327例溃疡性结肠炎临床特征分析

背景：近年我国溃疡性结肠炎（UC）患病率有逐渐增加的趋势。目的：探讨我国UC的发病特点，指导临床治疗。方法：对1978年4月～2006年6月在北京军区总医院消化内科内镜中心确诊为UC的病例进行回顾性分析。结果：327例患者中。男女之比为1．7：1，中位年龄为40岁，平均病程3．1年。UC患者的黏液血便发生率最高（71.3％）．其次为腹泻（53．8％）和腹痛（52.3％）。病变以直乙结肠炎（29．1％）和直肠炎（21．1％）为主。临床分型以初发型（44．4％）和慢性复发型（36．4％）为主，其次为慢性持续型（16．4％），暴发型仅占2．8％。病情以轻度（33．6％）和中度（48.3％）为主，重度仅占18．0％。治疗药物主要为单纯5-氨基水杨酸类药物（41．5％）和5-氨基水杨酸类药物联用糖皮质激素（37．0％）．单纯内科治疗的有效率为94．1％，无效7例（5．2％），死亡1例（0．7％）。结论：我国UC患者的特点与国外报道存在一定的差异，主要表现是以直乙结肠炎为主，轻中度病变居多，肠外表现和并发症较少。大多数轻中度UC患者以局部病变为主，且局部治疗效果较好，重度UC患者多为全结肠炎，以全身治疗为主；需行结肠切除、癌变和死亡病例少见．

Analysis of Clinical Characteristics of 327 Patients with Ulcerative Colitis

Background: The incidence of ulcerative colitis (UC) in China has been increasing in recent years. Aims: To retrospectively analyze the clinical characteristics of UC in China and guide the clinical therapy. Methods: The clinical data of 327 patients with UC were collected retrospectively from Gastrointestinal endoscopic center of General Hospital of Beijing Military Area. Results: Of these 327 patients, the ratio of male to female was 1.7:1, the median age was 40 years, and the mean course was 3.1 years. The main clinical manifestations were bloody stool (71.3%), diarrhea (53.8%) and abdominal pain (52.3%). The main sites of lesion were located at rectosigmoid (29.1%) and rectum (21.1%). Clinical manifestations included initial onset type (44.4%), chronic relapsing type (36.4%), chronic persistent type (16.4%), and acute fulminant type (2.8%). Most of these UC patients were mild (33.7%) or moderate (48.3%), and only 18.0% were severe. 41.5% of patients with UC were treated with aminosalicylate alone, and 37.0% were treated with both aminosalicylate and glucocorticoids. The remission rate approached 94.1%, and the ineffectiveness rate was 5.2% (7 cases). The mortality rate was 0.7% (1 case). Conclusions: In patients with UC, the lesions are mainly located at rectosigmoid colon and most of them are mild or moderate, extra-intestinal manifestations and complications are rare. Mild or moderate UC patients may be treated with regional therapy with good response. Pancolitis occurs in severe cases, which needs systemic therapy. Only few patients require colectomy and malignant transformation of the lesions is uncommon.