Department of Medicine, Alimentary Pharmabiotic Centre, Cork University Hospital, University College Cork, National University of Ireland, Wilton, Cork, Ireland.
Ir J Med Sci. 2012 Mar;181(1):65-71. doi: 10.1007/s11845-011-0760-y. Epub 2011 Sep 24.
Health care planning demands a detailed knowledge of the course of chronic diseases in the Irish population. This study describes hospital admission rates, medication use and outcomes in a large cohort of patients with ulcerative colitis attending a tertiary referral centre in Ireland.
Four hundred and twenty-four patients who attended during the 18-year period from January 1991 to January 2009 were identified. Baseline demographics, hospital admission, medications required, extent of colitis and date of colectomy were recorded.
More than half (55.4%) of the patients were managed exclusively in an outpatient setting throughout diagnosis and follow-up. Systemic corticosteroids, thiopurines and infliximab were required by 70, 29.5 and 5% of the patients, respectively. Overall 5-year colectomy rate due to failure of medical therapy was 15.8%. Independent predictors of colectomy were hospital admission at first presentation (odds ratio 3.6, p < 0.0001) and pancolitis at diagnosis (odds ratio 2.3, p < 0.01).
The majority of patients with colitis have an uncomplicated disease course and do not require thiopurines, biologic agents or hospital admission. Principal management at a primary care level may be appropriate in many cases. Colectomy rates at a specialist centre in Ireland compare favourably with international figures.
医疗保健规划需要详细了解爱尔兰人群中慢性病的病程。本研究描述了在爱尔兰一家三级转诊中心就诊的大量溃疡性结肠炎患者的住院率、药物使用和结局。
从 1991 年 1 月至 2009 年 1 月的 18 年期间，确定了 424 名就诊患者。记录了基线人口统计学、住院、所需药物、结肠炎程度和结肠切除术日期。
超过一半（55.4%）的患者在整个诊断和随访期间仅在门诊接受治疗。分别有 70%、29.5%和 5%的患者需要全身皮质类固醇、硫嘌呤和英夫利昔单抗。由于药物治疗失败，总体 5 年结肠切除术率为 15.8%。结肠切除术的独立预测因素为首次就诊时住院（优势比 3.6，p<0.0001）和诊断时全结肠炎（优势比 2.3，p<0.01）。
大多数结肠炎患者的疾病过程较为简单，不需要硫嘌呤、生物制剂或住院治疗。在许多情况下，初级保健一级的主要管理可能是合适的。爱尔兰一家专科中心的结肠切除术率与国际数据相比情况较好。
