發(fā)布時間：2018-02-22 11:54

  本文關(guān)鍵詞： 潰瘍性結(jié)腸炎 臨床特點(diǎn) 復(fù)發(fā) 危險因素　出處：《鄭州大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討潰瘍性結(jié)腸炎(uleerativecolitis,UC)的臨床特點(diǎn),并對該病復(fù)發(fā)及其危險因素進(jìn)行分析,以增進(jìn)UC的診治水平,并為臨床制定治療和預(yù)后方案提供依據(jù)。方法:對2011年8月~2014年8月本院收治的112例潰瘍性結(jié)腸炎患者臨床資料進(jìn)行回顧性研究,通過對患者的年齡、性別、發(fā)病部位、病程、臨床表現(xiàn)、腸鏡、病理檢查、實(shí)驗(yàn)室檢查、腸外癥狀、治療方法、隨訪資料等相關(guān)數(shù)據(jù)資料進(jìn)行統(tǒng)計分析,從而對UC的臨床特點(diǎn)、治療、復(fù)發(fā)及其危險因素進(jìn)行全面的研究。結(jié)果:112例UC患者中,男性60例,女性52例,男女比例為1.15:1;發(fā)病年齡為41.2±11.3歲,30~39歲和50~59歲兩個年齡段為UC的兩個發(fā)病高峰;病程小于5年的有73例,5~10年有23例,大于10年16例;臨床表現(xiàn)主要以消化系統(tǒng)癥狀為主,如腹瀉(94.6%)、黏液膿血便(82.1%)和腹痛(78.6%);全身癥狀以體重下降(35.7%)、發(fā)熱(20.5%)和乏力(10.7%)為主;23.2%的患者具有腸外表現(xiàn),主要癥狀為關(guān)節(jié)疼痛(7.1%)、口腔病變(10.7%)和皮膚病變(5.4%);27.7%的患者發(fā)病部位為直腸型,25.0%為左半結(jié)腸型,2.7%為廣泛結(jié)腸型;病情程度:25.0%為輕度,45.5%為中度,20.5%為重度;按發(fā)病類型75.0%為慢性復(fù)發(fā)型,15.2%為初發(fā)型,6.3%為慢性持續(xù)型,3.6%為急性暴發(fā)型;腸鏡檢查表現(xiàn)主要以腸黏膜彌漫性充血水腫或伴有糜爛性淺潰瘍?yōu)橹?分別占81.3%和76.8%;腸黏膜病理活檢83.9%患者呈現(xiàn)急慢性炎癥病變,另有1例發(fā)展為結(jié)腸癌;實(shí)驗(yàn)室檢查結(jié)果顯示112潰瘍性結(jié)腸炎患者中血小板計數(shù)、C反應(yīng)蛋白和紅細(xì)胞沉降率的升高率分別為54.5%(61/112)、16.1%(18/112)和22.3%(25/112),而血紅蛋白和白蛋白的下降率分別為46.4%(52/112)與33.0%(37/112),并且重度UC患者的血小板計數(shù)、C反應(yīng)蛋白和紅細(xì)胞沉降率與中度和輕度UC患者均有顯著差異(P0.05)。108例患者通過單純內(nèi)科藥物治療病情均得到緩解,緩解率達(dá)到100%,4例患者內(nèi)科治療無效轉(zhuǎn)入外科手術(shù)治療;預(yù)后隨訪分析結(jié)果顯示58.9%的患者出現(xiàn)病情復(fù)發(fā),單因素分析和Logistic回歸分析顯示年齡、病程、未維持治療和腸外表現(xiàn)是UC復(fù)發(fā)的危險因素。結(jié)論:本研究顯示潰瘍性結(jié)腸炎患者平均發(fā)病年齡為41.2歲,男女比例相當(dāng)。病變部位以直腸、乙狀結(jié)腸和左半結(jié)腸為主,臨床主要表現(xiàn)為腹瀉、黏液膿血便和腹痛等癥狀,結(jié)腸鏡下主要表現(xiàn)為腸黏膜彌漫性充血水腫、糜爛或伴潰瘍形成。病理活檢主要為炎性病變。潰瘍性結(jié)腸炎患者血小板計數(shù)(PLT)、C反應(yīng)蛋白水平(CRP)、紅細(xì)胞沉降率(ESR)、血紅蛋白(HGB)和白蛋白(ALB)等指標(biāo)可作為UC診斷和分期分型標(biāo)準(zhǔn)。108例UC患者可以通過單純藥物治療使病情得到緩解,但是具有較高的復(fù)發(fā)率,年齡、病程、維持治療和腸外表現(xiàn)等是UC復(fù)發(fā)的危險因素。
[Abstract]:Objective: to investigate the clinical features of ulcerative colitis (UC), and to analyze the recurrence and risk factors of UC, so as to improve the diagnosis and treatment of UC. Methods: the clinical data of 112 patients with ulcerative colitis from August 2011 to August 2014 were retrospectively studied. Clinical manifestations, enteroscopy, pathological examination, laboratory examination, extraintestinal symptoms, treatment methods, follow-up data and other related data were statistically analyzed, so as to analyze the clinical characteristics and treatment of UC. Results among 112 UC patients, 60 were male, 52 were female, the ratio of male to female was 1.15: 1, the age of onset was 41.2 鹵11.3 years old, 30 ~ 39 years old and 50 ~ 59 years old were two peaks of UC. There were 73 cases with disease course less than 5 years, 23 cases with 5 ~ 10 years, 16 cases with more than 10 years, and the main clinical manifestations were digestive system symptoms. For example, the patients with diarrhea (94. 