Prantera C, Lorenzetti R
Department of Gastroenterology, Ospedale Nuovo Regina Margherita, Rome, Italy.
Hepatogastroenterology. 1989 Aug;36(4):240-3.
In the course of their disease about 15% of all ulcerative colitis patients have a severe attack with evidence of systemic toxicity. On the basis of our personal experience of a recent series of 46 patients, and of a review of the literature, several conclusions can be drawn. A number of more severe attacks (28 out of 46 patients in our series), defined as "fulminating" or "toxic" colitis, must be regarded as major determinants of complications and mortality (4.3% in our series). The disease severity and the presence of signs and symptoms of toxicity seem likely to be determined by the amount of colonic tissue involved by inflammation, both in depth and in extent. A number of laboratory abnormalities are frequently found in the acute phase of severe ulcerative colitis, but C-reactive protein appears the most reliable factor reflecting activity and extension of lesion. Patients with increased small intestinal gas and multiple air-fluid levels, seen on the abdominal plain film, even in the absence of megacolon, must be considered to be gravely ill and at high risk of complications and mortality. With regard to timing of surgery, a short period of medical management (72-120 hrs) is justified to exclude an infectious etiology, to prepare the patient for surgery, and to allow for improvement.
在溃疡性结肠炎患者病程中，约15%的患者会出现伴有全身中毒迹象的严重发作。基于我们近期对46例患者的个人经验以及文献回顾，可以得出几个结论。一些更严重的发作（我们系列中的46例患者中有28例），定义为“暴发性”或“中毒性”结肠炎，必须被视为并发症和死亡率的主要决定因素（我们系列中的死亡率为4.3%）。疾病的严重程度以及毒性体征和症状的出现似乎可能取决于炎症累及的结肠组织的量，包括深度和范围。在严重溃疡性结肠炎的急性期经常发现一些实验室异常，但C反应蛋白似乎是反映病变活动和范围的最可靠因素。即使没有巨结肠，在腹部平片上显示小肠气体增多和多个气液平面的患者，也必须被视为病情严重，并发症和死亡风险高。关于手术时机，进行短时间的内科治疗（72 - 120小时）是合理的，以排除感染性病因，为患者进行手术准备，并促进病情改善。
