未确定型结肠炎临床特点分析

发布时间：2018-05-12 17:49

本文选题：炎症性肠病 + 未确定型结肠炎　；参考：《北京协和医学院》2017年硕士论文

【摘要】：目的:总结未确定型结肠炎(IC)的临床表现、诊疗方法和转归。方法:对2012年11月至2015年11月在北京协和医院消化内科住院诊治IC患者共28例进行回顾性分析,随机选取同期入院年龄、性别与IC匹配的溃疡性结肠炎(UC)和克罗恩病(CD)患者各28例,比较其在临床表现、肠外表现、并发症、内镜下特点、组织病理、治疗方法及转归情况等方面的异同。结果:IC组28例患者中,男18例(64.3%),平均发病年龄(29.8±10.2)岁。主要临床表现为粘液血便(23例,82.1%)、腹痛(23例,82.1%)、腹泻(19例,67.9%)、单纯血便(15例,53.6%)、发热(15例,53.6%);粘液血便发生率高于CD(82.1%比14.3%,P=0.000001),单纯血便发生率较UC组高(53.6%比0,P=0.000024)。IC组全结肠病变发生率高于CD组(32.1%比3.6%,p=0.01),节段型病变(28.6%比 57.1%,p=0.(3)、回肠受累(28.6%比 71.4%,P=0.001)、直肠赦免(25.0%比82.1%,P=0.00002)发生率均低于CD;IC节段型病变(28.6%比0,P=0.008)、回肠受累(28.6%比 3.6%,P=0.03)、直肠赦免(25.0%比 0,P=0.02)发生率均高于UC,虽全结肠病变低于UC(32.1%比46.4%,p=0.27),但差异无统计学意义。IC与UC、CD比较,肠外表现、并发症、病理表现差异均无统计学意义。IC免疫抑制剂使用率明显低于CD(57.1%比85.7%,p=0.04),高于UC(57.1%比32.1%,P=0.06),但与UC比较差异无统计学意义;IC组英夫利昔单抗(IFX)使用率(7.1%比 53.6%,P=0.0002)和手术率(25.0%比 64.3%,P=0.007)均显著低于CD。对28例IC随访,仅2例失访,平均随访时间为(30.0± 12.9)月,5例(19.2%)随访过程中确诊为UC,2例(7.7%)确诊为CD。结论:IC在兼具UC和CD特点的同时,也有其独特的临床特征。IC可在长期随访过程中重新诊断为UC或CD,了解其临床特点及随访其转归对于治疗及预后具有极其重要的意义。
[Abstract]:Objective: to summarize the clinical manifestations, diagnosis and treatment methods and outcome of undetermined colitis. Methods: from November 2012 to November 2015, 28 inpatients with IC in Department of Digestive Medicine, Peking Union Union Hospital, were retrospectively analyzed. There were 28 patients with ulcerative colitis (UC) and 28 patients with Crohn's disease (CDD). The clinical manifestations, parenteral manifestations, complications, endoscopic features, histopathology, treatment methods and prognosis were compared. Results among 28 patients in the group of 10% IC, 18 cases were male and 64.3 years old, with an average onset age of 29.8 卤10.2 years. The main clinical manifestations were mucus stool in 23 cases, abdominal pain in 23 cases, diarrhea in 19 cases (67.9%), simple blood stool in 15 cases (53.66%) and fever in 15 cases (53.6%). The incidence of mucus blood stool was higher than that of CD82.1% in CD82.1% compared with 14.3P0. 000001%. The incidence of colonic lesions in simple blood stool group was 53.6% higher than that in group C (0 Pn002424.IC). The incidence rate was higher than that in CD group (32.1% vs 3.6p0. 01%), segmental lesion 28.6% vs 57.1%, ileal involvement 28.6% vs 71.4 P0. 001C, rectal pardon 25.0% vs 82.1% P0.00002) lower than CDIC segment lesion 28. 6% vs 0. 008, ileum involvement 28. 6% vs 3. 6m P0. 03. The incidence of rectum pardon was 25. 0% vs 0. 0P0. 02). The incidence of ileal involvement was 28. 6% vs 3. 66%. The incidence of rectal pardonement was 25. 0% vs 0. 0P0. 02). Although the total colonic lesion was 32.1% lower than that of UCU 32.1% vs 46.4%, the difference was not statistically significant. Parenteral manifestations, complications, The use rate of immunosuppressant in IC group was significantly lower than that in CDT group (57.1% vs 85.7%, higher than that in UCU 57.1% vs 32.1%), but there was no significant difference between IC group and UC group. The utilization rate of IFX (7.1% vs 53.6P+ 0.0002) and operation rate (25.0% vs 64.3P0.007) in IC group were significantly lower than those in UC group. Of the 28 cases with IC, only 2 cases were missing, and the average follow-up time was 30.0 卤12.9 months (5 cases).) during the follow-up, 2 cases (7. 7%) were diagnosed as CDCD. Conclusion while having both UC and CD characteristics, the fraction IC has its unique clinical features. IC can be rediagnosed as UC or CDduring the long term follow-up. It is very important to understand the clinical characteristics and prognosis of the disease for treatment and prognosis.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.62

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