| ObjectiveThis restropective analyzed the cause, pathogenesis, clinical characteristics and effect of treatment of hospitalized patients with ulcerative colitis (UC) in The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine for 10 years. This study helps improve the understanding of the disease, as well as improve the patient’s quality of life.MethodA total of 179 hospitalized patients with UC were admitted at the Spleen-Stomach Department in The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from January,2004 to December,2013 and were retrospectively investigated and their clinical characteristics were analyzed.ResultsThe patients with UC showed a rising trend year by year in The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. A male/female ratio of 1.00/0.97 was found in the 179 patients within the ages of 12-84 years old, an average age of 48.88 ± 16.93 years at diagnosis. Patients with the highest UC levels were between the ages of 20-40 and 41-60.The patients with mental labor were more than that with physical labor. The study showed that there was a statistically significant difference between the patients who lived in urban (86.0%) and rural (14.0%)areas (P< 0.001). The pathogenetic seasons were mainly winter and summer. Of the patients, 15.1% had a clear history of allergies,67.0% had a combination with other diseases, of which is mainly combined with digestive system diseases. Relative factors of pathogenesis were mainly due to diet (20.1%) and smoking (14.6%), of which were mainly drinking (13.4%), eating spicy hot foods (7.3%) and over 10 years smoking (12.8%).62.6% of the patients had a disease duration of less than 1 year, while the average disease duration is 2.37 ± 4.00 years. Mode of pathogenesis was usually acute(60.3%). There was a statistically significant difference between the mode of pathogenesis in the different periods of disease (P< 0.001).Clinical symptoms of UC:The predominant complaints of patients with digestive system symptoms were abdominal pain (82.1%), bloody stools (68.7%), mucus stools (66.5%), diarrhea (45.3%), poor appetite (46.4%), pain defecation-then remission (25.1%), borborygmus (23.5%), rectal tenesmus (18.4%); along with body symptoms of fatigue (47.5%), weight loss (28.5%), and fever (18.4%). There was a statistically significant difference between mucus stools and extraintestinal manifestations in every age group (P<0.01). There was a statistically significant difference between average age of patients with UC and healthy persons (P<0.001). Among these patients,55.3% had extraintestinal manifestations of which were mainly moderate and severe degrees, as well as left-sided colitis and proctitis; 5.6% had related complications with canceration between the ages of 41-60 years and over 60 years. Disease severity were mainly mild (40.8%) and moderate (39.1%). Mild degree was mainly seen in young and middle aged patients, moderate and severe degrees were mainly seen in middle aged and elderly patients. There was a statistically significant difference between disease severity in lesion extents and clinical types (P<0.001).This study also showed that extraintestinal manifestations, lesion extents, disease severity, clinical symptoms and clinical types are closely related.Disease stage was mainly in the active stage (79.3%). There was a statistically significant difference between the active stage and the remission stage (P<0.001). There was a statistically significant difference between he active stage and the remission stage in clinical symptoms such as abdominal distention, bloody stools, weight loss, and fatigue (P<0.05). This study also showed that the disease stage and clinical symptoms are closely related.Of the 179 patients with a description of their lesion extents,24.0% had proctitis,31.8% had proctosigmoiditis,25.7% had left-sided colitis,17.3% had pancolitis and 1.1% had regional colitis. Therefore, lesion extent was mainly in proctosigmoiditis. Clinical type was mainly chronic relapsing (53.1%). There was a statistically significant difference between clinical types in gender (P<0.05), as well as a statistically significant difference between clinical types in clinical symptoms such as bloody stools and rectal tenesmus (P<0.05).Colonoscopy results were mainly of erosion and ulcer (92.7%), congestion and edema (44.7%). Pathological manifestations were mainly in all lesions with chronic inflammation(87.2%). There was a statistically significant difference between atypical hyperplasia of glands in all the lesions (P<0.05).There was a statistically significant difference between disease degrees in