,特异度85.7%;Edinburgh指数敏感度41.4%,特异度94.3%;Seo指数敏感度34.5%,特异度94.7%。Oxford指数与Swedish指数预测手术的准确性相当(k=0.874,P=0.000),且明显优于Edinburgh指数和Seo指数(P=0.032,0.028)。结论上述7项预测因子及2项指数均可作为重度UC患者激素治疗无效和转换手术的预测手段。Objective To investigate predictors of predicting the need of colectomy in patients with severe ulcerative colitis （UC）. Methods A retrospective analysis of 62 cases with severe UC was investigated by single factor regression analysis. Clinical data were collected on admission and after 3 days treated by intravenous administration of cortieoste- roids. A series of clinical parameters, as well as four predictive indices （ Oxford, Swedish, Edinburgh and Seo index） , were compared in accuracy of predicting the need of colectomy. Results There were significant differences in stool frequency, serum albumin, CRP , and fecal calproteetin at 3rd treated by eortieosteroidsbetween eolectomy group and control group （ P 〈 0.05 ）. Meanwhile, there were significant differences in medical treatments such as paraenteral nutri- tion, antibiotics and traditional Chinese medicine enema between two groups （P 〈 0.05）. The sensitivity of Oxford in- dex, Swedish index, Edinburgh index and Seo index＇ s were 65.5% , 58.6% , 41.4% and 34.5% , while the specifici- ty were 91.4% , 85.7%, 94.3% and 94.7%, respectively. Oxford index was correlated with Swedish index （k = 0. 874, P = 0. 000） , superior to Edinburgh index and Seo index （P = 0. 032, 0. 028）. Conclusion The above seven predictive factors clinical parameters, as well as Oxford index and Swedish index, may be useful for predicting those pa- tients who need eolectomy in severe UC.

关 键 词：重度溃疡性结肠炎 结肠切除术 预测因子 激素治疗 

分 类 号：R574.62[医药卫生—消化系统]