口服皮质类固醇激素抵抗的活动期溃疡性结肠炎的临床转归和预测因素。
Clinical outcomes and predictive factors in oral corticosteroid-refractory active ulcerative colitis.
机构信息
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
出版信息
World J Gastroenterol. 2013 Jan 14;19(2):265-73. doi: 10.3748/wjg.v19.i2.265.
AIM
To evaluate the clinical outcomes and prognostic factors after intravenous corticosteroids following oral corticosteroid failure in active ulcerative colitis patients.
METHODS
Consecutive patients with moderate to severe ulcerative colitis who had been treated with a course of intravenous corticosteroids after oral corticosteroid therapy failure between January 1996 and July 2010 were recruited at Severance Hospital, Seoul, South Korea. The disease activity was measured by the Mayo score, which consists of stool frequency, rectal bleeding, mucosal appearance at flexible sigmoidoscopy, and Physician Global Assessment. We retrospectively evaluated clinical outcomes at two weeks, one month, three months, and one year after the initiation of intravenous corticosteroid therapy. Two weeks outcomes were classified as responders or non-responders. One month, three month and one year outcomes were classified into prolonged response, steroid dependency, and refractoriness.
RESULTS
Our study included a total of 67 eligible patients. At two weeks, 56 (83.6%) patients responded to intravenous corticosteroids. At one month, complete remission was documented in 18 (32.1%) patients and partial remission in 26 (46.4%). Eleven patients (19.7%) were refractory to the treatment. At three months and one year, we found 37 (67.3%) and 25 (46.3%) patients in prolonged response, ten (18.2%) and 23 (42.6%) patients in corticosteroid dependency, 8 (14.5%) and 6 (11.1%) patients with no response, respectively. Total 9 patients were underwent elective proctocolectomy within 1 year. The duration of oral corticosteroid therapy (> 14 d vs ≤ 14 d, P = 0.049) and lower hemoglobin level (≤ 11.0 mg/dL vs >11.0 mg/dL, P = 0.02) were found to be poor prognostic factors for response at two weeks. For one year outcome, univariate analysis revealed that only a partial Mayo score (≥ 6 vs <6, P = 0.057) was found to be associated with a poor response.
CONCLUSION
The duration of oral corticosteroid therapy and lower hemoglobin level were strongly associated with poor outcome.
目的
评估溃疡性结肠炎患者口服皮质类固醇治疗失败后静脉用皮质类固醇治疗的临床转归和预后因素。
方法
本研究连续纳入了 1996 年 1 月至 2010 年 7 月在韩国首尔 Severance 医院接受静脉用皮质类固醇治疗的中重度溃疡性结肠炎患者。疾病活动度采用 Mayo 评分评估，包括粪便频率、直肠出血、乙状结肠镜下黏膜表现和医生总体评估。我们回顾性评估了静脉用皮质类固醇治疗开始后两周、一个月、三个月和一年的临床转归。两周的转归分为应答者和无应答者。一个月、三个月和一年的转归分为延长应答、皮质类固醇依赖和难治性。
结果
本研究共纳入 67 例符合条件的患者。两周时，56 例（83.6%）患者对静脉用皮质类固醇有应答。一个月时，18 例（32.1%）患者完全缓解，26 例（46.4%）患者部分缓解。11 例（19.7%）患者对治疗无反应。三个月和一年时，我们发现 37 例（67.3%）和 25 例（46.3%）患者有延长应答，10 例（18.2%）和 23 例（42.6%）患者有皮质类固醇依赖，8 例（14.5%）和 6 例（11.1%）患者无应答。共有 9 例患者在 1 年内接受了择期结肠切除术。两周时，口服皮质类固醇治疗时间（>14d 与≤14d，P=0.049）和较低的血红蛋白水平（≤11.0mg/dL 与>11.0mg/dL，P=0.02）是应答不良的预后因素。单因素分析显示，只有部分 Mayo 评分（≥6 与<6，P=0.057）与一年的不良转归相关。
结论
口服皮质类固醇治疗时间和较低的血红蛋白水平与不良预后密切相关。
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