Fleshner Phillip, Ippoliti Andrew, Dubinsky Marla, Ognibene Steven, Vasiliauskas Eric, Chelly Marjorie, Mei Ling, Papadakis Konstantinos A, Landers Carol, Targan Stephan
Division of Colon and Rectal Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Clin Gastroenterol Hepatol. 2007 Aug;5(8):952-8; quiz 887. doi: 10.1016/j.cgh.2007.03.020. Epub 2007 Jun 4.
BACKGROUND & AIMS: Although acute pouchitis (AP) after ileal pouch-anal anastomosis (IPAA) for UC is common and easily treated, chronic pouchitis (CP) remains a difficult management issue. The aim of this study was to identify important clinical risk factors associated with AP or CP.
AP and CP were prospectively assessed, and demographic, disease, and treatment characteristics were tabulated. Univariate and multivariate analyses were performed to evaluate associations between AP or CP and potential risk factors.
Two hundred IPAA patients were followed for a median of 24 months (range, 3-117 months). Thirty-six patients (18%) developed AP, and 23 patients (12%) developed CP. On univariate analysis, the use of steroids before colectomy and smoking were associated with the development of AP. CP was associated with male gender, smoking, length of follow-up, extraintestinal manifestations, backwash ileitis, and elevated (450x10(9)/L) platelet count. On multivariate analysis, the following risk factors were found to be independently associated with AP: use of steroids before colectomy (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5-8.9; P = .004) and smoking (OR, 2.3; 95% CI, 1.1-5.3; P = .04). CP was directly associated with extraintestinal manifestations (OR, 3.5; 95% CI, 1.1-11.1; P = .03), elevated platelet count (OR, 3.1; 95% CI, 1.1-8.9; P = .03), and increased length of follow-up (OR, 1.3; 95% CI, 1.1-1.6; P = .002). Smoking reduced the incidence of CP (OR, 0.2; 95% CI, 0.05-0.74; P = .04).
Clinical factors associated with AP included use of steroids before colectomy and smoking. Factors directly related to CP were extraintestinal manifestations, elevated platelet count, and length of follow-up after IPAA. Smoking appears to protect against the development of CP.
尽管溃疡性结肠炎（UC）行回肠储袋肛管吻合术（IPAA）后急性储袋炎（AP）很常见且易于治疗，但慢性储袋炎（CP）仍然是一个难以处理的问题。本研究的目的是确定与AP或CP相关的重要临床风险因素。
对AP和CP进行前瞻性评估，并将人口统计学、疾病和治疗特征制成表格。进行单因素和多因素分析以评估AP或CP与潜在风险因素之间的关联。
200例IPAA患者的中位随访时间为24个月（范围3 - 117个月）。36例患者（18%）发生AP，23例患者（12%）发生CP。单因素分析显示，结肠切除术前使用类固醇和吸烟与AP的发生有关。CP与男性、吸烟、随访时间、肠外表现、反流性回肠炎以及血小板计数升高（>450×10⁹/L）有关。多因素分析发现，以下风险因素与AP独立相关：结肠切除术前使用类固醇（比值比[OR]，3.7；95%置信区间[CI]，1.5 - 8.9；P = 0.004）和吸烟（OR，2.3；95% CI，1.1 - 5.3；P = 0.04）。CP与肠外表现（OR，3.5；95% CI，1.1 - 11.1；P = 0.03）、血小板计数升高（OR，3.1；95% CI，1.1 - 8.9；P = 0.03）以及随访时间延长（OR，1.3；95% CI，1.1 - 1.6；P = 0.002）直接相关。吸烟降低了CP的发生率（OR，0.2；95% CI，0.05 - 0.74；P = 0.04）。
与AP相关的临床因素包括结肠切除术前使用类固醇和吸烟。与CP直接相关的因素是肠外表现、血小板计数升高以及IPAA后的随访时间。吸烟似乎可预防CP的发生。
