479例炎症性肠病患者复发相关危险因素临床分析

摘要

Background:Inflammatory bowel disease(IBD)is a chronic,non-specific,relapsing inflammatory bowel disorder. Prediction of prognosis and relapse is of great importance for disease control. Aims:To analyze the characteristics and related factors for relapse in IBD patients. Methods:Four hundred and seventy-nine hospitalized patients diagnosed as ulcerative colitis(UC,n = 301)or Crohn’s disease( CD,n = 178)from Jan. 2004 to Jun. 2014 were enrolled and divided into relapse group and non-relapse group. The clinical characteristics were collected and univariate and multivariate analysis were performed to identify the influencing factors for relapse. Results:The relapse rates for UC and CD were 52. 49% and 77. 53% ,respectively. In stepwise Logistic regression analysis,younger onset age( < 40 years old,OR =0. 825,95% CI:0. 777-0. 876,P = 0. 000),longer disease duration(OR = 1. 186,95% CI:1. 089-1. 291,P = 0. 000) and extensive colitis(OR = 16. 993,95% CI:2. 670-108. 170,P = 0. 003)were independent risk factors for relapse of UC,while younger onset age( < 40 years old,OR = 0. 944,95% CI:0. 915-0. 974,P = 0. 000)and poor medication adherence(OR = 31. 074,95% CI:10. 456-92. 343,P = 0. 000)were independent risk factors for relapse of CD. Conclusions:Patients at high risk for relapse of IBD can be identified by referring to the related risk factors. Early identification and intervention,persistence for maintenance therapy and improving medication adherence by health education may reduce the clinical relapse of IBD.%背景：炎症性肠病（IBD）是一组易反复发作的慢性非特异性肠道炎症性疾病，预后和复发预测对控制病情具有重要意义。目的：分析 IBD 患者的复发特征以及影响复发的临床因素。方法：收集2004年1月-2014年6月明确诊断的住院 IBD 患者479例，其中溃疡性结肠炎（UC）301例，克罗恩病（CD）178例，按是否复发分为两组，对可能影响 IBD 复发的各项临床特征行单因素和多因素分析。结果：UC 组复发率为52.49%，CD 组为77.53%。Logistic 逐步回归分析显示，发病年龄轻（<40岁，OR =0.825，95% CI：0.777~0.876，P =0.000）、病程长（OR =1.186，95% CI：1.089~1.291，P =0.000）和广泛结肠炎（OR =16.993，95% CI：2.670~108.170，P =0.003）是 UC 复发的独立危险因素；发病年龄轻（<40岁，OR =0.944，95% CI：0.915~0.974，P =0.000）和服药依从性差（OR =31.074，95% CI：10.456~92.343，P =0.000）是 CD 复发的独立危险因素。结论：参考上述复发相关危险因素对复发早期识别、早期积极干预、坚持维持治疗，同时加强健康宣教以改善服药依从性，可能对降低 IBD 临床复发率具有积极意义。