溃疡性结肠炎患者发生阑尾口周围炎的危险因素及预后分析  

Risk factors of appendiceal orifice inflammatory in patients with ulcerative colitis and prognosis analysis

作　　者：史刚刚[1] 郑冰 韩梅 SHI Ganggang;ZHENG Bing;HAN Mei(Department of Colorectal Surgery,the Second Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院肛肠外科,300211

出　　处：《天津医药》2023年第4期404-408,共5页Tianjin Medical Journal

基　　金：天津市教委科研计划项目(2020KJ175)。

摘　　要：目的 分析溃疡性结肠炎(UC)患者发生阑尾口周围炎(AOI)的危险因素及AOI对UC预后的影响。方法共纳入288例UC患者,其中AOI阳性105例,AOI阴性183例。收集肛肠外科进行结肠镜检查和治疗的UC患者的临床资料,包括性别、年龄、病史、结肠镜下病变累及范围和Mayo内镜评分、显微镜下病理表现以及治疗情况,根据镜下是否存在AOI将患者分为2组,比较2组患者的临床特征。采用Logistic回归分析UC患者发生AOI的影响因素。采用Kendall等级相关性分析AOI病理炎症程度分级与直肠病理炎症程度分级的相关性。结果 AOI阳性与阴性组间年龄、性别、临床分型比较差异无统计学意义,病变累及范围、Mayo内镜评分比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示较广的累及范围与较高的Mayo内镜评分是发生AOI的独立危险因素(P<0.05)。AOI阳性患者的AOI病理炎症程度分级与直肠病理炎症程度分级呈正相关(rs=0.512,P<0.05)。经过治疗后大部分患者均获缓解,AOI阳性与阴性患者治疗效果比较差异无统计学意义。按照治疗方式将AOI阳性的直肠型患者分为单纯外用药物组和外用加口服药物组,外用加口服药物组较单纯外用药物组治疗效果更好(P<0.05)。结论 UC患者镜下病变累及范围越广、Mayo内镜评分越高,越易出现AOI阳性;镜下对AOI的评估有助于更好地指导UC患者的治疗。Objective To analyze the risk factors of appendiceal orifice inflammation(AOI)in patients with ulcerative colitis(UC)and the influence of AOI on the prognosis of UC.Methods A total of 288 UC patients were enrolled,of them 105 were AOI positive and 183 were AOI negative.The medical records of UC patients who underwent colonoscopy and treatment in the department of colorectal surgery were collected,and data including gender,age,medical history,colonoscopic lesion involvement and Mayo endoscopic subscore,microscopic pathological features and treatment.All patients were divided into two groups according to AOI.The demographics and endoscopic features of the two groups were analyzed.Logistic regression was used to analyze risk factors of AOI in UC patients.Kendall grade correlation was used to analyze the correlation between AOI inflammatory grade and rectal inflammatory grade in AOI-positive UC patients.Results There were no significant differences in age,gender and clinical classification between the two groups.There were significant differences in the scope of lesion involved and Mayo endoscopic subscore between the two groups(P<0.05).Multivariate Logistic regression analysis showed that wide lesion involvement and higher Mayo endoscopic subscore were independent risk factors for AOI(P<0.05).In AOI-positive UC patients,the grade of AOI pathological inflammation was positively correlated with the grade of rectal pathological inflammation(rs=0.512,P<0.05).After treatment,most patients achieved remission,and there was no significant difference in the therapeutic effect between AOI positive and AOI negative patients.According to the treatment methods,AOI positive patients with proctitis were divided into the suppository drug group and the suppository combined with oral drug group,and the remission rate was higher in the suppository combined with oral drug group than that of the suppository drug group(P<0.05).Conclusion The wider the scope of endoscopic lesion involvement and the higher the Mayo endoscopic subscore in U

关 键 词：结肠炎 溃疡性 结肠镜检查 阑尾口周围炎 跳跃性病变 蒙特利尔分型 Mayo内镜评分 

分 类 号：R656.9[医药卫生—外科学]