糖皮质激素无效或依赖UC患者的临床特征和治疗分析

背景:溃疡性结肠炎(UC)是一种病因未明的肠道炎性肠病,目前预测糖皮质激素(GCS)治疗无效或依赖的因素尚不一致。目的:探讨GCS无效或依赖UC患者的临床特征和治疗现状。方法:回顾性分析2003年1月～2011年9月上海交通大学附属第一人民医院确诊为UC的住院患者资料,根据对GCS治疗的反应,将患者分为有效组和难治组(GCS无效或依赖)。比较两组患者一般资料、病变部位、临床表现、实验室检查结果和修正的Truelove-Witts评分,并分析难治组患者进一步的治疗方案和效果。结果:共纳入146例UC患者,50例(34.2%)患者使用过GCS治疗,其中难治组15例,有效组35例。难治组和有效组病变部位、实验室指标(WBC、Hb、PLT、Alb、ESR)、修正的Truelove-Witts评分相比差异均无统计学意义(P>0.05)。与有效组相比,难治组中重度腹痛的发生率显著升高(53.3%对22.9%,P=0.049)。难治组UC患者可通过延长GCS使用时间、加用免疫抑制剂、生物制剂等方法获得缓解。结论:UC患者起病时若存在中重度腹痛,可能预示GCS的治疗反应相对较差,GCS无效或依赖的UC患者可采用免疫抑制剂、生物制剂等行进一步治疗。

Analysis of Clinical Characteristics and Treatment of UC Patients with Glucocorticosteroid-ineffective or Glucocorticosteroid-dependent

Background： Ulcerative colitis（UC） is an inflammatory intestinal disease with uncertain etiology.Studies on factors for predicting glucocorticosteroid（GCS）-ineffective or GCS-dependent UC are still controversial.Aims： To investigate the clinical characteristics and current treatment status of GCS-dependent and GCS-ineffective UC.Methods： A retrospective analysis was conducted on the medical records of UC patients from January 2003 to September 2011 at Shanghai Jiaotong University Affiliated First People’s Hospital.According to the response to GCS treatment,UC patients were divided into GCS effective group and GCS refractory group（including GCS-ineffective and GCS-dependent patients）.The general data,extension of disease,clinical symptoms,laboratory findings and modified Truelove-Witts severity index of these two groups were compared.Further treatment and therapeutic results of refractory group were analyzed.Results： A total of 146 UC patients were enrolled,of which 34.2%（50 /146） patients received GCS treatment,including 15 patients in refractory group and 35 patients in effective group.No significant differences in extension of disease,laboratory findings（WBC,Hb,PLT,Alb,ESR） and modified Truelove-Witts severity index were found between refractory group and effective group.Compared with effective group,the incidence of moderate to severe abdominal pain in refractory group was significantly increased（53.3% vs.22.9%,P = 0.049）.Patients in refractory group could have remission through extending the period of GCS treatment,adding immunosuppressive or biological agents.Conclusions： UC patients with moderate to severe abdominal pain may indicate relatively poor response to GCS treatment.Immunosuppressive and biological agents are the further treatment for GCS-ineffective or GCS-dependent patients.