溃疡性结肠炎临床特征及其复发危险因素分析

发布时间：2018-02-22 11:54

本文关键词： 溃疡性结肠炎临床特点复发危险因素　出处：《郑州大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨溃疡性结肠炎(uleerativecolitis,UC)的临床特点,并对该病复发及其危险因素进行分析,以增进UC的诊治水平,并为临床制定治疗和预后方案提供依据。方法:对2011年8月~2014年8月本院收治的112例溃疡性结肠炎患者临床资料进行回顾性研究,通过对患者的年龄、性别、发病部位、病程、临床表现、肠镜、病理检查、实验室检查、肠外症状、治疗方法、随访资料等相关数据资料进行统计分析,从而对UC的临床特点、治疗、复发及其危险因素进行全面的研究。结果:112例UC患者中,男性60例,女性52例,男女比例为1.15:1;发病年龄为41.2±11.3岁,30~39岁和50~59岁两个年龄段为UC的两个发病高峰;病程小于5年的有73例,5~10年有23例,大于10年16例;临床表现主要以消化系统症状为主,如腹泻(94.6%)、黏液脓血便(82.1%)和腹痛(78.6%);全身症状以体重下降(35.7%)、发热(20.5%)和乏力(10.7%)为主;23.2%的患者具有肠外表现,主要症状为关节疼痛(7.1%)、口腔病变(10.7%)和皮肤病变(5.4%);27.7%的患者发病部位为直肠型,25.0%为左半结肠型,2.7%为广泛结肠型;病情程度:25.0%为轻度,45.5%为中度,20.5%为重度;按发病类型75.0%为慢性复发型,15.2%为初发型,6.3%为慢性持续型,3.6%为急性暴发型;肠镜检查表现主要以肠黏膜弥漫性充血水肿或伴有糜烂性浅溃疡为主,分别占81.3%和76.8%;肠黏膜病理活检83.9%患者呈现急慢性炎症病变,另有1例发展为结肠癌;实验室检查结果显示112溃疡性结肠炎患者中血小板计数、C反应蛋白和红细胞沉降率的升高率分别为54.5%(61/112)、16.1%(18/112)和22.3%(25/112),而血红蛋白和白蛋白的下降率分别为46.4%(52/112)与33.0%(37/112),并且重度UC患者的血小板计数、C反应蛋白和红细胞沉降率与中度和轻度UC患者均有显著差异(P0.05)。108例患者通过单纯内科药物治疗病情均得到缓解,缓解率达到100%,4例患者内科治疗无效转入外科手术治疗;预后随访分析结果显示58.9%的患者出现病情复发,单因素分析和Logistic回归分析显示年龄、病程、未维持治疗和肠外表现是UC复发的危险因素。结论:本研究显示溃疡性结肠炎患者平均发病年龄为41.2岁,男女比例相当。病变部位以直肠、乙状结肠和左半结肠为主,临床主要表现为腹泻、黏液脓血便和腹痛等症状,结肠镜下主要表现为肠黏膜弥漫性充血水肿、糜烂或伴溃疡形成。病理活检主要为炎性病变。溃疡性结肠炎患者血小板计数(PLT)、C反应蛋白水平(CRP)、红细胞沉降率(ESR)、血红蛋白(HGB)和白蛋白(ALB)等指标可作为UC诊断和分期分型标准。108例UC患者可以通过单纯药物治疗使病情得到缓解,但是具有较高的复发率,年龄、病程、维持治疗和肠外表现等是UC复发的危险因素。
[Abstract]:Objective: to investigate the clinical features of ulcerative colitis (UC), and to analyze the recurrence and risk factors of UC, so as to improve the diagnosis and treatment of UC. Methods: the clinical data of 112 patients with ulcerative colitis from August 2011 to August 2014 were retrospectively studied. Clinical manifestations, enteroscopy, pathological examination, laboratory examination, extraintestinal symptoms, treatment methods, follow-up data and other related data were statistically analyzed, so as to analyze the clinical characteristics and treatment of UC. Results among 112 UC patients, 60 were male, 52 were female, the ratio of male to female was 1.15: 1, the age of onset was 41.2 卤11.3 years old, 30 ~ 39 years old and 50 ~ 59 years old were two peaks of UC. There were 73 cases with disease course less than 5 years, 23 cases with 5 ~ 10 years, 16 cases with more than 10 years, and the main clinical manifestations were digestive system symptoms. For example, the patients with diarrhea (94. 6) and mucus abscess (82. 1) and abdominal pain (78. 6); the symptoms of the whole body included weight loss (35. 7%), fever (20. 5%) and fatigue (10. 7%).) 23.2% of the patients had extraintestinal symptoms. The main symptoms were as follows: articular pain was 7.1%, oral lesion 10.7%) and skin lesion 5.4B 27.7% of the patients were rectum type 25.0%, left hemicolon type 2.7%, degree of disease: 25.0%, mild grade, 45.5%, moderate, 20.5%, severe. According to the type of disease 75.0%, 15. 2% of the patients were chronic recurrent type, 6. 3% were chronic persistent type and 3. 6% were acute fulminant type, the main findings of colonoscopy were diffuse hyperemia and edema of intestinal mucosa or superficial ulcer with erosion. The pathological biopsy of intestinal mucosa showed acute and chronic inflammation in 83.9% patients, and one patient developed colon cancer. Laboratory tests showed that the elevated rates of platelet count C reactive protein and erythrocyte sedimentation rate in 112 patients with ulcerative colitis were 54.5b / 61.1 / 16.1 / 112) and 22.33n / 25 / 112 / 112, respectively, while the decrease rates of hemoglobin and albumin were 46.452 / 112) and 33.0 / 37112 / 12, respectively, and severe UC. There were significant differences in platelet count, C-reactive protein and erythrocyte sedimentation rate between patients with moderate and mild UC and patients with mild UC. The remission rate was 100% and 4 cases were transferred to surgical treatment, the results of prognostic follow-up analysis showed that 58.9% of the patients had relapse, and univariate analysis and Logistic regression analysis showed age and course of disease. Unsustained treatment and parenteral manifestations were risk factors for UC recurrence. Conclusion: the average age of ulcerative colitis is 41.2 years old and the ratio of male and female is the same. The lesions are mainly located in rectum, sigmoid colon and left hemicolon. The main clinical manifestations were diarrhea, mucus purulent stool and abdominal pain, and the main manifestations under colonoscopy were diffuse hyperemia and edema of intestinal mucosa. In patients with ulcerative colitis, the platelet count and the level of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin HGBs (HGB) and Albumin (ALB) can be used as indicators for the diagnosis and classification of UC. Stage classification criteria. 108 patients with UC can be relieved by drug therapy alone. However, high recurrence rate, age, course of disease, maintenance treatment and parenteral manifestations were risk factors for UC recurrence.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R574.62

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