目的:了解初发型溃疡性结肠炎患者经过规范化治疗后的长期病程演变,并分析复发的相关因素.方法:筛选初发型溃疡性结肠炎经过规范化治疗并接受长期随访(≥5年)患者共37例.分析其临床表现、内镜及病理结果、复发情况.结果:37例初发型溃疡性结肠炎患者中,首次规范化治疗的完全缓解率为27％,部分缓解率为73％,有效率为100％.1年复发率为35.14％,5年复发率为83.78％.首诊病情为中、重度者5年复发率为88.24％及 100％,高于轻度者77.78％(P＜0.05).发病年龄小于50岁者复发率为90％,发病年龄大于50岁者为82.35％(P＜0.05).首诊时全结肠炎的患者复发率为100％,较病变局限的患者更易复发(P＜0.05).复发组中49％的患者对维持治疗具有良好依从性,显著低于无复发组的67％(P＜0.05).饮食不当是疾病复发的主要诱因(41.94％),其次为情绪因素.结论:初发型溃疡性结肠炎经规范化治疗后,首次治疗有效率高,维持治疗有助于减少复发.发病年龄、病情严重程度、病变范围是复发的相关因素,对维持治疗依从性差、饮食不当和心理因素是复发的危险因素.%Objective: To analyze the prognosis of ulcerative cditis (UC) patients following standardized therapeutic procedures and the risk factors associated to relapse. Methods: 37 patients were treated by standardized therapeutic procedures and with adherence to the long-term follow-up (≥5 years). Clinical characteristics, endoscopic and pathologic data of these 37 patients were analyzed. Results: Following initial treatment, complete remission was achieved in 27/37(73%) patients, partial remission rate was achieved in 10/37(27%) patients, effective rate was achieved in 100%. In these patients, 1-year and 5-year recurrence rates were 35.14% and 83.78% respectively. Recurrence was more frequent in severe patients (100%) (P<0.05), that in those with early onset (<50-year old) was 90% (P<0.05) and that in those with pancolitis was 100% (P<0.05). Compared to relapsing-free group(67%), relapsing patients showed significantly low adherence to the maintenance therapy (49%). Poor diet was the major cause leading to relapse (41.94%), followed by emotional factors. Conclusion: The standardized therapeutic procedure is effective to induce initial response in newly diagnosed UC patients. Severity, age of onset, the extent of disease, low adherence to the maintenance therapy and poor diet are associated to the recurrence of the disease. Poor diet and emotional factors are the major cause leading to relapse.
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