Bojic D, Radojicic Z, Nedeljkovic-Protic M, Al-Ali M, Jewell D P, Travis S P L
Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
Inflamm Bowel Dis. 2009 Jun;15(6):823-8. doi: 10.1002/ibd.20843.
To determine the long-term outcome of patients admitted with acute severe colitis (ASC) who avoided colectomy on the index admission, a retrospective cohort study was performed.
Patients admitted for intensive treatment of ASC in 1992-1993 previously described for a predictive index of short-term outcome in severe ulcerative colitis (UC) were followed for a median 122 months (range 3-144). Complete responders (CR) to intensive therapy had <3 nonbloody stools/day on day 7 of the index admission; incomplete responders (IR) were all others who avoided colectomy on that admission. Main outcome measures were colectomy-free survival, time to colectomy, and duration of steroid-free remission.
In all, 6/19 CR (32%) came to colectomy compared to 10/13 IR (P = 0.016; relative risk 3.33, 95% confidence interval [CI] 1.12-9.9). The median +/- interquartile range time to colectomy was 28 +/- 47 months (range 6-99) for CR who came to colectomy versus 7.5 +/- 32 (3-72) months for IR (P = 0.118). Among the IR, 7/13 came to colectomy within 12 months, and all within 6 years from the index admission. The longest period of steroid-free remission was 42 +/- 48 (0-120) months for CR, but 9 +/- 20 (1-35) months for IR (P = 0.011).
One week after admission with ASC in the prebiologic era, IRs had a 50% chance of colectomy within a year and 70% within 5 years, despite cyclosporin and azathioprine where appropriate. The maximum duration of remission in CRs was almost 5 times longer than IRs. It is unknown whether biologics change the long-term outcome.
为了确定在首次入院时避免行结肠切除术的急性重症结肠炎（ASC）患者的长期预后，我们进行了一项回顾性队列研究。
对1992 - 1993年因ASC接受强化治疗的患者进行随访，这些患者先前曾被描述用于严重溃疡性结肠炎（UC）短期预后的预测指标，随访时间中位数为122个月（范围3 - 144个月）。对强化治疗的完全缓解者（CR）在首次入院第7天时每天非血性粪便少于3次；不完全缓解者（IR）是指在该次入院时避免行结肠切除术的其他所有患者。主要结局指标为无结肠切除生存率、至结肠切除的时间以及无类固醇缓解期的持续时间。
总共，19例CR中有6例（32%）接受了结肠切除术，而13例IR中有10例（P = 0.016；相对风险3.33，95%置信区间[CI] 1.12 - 9.9）。接受结肠切除术的CR至结肠切除的时间中位数±四分位间距为28±47个月（范围6 - 99个月），而IR为7.5±32（3 - 72）个月（P = 0.118）。在IR中，13例中有7例在12个月内接受了结肠切除术，且所有患者均在首次入院后6年内接受了手术。CR的最长无类固醇缓解期为42±48（0 - 120）个月，而IR为9±20（1 - 35）个月（P = 0.011）。
在生物制剂时代之前，ASC患者入院1周后，尽管酌情使用了环孢素和硫唑嘌呤，但IR患者在1年内有50%的结肠切除几率，5年内有70%的几率。CR患者的最长缓解期几乎是IR患者的5倍。生物制剂是否会改变长期预后尚不清楚。
