皮质类固醇的短期临床反应可预测溃疡性结肠炎的长期自然病程：前瞻性研究经验
Short-Term Clinical Response to Corticosteroids Can Predict Long-Term Natural History of Ulcerative Colitis: Prospective Study Experience.
作者信息
Rai Tarun, Choudhury Bikash Narayan, Kedia Saurabh, Bopanna Sawan, Venigalla Pratap Mouli, Garg Sushil Kumar, Singla Vikas, Makharia Govind, Ahuja Vineet
机构信息
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No. 3111, Third Floor, Teaching Block, New Delhi, 110029, India.
出版信息
Dig Dis Sci. 2017 Apr;62(4):1025-1034. doi: 10.1007/s10620-017-4450-0. Epub 2017 Feb 4.
BACKGROUND
Long-term outcome and natural history of steroid response in adult ulcerative colitis patients based on short-term response is largely unknown.
AIM
To evaluate whether short-term clinical response at 30 days after steroid initiation for moderate to severe disease can predict long-term outcome.
METHODS
This prospective observational study recruited 161 patients who received oral/intravenous steroid therapy at our institution from April 2005 to July 2009. Short-term response at 30 days and long-term response at the end of first and third years were measured. Risk factors for long-term outcome at 1 and 3 years were analyzed by multivariate regression model.
RESULTS
At the end of 30 days, 90 patients (55.9%) had complete response, 47 (29.2%) partial response, and 24 (14.9%) did not respond at all. At the end of first year, 53/90 (60%) complete responders (at 30 days) maintained steroid-free remission when compared to 17/71 (23.9%, p < 0.001) partial/no responders. Similar result was observed at the end of third year (74.7 vs 55.1%, p = 0.017). On multivariable analysis, short-term outcome at 30 days was a predictor of outcome at the end of one year (RR 4.1, 95% CI 2.2-8.5) and 3 years (RR 2.1, 95% CI 1.02-4.5).
CONCLUSIONS
Short-term response to steroids is a strong predictor of long-term outcome at 1 and 3 years in active ulcerative colitis patients.
背景
基于短期反应的成年溃疡性结肠炎患者类固醇反应的长期结局和自然病史在很大程度上尚不清楚。
目的
评估中度至重度疾病患者在开始使用类固醇30天后的短期临床反应是否能预测长期结局。
方法
这项前瞻性观察性研究招募了2005年4月至2009年7月在我们机构接受口服/静脉类固醇治疗的161例患者。测量了30天的短期反应以及第一年末和第三年末的长期反应。通过多变量回归模型分析了1年和3年长期结局的危险因素。
结果
在30天结束时，90例患者（55.9%）有完全反应，47例（29.2%）部分反应，24例（14.9%）无反应。在第一年末，53/90（60%）的完全反应者（30天时）维持了无类固醇缓解，而部分/无反应者为17/71（23.9%，p<0.001）。在第三年末观察到类似结果（74.7%对55.1%，p=0.017）。多变量分析显示，30天的短期结局是1年末（RR 4.1，95%CI 2.2-8.5）和3年末（RR 2.1，95%CI 1.02-4.5）结局的预测因素。
结论
在活动性溃疡性结肠炎患者中，类固醇的短期反应是1年和3年长期结局的有力预测因素。
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