中华消化杂志
中華消化雜誌
중화소화잡지
Chinese Journal of Digestion
2014年
4期
235-239
,共5页
结肠炎,溃疡性%糖皮质激素类%环孢素A
結腸炎,潰瘍性%糖皮質激素類%環孢素A
결장염,궤양성%당피질격소류%배포소A
Colitis,ulcerative%Glucocorticoids%Cyclosporin A
目的 了解重度UC患者的临床特征及药物治疗情况,糖皮质激素(GCS)抵抗的重度UC患者的药物拯救治疗效果,以及GCS难治性重度UC患者的临床危险因素.方法 回顾性分析2001年1月至2012年12月的106例重度UC患者的临床、实验室、内镜、影像学资料和治疗用药情况,并对其预后进行随访,评价其临床疗效和Mayo评分的内镜下表现.应用Logistic回归分析GCS难治性重度UC的高危因素.结果 106例重度UC患者中,慢性复发型95例,占89.6％.排便次数≥6次/d占73.6％(78/106),重度脓血便占51.0％(54/106),中重度腹痛占83.0％(88/106).广泛结肠占83.0％(88/106),Mayo评分的内镜下表现≥2分占87.7％ (93/106).Hb下降占65.1％(69/106),PLT升高占48.1％(51/106),CRP升高占88.7％ (94/106),血清白蛋白下降占42.5％ (45/106).89.6％ (95/106)的重度UC患者接受GCS治疗,诱导缓解达64.2％(61/95),有效占16.8％(16/95),无效占18.9％(18/95).GCS难治占35.8％ (34/95),其中GCS抵抗为23例,GCS依赖为11例.10例GCS抵抗的重度UC患者接受了药物拯救治疗,其中采用环孢素A治疗5例,2例诱导缓解,1例有效,2例无效;采用英夫利西单克隆抗体治疗5例,3例诱导缓解,2例无效.多因素Logistic回归分析显示,重度贫血(OR=6.750,95％CI=2.656～17.152,P＜0.01)、PLT升高(OR=4.032,95％CI=1.226～13.261,P=0.015)、白蛋白＜25 g/L(OR=3.022,95％CI=1.236～7.390,P=0.022)是GCS难治性重度UC患者的危险因素.结论 部分重度UC患者存在GCS抵抗或GCS依赖.GCS抵抗的重度UC患者可采用环孢素A或英夫利西单克隆抗体进行拯救治疗.重度贫血、PLT升高、白蛋白＜25 g/L为GCS难治性重度UC患者的临床预测因素.
目的 瞭解重度UC患者的臨床特徵及藥物治療情況,糖皮質激素(GCS)牴抗的重度UC患者的藥物拯救治療效果,以及GCS難治性重度UC患者的臨床危險因素.方法 迴顧性分析2001年1月至2012年12月的106例重度UC患者的臨床、實驗室、內鏡、影像學資料和治療用藥情況,併對其預後進行隨訪,評價其臨床療效和Mayo評分的內鏡下錶現.應用Logistic迴歸分析GCS難治性重度UC的高危因素.結果 106例重度UC患者中,慢性複髮型95例,佔89.6％.排便次數≥6次/d佔73.6％(78/106),重度膿血便佔51.0％(54/106),中重度腹痛佔83.0％(88/106).廣汎結腸佔83.0％(88/106),Mayo評分的內鏡下錶現≥2分佔87.7％ (93/106).Hb下降佔65.1％(69/106),PLT升高佔48.1％(51/106),CRP升高佔88.7％ (94/106),血清白蛋白下降佔42.5％ (45/106).89.6％ (95/106)的重度UC患者接受GCS治療,誘導緩解達64.2％(61/95),有效佔16.8％(16/95),無效佔18.9％(18/95).GCS難治佔35.8％ (34/95),其中GCS牴抗為23例,GCS依賴為11例.10例GCS牴抗的重度UC患者接受瞭藥物拯救治療,其中採用環孢素A治療5例,2例誘導緩解,1例有效,2例無效;採用英伕利西單剋隆抗體治療5例,3例誘導緩解,2例無效.多因素Logistic迴歸分析顯示,重度貧血(OR=6.750,95％CI=2.656～17.152,P＜0.01)、PLT升高(OR=4.032,95％CI=1.226～13.261,P=0.015)、白蛋白＜25 g/L(OR=3.022,95％CI=1.236～7.390,P=0.022)是GCS難治性重度UC患者的危險因素.結論 部分重度UC患者存在GCS牴抗或GCS依賴.GCS牴抗的重度UC患者可採用環孢素A或英伕利西單剋隆抗體進行拯救治療.重度貧血、PLT升高、白蛋白＜25 g/L為GCS難治性重度UC患者的臨床預測因素.
