Gastroenterology Department, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, WA, 6008, Australia.
Gastroenterology Department, Lady Cilento Hospital, Brisbane, 4101, Australia.
Dig Dis Sci. 2019 Jul;64(7):1929-1937. doi: 10.1007/s10620-019-05486-w. Epub 2019 Feb 7.
Initial response to corticosteroids (CS) is recognized as a strong predictor of outcomes in ulcerative colitis (UC).
To compare outcomes of early poor responders (PR) versus good responders (GR) to initial CS at 1, 2, and 3 years from diagnosis.
In this retrospective study, we report longitudinal outcomes of children with moderate-severe UC, initiating oral/IV CS < 1 month of diagnosis and a minimum follow-up (FU) of 1 year. CS resistance (CSR) and CS dependency (CSD) were combined as PR, and those with CS-free remission (CSFR) at 6 months were GR.
Of 116 children with UC, 76 (33 males) fulfilled study criteria. Median age at diagnosis was 12 years (IQR 12-14), and a median FU was 48 months (IQR 27-65). Thirty-five (46%, CSR = 10, CSD = 25) were PR, and 41 (54%) were GR. Mean relapse (2.39 vs. 1.1, p = 0.0009), acute severe UC flare-up (40% vs. 9.7%, p = 0.002), and colectomy rates (34.2% vs. 2.4%) were greater in PR versus GR, despite frequent early (< 6 months) use of azathioprine (74% vs. 27%, p = 0.004) and anti-TNFs (43% vs. 2.4%, p = 0.0001). Cumulative colectomy at 3 years was lowest in those with GR versus CSD and CSR (2.4% vs. 28% and 50% p = 0.001). On univariate analysis, CRP > 20 mg/L at diagnosis, Mayo Clinical Score > 1 at 3 months, and PR predicted colectomy. On multivariate regression, only baseline CRP > 20 mg/L predicted colectomy (HR 4.9, p = 0.03).
Baseline CRP and poor response to initial CS are associated with unfavorable outcomes in children with UC.
溃疡性结肠炎（UC）患者对皮质类固醇（CS）的初始反应被认为是其预后的强有力预测因素。
比较初治时对 CS 早期不良反应（PR）和良好反应（GR）患者在诊断后 1、2、3 年的结局。
在这项回顾性研究中，我们报告了在诊断后 1 个月内接受口服/静脉 CS 治疗且随访时间至少 1 年的中重度 UC 儿童的纵向结局。CS 抵抗（CSR）和 CS 依赖（CSD）合并为 PR，6 个月时 CS 缓解（CSFR）者为 GR。
116 例 UC 患儿中，76 例（33 例男性）符合研究标准。诊断时的中位年龄为 12 岁（IQR 12-14），中位随访时间为 48 个月（IQR 27-65）。35 例（46%，CSR=10，CSD=25）为 PR，41 例（54%）为 GR。PR 组的复发率（2.39 比 1.1，p=0.0009）、急性重度 UC 发作率（40%比 9.7%，p=0.002）和结肠切除术率（34.2%比 2.4%）均高于 GR 组，尽管 PR 组更频繁地早期（<6 个月）使用硫唑嘌呤（74%比 27%，p=0.004）和抗 TNF 药物（43%比 2.4%，p=0.0001）。在诊断时 CRP>20mg/L、3 个月时 Mayo 临床评分>1 以及 PR 均与结肠切除术相关。多变量回归分析显示，只有基线 CRP>20mg/L 与结肠切除术相关（HR 4.9，p=0.03）。
在 UC 患儿中，基线 CRP 和对初始 CS 的不良反应与不良结局相关。
