Gustavsson Anders, Halfvarson Jonas, Magnuson Anders, Sandberg-Gertzén Hanna, Tysk Curt, Järnerot Gunnar
Division of Gastroenterology, Department of Medicine, Orebro University Hospital, Orebro, Sweden.
Am J Gastroenterol. 2007 Nov;102(11):2513-9. doi: 10.1111/j.1572-0241.2007.01435.x. Epub 2006 Aug 4.
Corticosteroids are a cornerstone in the treatment of a severe attack of ulcerative colitis (UC). The long-term prognosis in this patient group is not well described. We studied the long-term colectomy and relapse rates in patients given intensive intravenous corticosteroid treatment (IIVT) for acute UC.
A retrospective clinical study of 158 patients with UC treated in 1975-1982 with IIVT. Patients were followed-up to death, colectomy or last visit.
A total of 11 patients were excluded due to change of diagnosis (N = 10) or lost to follow-up (N = 1). The indication for index IIVT in the remaining 147 patients was a severe attack (N = 61), a moderately severe attack (N = 45), a mild attack (N = 29) or chronic continuous disease (N = 12). The median (range) duration of follow-up was 173 (4-271) months in patients escaping colectomy during the first 3 months. Three months after IIVT, the colectomy rates were 28/61 (46%) in a severe attack, 4/45 (9%) in a moderately severe, and 1/29 (3%) in a mild attack. After 10 yr, the colectomy rates were 39/61 (64%), 22/45 (49%), and 8/29 (28%), respectively. During follow-up, neither colectomy incidence beyond 3 months, time to first relapse nor relapse incidence was influenced by severity of initial attack, except for a lower relapse incidence after a severe attack.
In patients escaping colectomy during the first 3 months after IIVT, the future prognosis was similar irrespective of initial disease severity.
皮质类固醇是治疗溃疡性结肠炎（UC）严重发作的基石。该患者群体的长期预后尚无充分描述。我们研究了接受强化静脉注射皮质类固醇治疗（IIVT）的急性UC患者的长期结肠切除术和复发率。
对1975年至1982年接受IIVT治疗的158例UC患者进行回顾性临床研究。对患者进行随访直至死亡、结肠切除术或最后一次就诊。
共有11例患者因诊断改变（n = 10）或失访（n = 1）被排除。其余147例患者首次IIVT的指征为严重发作（n = 61）、中度严重发作（n = 45）、轻度发作（n = 29）或慢性持续疾病（n = 12）。在最初3个月内未接受结肠切除术的患者中，随访的中位（范围）持续时间为173（4 - 271）个月。IIVT后3个月，严重发作患者的结肠切除率为28/61（46%），中度严重发作患者为4/45（9%），轻度发作患者为1/29（3%）。10年后，结肠切除率分别为39/61（64%）、22/45（49%）和8/29（28%）。在随访期间，除严重发作后复发率较低外，3个月后的结肠切除发生率、首次复发时间或复发发生率均不受初始发作严重程度的影响。
在IIVT后最初3个月内未接受结肠切除术的患者中，无论初始疾病严重程度如何，未来预后相似。
