糖皮质激素无效或依赖UC患者的临床特征和治疗分析

摘要

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.%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Iruelove-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.