Mosele Marco, Cardin Fabrizio, Inelmen Eminè Meral, Coin Alessandra, Perissinotto Egle, Sergi Giuseppe, Terranova Oreste, Manzato Enzo
Department of Medical and Surgical Sciences, Division of Geriatrics, University of Padua, Padua, Italy.
Scand J Gastroenterol. 2010 Apr;45(4):428-33. doi: 10.3109/00365520903513225.
Ischemic colitis (IC) poses a challenge for physicians, especially in elderly patients. The aim of this study was to identify predictors of the disease and to assess the factors predicting its evolution in elderly people.
A retrospective study was undertaken in patients with IC admitted to Padua General Hospital between 2003 and 2008. Only patients with biopsy-proven IC were considered. Fifty control subjects were randomly selected from those seen at our units for acute geriatric disease during the same interval. Patients with IC were classified as having either a positive or negative outcome.
A total of 46 patients were considered. The risk factors for IC identified from univariate analysis were analyzed in a multivariate logistic regression model and constipation [adjusted odds ratio (OR) 4.8; 95% confidence interval (CI) 1.1-20.1], vasculopathy (OR 4.9; 95% CI 1.4-16.6), hepatitis C virus (HCV) (OR 9.9; 95% CI 1.1-92.9) and cancer (OR 7.5; 95% CI 2.1-26.9) confirmed their independent significance as risk factors. Hematochezia was predictive of a positive outcome (OR 0.07; 95% CI 0.02-0.40), while cancer (OR 3.2; 95% CI 1.2-11.9), HCV positivity (OR 9.6; 95% CI 1.6-56.5), signs of peritonism (OR 4.7; 95% CI 1.2-18.4), localization in the right colon (OR 5.75; 95% CI 1.5-21.9) and increased levels of lactate dehydrogenase (LDH) and urea were independently predictive of a negative outcome.
Elderly patients with IC are characterized by significant comorbidities. The absence of hematochezia and the presence of a concomitant malignancy, HCV, a marked increase in urea and LDH and disease involving only the right colon are factors that may predict a negative outcome in elderly patients.
缺血性结肠炎（IC）给医生带来了挑战，尤其是在老年患者中。本研究的目的是确定该疾病的预测因素，并评估预测老年人病情发展的因素。
对2003年至2008年期间入住帕多瓦综合医院的IC患者进行了一项回顾性研究。仅纳入经活检证实为IC的患者。在同一时期，从我们科室诊治的急性老年病患者中随机选取50名对照者。将IC患者分为预后阳性或阴性。
共纳入46例患者。单因素分析确定的IC危险因素在多因素逻辑回归模型中进行分析，便秘[调整优势比（OR）4.8；95%置信区间（CI）1.1 - 20.1]、血管病变（OR 4.9；95% CI 1.4 - 16.6）、丙型肝炎病毒（HCV）（OR 9.9；95% CI 1.1 - 92.9）和癌症（OR 7.5；95% CI 2.1 - 26.9）证实了它们作为危险因素的独立意义。便血可预测阳性预后（OR 0.07；95% CI 0.02 - 0.40），而癌症（OR 3.2；95% CI 1.2 - 11.9）、HCV阳性（OR 9.6；95% CI 1.6 - 56.5）、腹膜炎体征（OR 4.7；95% CI 1.2 - 18.4）、右半结肠病变（OR 5.75；95% CI 1.5 - 21.9）以及乳酸脱氢酶（LDH）和尿素水平升高独立预测阴性预后。
老年IC患者具有显著的合并症。无便血以及合并恶性肿瘤、HCV感染、尿素和LDH显著升高且病变仅累及右半结肠是可能预测老年患者预后不良的因素。
