Meucci G, Vecchi M, Astegiano M, Beretta L, Cesari P, Dizioli P, Ferraris L, Panelli M R, Prada A, Sostegni R, de Franchis R
Dipartimento di Gastroenterologia, Ospedale Valduce, Como, Italy.
Am J Gastroenterol. 2000 Feb;95(2):469-73. doi: 10.1111/j.1572-0241.2000.t01-1-01770.x.
The aim of this study was to evaluate the clinical features and the long term evolution of patients with a well defined initial diagnosis of ulcerative proctitis.
Patients with an original diagnosis of ulcerative proctitis who had been seen at any of 13 institutions from 1989 to 1994 were identified. Data on disease onset and subsequent evolution were recorded. In addition, 575 patients with more extensive disease, treated in the same centers, were used as controls.
A total of 341 patients satisfied the inclusion criteria. The percentage of smokers in these patients was slightly lower than in controls; no differences were found in the other clinical/demographic variables evaluated. A total of 273 patients entered long term follow-up (mean, 52 months). Proximal extension of the disease occurred in 74 of them (27.1%). The cumulative rate of proximal extension and of extension beyond the splenic flexure was 20% and 4% at 5 yr and 54% and 10% at 10 yr, respectively. The risk of proximal extension was higher in nonsmokers, in patients with >3 relapses/yr, and in patients needing systemic steroid or immunosuppressive treatment. Refractory disease was confirmed as an independent prognostic factor at multivariate analysis.
Proximal extension of ulcerative proctitis is frequent and may occur even late after the original diagnosis. However, the risk of extension beyond the splenic flexure appears to be quite low. Smoking seems to be a protective factor against proximal extension, whereas refractoriness is a risk factor for proximal extension of the disease.
本研究旨在评估初诊明确的溃疡性直肠炎患者的临床特征及长期病情演变。
确定1989年至1994年期间在13家机构中任何一家就诊的初诊为溃疡性直肠炎的患者。记录疾病发作及后续病情演变的数据。此外，将在同一中心接受治疗的575例病情更广泛的患者作为对照。
共有341例患者符合纳入标准。这些患者中的吸烟者比例略低于对照组；在评估的其他临床/人口统计学变量中未发现差异。共有273例患者进入长期随访（平均52个月）。其中74例（27.1%）出现疾病近端扩展。疾病近端扩展及扩展至脾曲以外的累积发生率在5年时分别为20%和4%，在10年时分别为54%和10%。非吸烟者、每年复发>3次的患者以及需要全身使用类固醇或免疫抑制治疗的患者近端扩展风险更高。在多变量分析中，难治性疾病被确认为独立的预后因素。
溃疡性直肠炎的近端扩展很常见，甚至可能在初诊后很久才发生。然而，扩展至脾曲以外的风险似乎相当低。吸烟似乎是预防近端扩展的保护因素，而难治性是疾病近端扩展的风险因素。
