Clinical outcome of ulcerative colitis in children
Clinical outcome of ulcerative colitis in children
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DOI：
10.1016/s0022-3476(96)70193-2
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发表时间：
1996-07-01
影响因子：
5.1
通讯作者：
Markowitz, J
中科院分区：
文献类型：
--
作者：
Hyams, JS;Davis, P;Markowitz, J
目的：了解儿童溃疡性结肠炎患者对当前药物治疗的反应，并确定可能预测需要结肠切除术的因素。设计：回顾性分析两个大型儿童炎症性肠病中心的图表。结果：我们确定了171名受试者，诊断时年龄从1.5岁到17.7岁（平均11.2岁）。平均随访5.1年。在这些受试者中，43%的人在就诊时患有轻度疾病，57%的人患有中度或重度疾病。治疗后6个月，前一组90%，后一组81%症状缓解。在随后的任何年度随访期间，大约55%的整个研究人群无症状，38%有慢性间歇性症状，7%有持续症状。与中度/重度疾病患者相比，轻度疾病患者结肠切除术的风险明显降低。1年时，轻度疾病患者结肠切除术的风险为1%，中度/重度疾病患者为8%；5年时，轻度疾病组结肠切除术的风险为9%，而中度/重度疾病组为26% （p < 0.03）。结论：大多数儿童溃疡性结肠炎患者在治疗后的前6个月内得到缓解；此后，在任何一年的随访中，约有50%的患者病情不活跃。在前5年的随访中，发病时疾病的严重程度是结肠切除术的重要危险因素。对于中度/重度疾病的儿童，未来的管理方案可能需要更积极的初始治疗。
Objectives: To characterize the response to current medical therapies in children with ulcerative colitis, and to identify those factors that may predict the need for colectomy.Design: Retrospective chart review at two large pediatric inflammatory bowel disease centers.Results: We identified 171 subjects ranging in age from 1.5 to 17.7 years at diagnosis (mean 11.2 years). Mean follow-up was 5.1 years. Of these subjects, 43% had mild disease at presentation and 57% had disease that was classified as moderate or severe. After treatment 90% of the former group and 81% of the latter group had resolution of symptoms by 6 months. During any subsequent yearly follow-up interval, approximately 55% of the entire study population was symptom free, 38% had chronic intermittent symptoms, and 7% had continuous symptoms. A significantly lower risk of colectomy was noted for those with initially mild disease compared with those with moderate/severe disease. At I-year the risk of colectomy was 1% among those with mild disease versus 8% with moderate/severe disease; at 5 years, the risk of colectomy was 9% in the mild disease group versus 26% in the moderate/severe disease group (p < 0.03).Conclusions: In the majority of pediatric subjects with ulcerative colitis remission is achieved in the first 6 months after therapy; thereafter disease is inactive in about 50% of patients during any given year of follow-up. Severity of disease at presentation is a significant risk factor for colectomy during the first 5 years of follow-up. Future management protocols with more aggressive initial therapy may be warranted in children with moderate/severe disease.