목적 료해중도UC환자적림상특정급약물치료정황,당피질격소(GCS)저항적중도UC환자적약물증구치료효과,이급GCS난치성중도UC환자적림상위험인소.방법 회고성분석2001년1월지2012년12월적106례중도UC환자적림상、실험실、내경、영상학자료화치료용약정황,병대기예후진행수방,평개기림상료효화Mayo평분적내경하표현.응용Logistic회귀분석GCS난치성중도UC적고위인소.결과 106례중도UC환자중,만성복발형95례,점89.6％.배편차수≥6차/d점73.6％(78/106),중도농혈편점51.0％(54/106),중중도복통점83.0％(88/106).엄범결장점83.0％(88/106),Mayo평분적내경하표현≥2분점87.7％ (93/106).Hb하강점65.1％(69/106),PLT승고점48.1％(51/106),CRP승고점88.7％ (94/106),혈청백단백하강점42.5％ (45/106).89.6％ (95/106)적중도UC환자접수GCS치료,유도완해체64.2％(61/95),유효점16.8％(16/95),무효점18.9％(18/95).GCS난치점35.8％ (34/95),기중GCS저항위23례,GCS의뢰위11례.10례GCS저항적중도UC환자접수료약물증구치료,기중채용배포소A치료5례,2례유도완해,1례유효,2례무효;채용영부리서단극륭항체치료5례,3례유도완해,2례무효.다인소Logistic회귀분석현시,중도빈혈(OR=6.750,95％CI=2.656～17.152,P＜0.01)、PLT승고(OR=4.032,95％CI=1.226～13.261,P=0.015)、백단백＜25 g/L(OR=3.022,95％CI=1.236～7.390,P=0.022)시GCS난치성중도UC환자적위험인소.결론 부분중도UC환자존재GCS저항혹GCS의뢰.GCS저항적중도UC환자가채용배포소A혹영부리서단극륭항체진행증구치료.중도빈혈、PLT승고、백단백＜25 g/L위GCS난치성중도UC환자적림상예측인소.
Objective To explore the clinical characteristics and medicine treatment of patients with severe ulcerative colitis (UC),the efficacy of rescue treatment in patients with glucocorticoid (GCS) resistant severe UC,and the clinical risk factors in patients with GCS-refractory severe UC.Methods From January 2001 to December 2012,clinical,laboratory,endoscopy,imaging data and medication of treatment of 106 patients with severe UC were retrospectively analyzed.Then the patients were followed up,and the clinical efficacy and under endoscopic presentation of Mayo score were evaluated.Logistic regression analysis was performed to analyze the high risk factor of GCS-refractory severe UC.Results Among 106 patients with severe UC,95 were chronic relapse type accounting for 89.6 ％.The percentage of patients with defecation times over six was 73.6％ (78/106),with severe purulent bloody stool was 51.0％ (54/106),and with moderately or severe abdominal pain was 83.0％ (88/106).The percentage of diffuse colon type was 83.0％ (88/106),endoscopic presentation of Mayo score over two was 87.7％ (93/106).Hemoglobin decreased in 65.1％ (69/106) patients,blood platelet increased in 48.1％ (51/106) patients,C-reaction protein elevated in 88.7％ (94/106) patients,and hypoalbuminemia decreased in 42.5％ (45/106) patients.Account to 89.6％ (95/106) of patients with severe UC received GCS treatment,and the percentage of induced remission was 64.2％ (61/95),effective rate was 16.8％ (16/95),and ineffective rate was 18.9％ (18/95).The percentage of GCS refractory was 35.8％(34/95).There were 23 patients with GCS resistance and 11 patients with GCS dependence.Ten patients with GCS resistant severe UC accepted medicine rescue therapy.Five cases were treated with cyclosporin A,of which two cases induced remission,one case was effective,and two cases were ineffective.Another five cases were treated with infliximab,of which three cases induced remission,and two cases were ineffective.The results of Logistic regression analysis showed that severe anemia (OR=6.750,95％CI:2.656 to 17.152,P＜0.01),elevated blood platelets (OR=4.032,95％CI:1.226 to 13.261,P=0.015) and albumin level less than 25 g/L (OR =3.022,95 ％ CI:1.236 to 7.390,P =0.022) were risk factors of GCS-refractory severe UC.Conclusions GCS resistant or dependent occurred in part of patients with severe UC.Patients with G-CS resistant severe UC receive rescue treatment of cyclosporin A or infliximab.Severe anemia,elevated blood platelets,albumin less than 25 g/L may be clinical predicting factors in patients with GCS-refractory severe UC.
