| Background ulcerative colitis(UC) has been considered to be common in western countries in the past. However, several reports have shown that there is a trend towards an increasing trend in Asian countries and China in recent years.Few reports have been pubulished regarding the etiology,clinical characteristics, treatment and prognosis of UC, and there has been no domestic report on clinical features of UC in early age vs.adult hood vs. older age.Objective To analyze the clinical characteristics,treatment and prognosis of hospitalized UC patients in a tertiary hopistal of China, explore the traits of UC who was infected with cytomegalovirus(CMV) and clostridium difficile(Cd), analyzes the differences between different age groups.Methods Patients diagnosed with UC during the period fromJanuary2005to December2012in Peking Union Medical College Hospital were registerd and their clinical profiles including onset age,sex distribution,family history,severity,extent of disease,clinical course, extraenteral manifestations,cortisoteroid and immunosuppressant usage and so on were analyzed.Results There was an increasing trend in the number of cases from2005to2012, the peak onset age ranges in19-29. Male:female was1.41:1, median duration was38.5months, town population:rural population was2.28:1, the mental workers:manual worker was2.68:1.1.5%of patients had positive family history.Bloody stool, diarrhea, abdominal pain were the most common symptoms.19.5%of patients were graded as mild,29.8%as moderate,and47.4%as severe UC.The predominant form of UC was extensive colitis, which affected65.8%of the patients, left-sided colitis was present in23.5%and rectum was present in19.5%.In all cases,76.5%were chronic relapsing type,16.9%were first onset,5.1%were chronic persistent,and only0.7%were acute fulminant type.The proportion of atypical hyperplasia was3.0%.23.2%of patients had a history of smoking, smoking had no relationship with the severity, location, type of the diasease,and the usage of glucocorticoid and immunosuppressants. Extraenteral manifestaions (EIMs) were found in25.0%of UC patient, the most commomly involved system were the skin,mucous and the skeletal system.4.4%had the UC-related complications, perforation and intestinal obstruction were the most common.16.5%and6.3%of the UC patients were infected with CMV and Cd. Patients got infected with CMV had a larger propotion of severe,steroid resistant disease, and lower average serum albumin level. Patients onset at an early age had the higher family history of UC,while the old-age onset group were more likely to be smokers and had a predominant form of mild,rectum involved, first onset type,and had less immunosuppressant usage.Of272patients,93.4%were treated with salicylic acids,70.2%were treated with steriods,25.0%were treated with immumosuppressants. Severe UC were more likely to be treated with cyclosporine.Colectomy was performed in14.0%of UC patients,and the most common indication of sugery was ineffective treatment of medical therapy. Patient underwent surgery had lower level of blood hemoglobin(HGB), Albumin(Alb) and higher level of C react protein(CRP).1.5%of patients died, most of them died of infection.Conclusions There has been an increasing number of hospitalized UC in recent years,mostly with severe,extensive disease,and the major type of UC is chronic relapsing. The rate of family history was less common than the western countries,however,EIMs were seen in more patients than in the western patients. No relationship was found between smoking and severity of the disease.Severe disease,malnutrition was a predictor of CMV infection,and CMV infection can make the disease to be more complex and become steriod resistent. Screening tests of CMV and Cd infection are very important in UC patients.UC patients in PUMC had more steriod and immunosuppressant use,and colectomy rate was low. Severe disease,low level of HGB, Alb,high level of CRP and cyclosporine use were predictors of colectomy. |
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