糖皮质激素治疗炎症性肠病的随访研究

目的 回顾性分析糖皮质激素治疗炎症性肠病(IBD)1个月的疗效及1年后的转归.方法 1998年1月至2006年9年确诊为克罗恩病(CD)患者55例,溃疡性结肠炎(UC)患者154例,评估口服糖皮质激素治疗1个月和1年后的疗效.Logistic回归分析决定预后的影响因子.结果 共有21例(38.2%)CD患者和20例(13.0 %)UC患者口服糖皮质激素(2例UC患者失访).经1个月治疗后,21例CD患者中完全缓解15例(71.4%),部分缓解3例(14.3%),无效3例(14.3%);18例UC患者中,完全缓解15例(83.3%),部分缓解3例(16.7%).随访1年时,21例CD患者中,维持完全或部分缓解11例(52.4%),激素依赖6例(28.6%),被迫接受外科手术者4例(19.0%),18例UC患者中,维持完全或部分缓解11例(61.1%),激素依赖3例(16.7%),手术4例(22.2%).Logistic回归分析显示,发病时血清白蛋白水平与1年后的疗效有关(OR=1.320,95%CI:1. 032～1.690,P=0.027).结论 IBD患者对首次激素治疗有效,近期疗效良好.但无法长期维持缓解状态,亦无法降低手术风险.其预后与血清白蛋白水平相关.

Follow-up study on corticosteroid treatment of inflammatory bowel disease

Objective To retrospectively analyze the effect of corticosteroids therapy for inflammatory bowel disease (IBD) at 1-month and 1-year. Methods Those who was diagnosed as Crohn's disease (CD, n=55) or ulcerative colitis (UC, n= 154) from 1998 to 2006 were investigated. The effect of corticosteroids was evaluated after one month and 1-year. The prognostic factors were calculated using Logistic regression analysis. Results The patients who received eortieosteroids therapy were 21 (38.2%) with CD and 20 (13.0%) with UC (2 cases withdrawn). In one month followe-up, the complete and partial remissions were found in 15 (71.4%) and 3 (14.3%) patients with CD, respectively, while there were 15 (83.3%) and 3 (16.7%) in patients UC, respectively. Only 3 (14.3%) patients with CD was no response. In one year follow up, 11 out of 21 (52.4%) patients with CD had prolonged response to corticosteroids, 6 (28.6%) were corticosteroid dependence, and 4 (19%) required surgery; whereas 11 out of 18 (61.1%) patients with UC had prolonged response, 3 (16.7%) were corticosteroid dependence, and 4 (22.2%) required surgery. Logistic regression analysis showed that serum albumin level was associated with efficacy of corticosteroids after one year (P= 0.027, OR: 1.320,95% CI: 1.032~1. 690). Conclusion The IBD patients who has response to initiating corticosteroids therapy will get shor-term remission. Its prognosis is related with serum albumin level.