6) and mucus abscess (82. 1) and abdominal pain (78. 6); the symptoms of the whole body included weight loss (35. 7%), fever (20. 5%) and fatigue (10. 7%).) 23.2% of the patients had extraintestinal symptoms. The main symptoms were as follows: articular pain was 7.1%, oral lesion 10.7%) and skin lesion 5.4B 27.7% of the patients were rectum type 25.0%, left hemicolon type 2.7%, degree of disease: 25.0%, mild grade, 45.5%, moderate, 20.5%, severe. According to the type of disease 75.0%, 15. 2% of the patients were chronic recurrent type, 6. 3% were chronic persistent type and 3. 6% were acute fulminant type, the main findings of colonoscopy were diffuse hyperemia and edema of intestinal mucosa or superficial ulcer with erosion. The pathological biopsy of intestinal mucosa showed acute and chronic inflammation in 83.9% patients, and one patient developed colon cancer. Laboratory tests showed that the elevated rates of platelet count C reactive protein and erythrocyte sedimentation rate in 112 patients with ulcerative colitis were 54.5b / 61.1 / 16.1 / 112) and 22.33n / 25 / 112 / 112, respectively, while the decrease rates of hemoglobin and albumin were 46.452 / 112) and 33.0 / 37112 / 12, respectively, and severe UC. There were significant differences in platelet count, C-reactive protein and erythrocyte sedimentation rate between patients with moderate and mild UC and patients with mild UC. The remission rate was 100% and 4 cases were transferred to surgical treatment, the results of prognostic follow-up analysis showed that 58.9% of the patients had relapse, and univariate analysis and Logistic regression analysis showed age and course of disease. Unsustained treatment and parenteral manifestations were risk factors for UC recurrence. Conclusion: the average age of ulcerative colitis is 41.2 years old and the ratio of male and female is the same. The lesions are mainly located in rectum, sigmoid colon and left hemicolon. The main clinical manifestations were diarrhea, mucus purulent stool and abdominal pain, and the main manifestations under colonoscopy were diffuse hyperemia and edema of intestinal mucosa. In patients with ulcerative colitis, the platelet count and the level of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin HGBs (HGB) and Albumin (ALB) can be used as indicators for the diagnosis and classification of UC. Stage classification criteria. 108 patients with UC can be relieved by drug therapy alone. However, high recurrence rate, age, course of disease, maintenance treatment and parenteral manifestations were risk factors for UC recurrence.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R574.62

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本文編號：1524346