Kim Bun, Park Soo Jung, Hong Sung Pil, Kim Tae Il, Kim Won Ho, Cheon Jae Hee
Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine , Seoul , Korea.
Scand J Gastroenterol. 2014 Feb;49(2):177-83. doi: 10.3109/00365521.2013.867360. Epub 2013 Dec 11.
Ulcerative colitis usually involves the rectum, may extend in a proximal and continuous fashion to involve varying portions of the bowel. However, the risk factors predictive of proximal extension have yet to be determined. The aim of this study was to evaluate both the natural course of disease and the risk factors influencing the proximal disease extension in ulcerative proctitis.
We retrospectively analyzed 98 patients with ulcerative proctitis at the time of diagnosis who were regularly followed and underwent sigmoidoscopy or colonoscopy between January 2000 and December 2007.
The mean duration of follow-up was 109.2 ± 49.5 months. A total of 27 (27.6%) patients experienced proximal disease extension. Mayo scores were significantly higher in the extension group compared with patients whose ulcerative proctitis did not extend proximally (p < 0.001). Corticosteroid use at initial diagnosis was also more frequent in the extension group (p = 0.026). In addition, chronic, continuous disease activation within 6 months of the initial diagnosis was significantly higher in the extension group (p < 0.001), as was disease relapse and the number of hospitalizations over the entire follow-up period (p < 0.001 and p = 0.002). According to multivariate analysis, disease extension after the initial diagnosis was associated with chronic disease activation, disease relapse and hospitalization (p = 0.030, p = 0.042 and p = 0.044, respectively).
Increased severity of disease upon diagnosis of ulcerative proctitis was associated with a higher probability of proximal disease extension during the follow-up period. Moreover, those with disease extension were more likely to experience relapse and to be hospitalized, indicating poor prognosis.
溃疡性结肠炎通常累及直肠，可能以向近端连续的方式扩展至肠道的不同部位。然而，预测近端扩展的危险因素尚未确定。本研究的目的是评估溃疡性直肠炎的疾病自然进程以及影响近端疾病扩展的危险因素。
我们回顾性分析了98例诊断为溃疡性直肠炎且在2000年1月至2007年12月期间定期随访并接受乙状结肠镜检查或结肠镜检查的患者。
平均随访时间为109.2±49.5个月。共有27例（27.6%）患者出现近端疾病扩展。与溃疡性直肠炎未向近端扩展的患者相比，扩展组的梅奥评分显著更高（p<0.001）。扩展组在初始诊断时使用皮质类固醇的频率也更高（p=0.026）。此外，扩展组在初始诊断后6个月内慢性、持续性疾病激活显著更高（p<0.001），整个随访期间的疾病复发和住院次数也是如此（p<0.001和p=0.002）。根据多变量分析，初始诊断后的疾病扩展与慢性疾病激活、疾病复发和住院相关（分别为p=0.030、p=0.042和p=0.044）。
溃疡性直肠炎诊断时疾病严重程度增加与随访期间近端疾病扩展的可能性更高相关。此外，疾病扩展的患者更可能经历复发和住院，提示预后不良。
