难治性克罗恩病的临床特征及影响因素分析
난치성극라은병적림상특정급영향인소분석
Clinical characteristics and risk factors of refractory Crohn's disease
  • 万方数据
    中华医学杂志 중화의학잡지
    National Medical Journal of China
    2014年 38期 2982-2987 ,共6页

    徐萍萍%何瑶%陈白莉%毛仁%唐睿晗%李蔓英%陈芳%武芸%曾志荣

    서평평%하요%진백리%모인%당예함%리만영%진방%무예%증지영

    Crohn病%糖皮质激素类%嘌呤类%疾病特征%危险因素 Crohn病%糖皮質激素類%嘌呤類%疾病特徵%危險因素
    Crohn병%당피질격소류%표령류%질병특정%위험인소
    Crohn disease%Glucocorticoids%Purines%Disease attributes%Risk factors
    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(OR =3.599,95％ CI:1.847～7.013,P=0.000)是AZA/6-MP疗效欠佳的独立危险因素.结论 近1/3的CD患者为难治性CD,血红蛋白低和激素使用是其独立危险因素,其中血红蛋白低是发生激素依赖的危险因素,而肛周病变、腹部压痛和激素依赖是AZA/6-MP治疗效果欠佳的危险因素.
    목적 분석난치성극라은병(CD)환자적림상특정급가능적영향인소.방법 납입2003년1월지2013년6월우중산대학부속제일의원염증성장병중심수방적학진CD환자,근거대약물치료적반응정의난치성CD,포괄격소의뢰화(혹)류서표령/6-구기표령(AZA/6-MP)치료효과흠가,회고성분석난치성CD적림상표현、약물치료、실험실검사등특정,병행다인소Logistic회귀분석기위험인소.결과 (1)공납입학진적CD환자402례,기중난치성CD발생솔위33.8％ (136/402);기중262례사용과격소,격소의뢰발생솔위37.0％ (97/262);294례사용과AZA/6-MP,료효흠가적발생솔위26.9％ (79/294).(2)난치성CD영향인소적단인소분석현시:병변부위(회결장형)、복통、복사、발열、복부압통、항주병변、격소사용、AZA/6-MP사용、백세포수평、혈홍단백수평、혈소판계수화초민C반응단백(HsCRP)수평재난치성CD조급비난치성CD조차이유통계학의의(균P＜0.05).다인소분석현시:격소사용(OR =6.516,95％ CI:2.884～ 14.722,P=0.000)화혈홍단백저(OR=1.023,95％ CI:1.008～1.037,P=0.002)시난치성CD적독립위험인소.(3)진일보분층분석격소료효적영향인소,단인소분석현시:혈홍단백화홍세포침강솔재격소의뢰조화비격소의뢰조간차이유통계학의의(균P ＜0.05).다인소분석현시:혈홍단백저(OR=1.021,95％ CI:1.006～1.036,P=0.005)시발생격소의뢰적독립위험인소.(4)진일보분층분석AZA/6-MP료효적영향인소,단인소분석현시:병변부위(회결장형)、항주병변、복통、복사、발열、복부압통、혈소판、격소사용화격소의뢰재AZA/6-MP료효흠가조화치료유효조간차이유통계학의의(균P＜0.05).다인소분석현시:항주병변(OR=2.085,95％ CI:1.007～4.039,P=0.029)、복부압통(OR=2.943,95％ CI:1.452～5.964,P=0.003)화격소의뢰(OR =3.599,95％ CI:1.847～7.013,P=0.000)시AZA/6-MP료효흠가적독립위험인소.결론 근1/3적CD환자위난치성CD,혈홍단백저화격소사용시기독립위험인소,기중혈홍단백저시발생격소의뢰적위험인소,이항주병변、복부압통화격소의뢰시AZA/6-MP치료효과흠가적위험인소.
    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).Multivariate Logistic regression showed that perianal lesion (OR =2.085,95 ％ CI:1.007-4.039,P =0.029),abdominal tenderness (OR =2.943,95％ CI:1.452-5.964,P =0.003) and steroid-dependency (OR =3.599,95％ CI:1.847-7.013,P =0.000) were independent risk factors related to thiopurines-ineffectiveness.Conclusions Nearly one third CD patients became refractory during the course of disease.Low Hb and steroid use are independent risk factors.Low Hb is an independent risk factor related to steroid-dependency.Perianal disease,abdominal tenderness and steroid-dependency are independent risk factors related to thiopurinesineffectiveness.
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