laboratory tests such as lower hemoglobin (HGB) (20.1%), lower serum albumin (ALB) (21.2%), higher C-reactive protein (CRP) (27.9%), lower blood potassium (K) (20.1%), and higher erythrocyte sedimentation rate (ESR) (18.4%)(P<0.05). The result showed that disease degree and laboratory test are closely related.TCM syndrome types were mainly of damp heat accumulation (19.6%), spleen deficiency and dampness (19.0%), large intestine damp heat (14.0%), liver stagnation and spleen deficiency (10.6%), and spleen deficiency damp heat (10.1%). There was a statistically significant difference between age groups of two TCM syndrome types (liver stagnation and spleen deficiency, spleen deficiency damp heat)(P< 0.05).The tongue and pulse manifestations were suitable to differentiate TCM syndrome types. The tongue colors were mainly red tongue (25.1%), light red tongue (21.2%), and dark red tongue (20.1%). The tongue fur were mainly thin white (43.0%), thin yellow (29.6%), thin greasy (37.4%) and yellow greasy (27.9%). The pulse were mainly string thin pulse (16.8%), deep thready pulse (8.4%) and smooth pulse (7.3%).Western medicine treatments mainly used includes vitamins, nutrition (62.0%), aminosalicylic acid drugs (49.2%), antibiotics (44.7%), gastric protection (44.7%) and antidiarrheal drugs (37.4%). There was a statistically significant difference between disease degrees in using glucocorticoid, hemostatic and blood nourishing drugs (P<0.05). There was a statistically significant difference between disease stages in using antibiotics, vitamins, nutrition, hemostatic and blood nourishing drugs (P<0.01). There was a statistically significant difference between lesion extents in using hemostatic and blood nourishing drugs (P<0.01)TCM treatments that were mainly used included basic prescriptions such as:Gegenqinlian(26.3%), Sijunzi(25.7%), Shenlingbaizhu(25.1%), Baitouweng(Pu lsatilla)(11.2%), Shaoyao (Peony) (9.5%), Tongxieyaofang and Siwu (8.4%). Treatment methods were mainly used for heat-clearing and dampness-eliminating (53.1%), replenishing qi to invigorate the spleen (29.6%), invigorating the spleen and dampness-elimination (21.2%), qi and blood circulation, and pain relieving (21.1%). Retention enema medicines were mainly used for TCM enema such as heat clearing and detoxifying drugs, sore astringing myogenic drugs, drugs promoting blood circulation to remove blood stasis and drugs cooling blood to stop bleeding. Acupoint application method (36.4%) was mainly used as an external treatmentThe combination of TCM and western medicine treatment for UC was very important (97.2%). The treatment of UC mainly combined oral administration with enema method (37.4%). There was a statistically significant difference between combined treatment methods in lesion extents (P<0.05). The adverse drug reactions were mainly toxic reactions in theblood system, damage of liver and kidney function, and gastrointestinal reactions.The effect of treatment with more effective patients accounted for 79.9%, the most effective patients accounted for 10.6%, non-effective patients accounted for 9.5%. The total effective rate accounted for 90.5%ConclusionThe First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine showed a rising trend year by year of new patients with UC.There were no significance in gender differences. The patients with UC were mainly at the age of 20-40 years and 41-60 years. Clinical symptoms were mainly digestive system symptoms such as abdominal pain, diarrhea, and bloody and mucus stools. Extraintestinal manifestations were arthritis pain and chronic gastritis. It had related complications with canceration within patients ages 41-60 years and over 60 years. Disease degrees were mainly mild and moderate. Disease stage was mainly in the active stage. Lesion extent was mainly proctosigmoiditis. Clinical type was mainly chronic relapsing. Colonoscopy results showed mainly erosion and ulcer. It showed that disease degree and laboratory test wereclosely related. TCM syndrome types were mainly of five types:damp heat accumulation, spleen deficiency and dampness, large intestine damp heat, liver stagnation and spleen deficiency, and spleen deficiency damp heat. Western medicine treatments mainly used were vitamins, nutrition, aminosalicylic acid drugs, antibiotics, as well as gastric protection and antidiarrheal drugs. TCM treatment methods used were mainly for heat-clearing and dampness-eliminating, replenishing qi to invigorate the spleen, invigorate the spleen and dampness-eliminating, qi and blood circulation, and pain relieving. The treatment of UC was mainly a combination of oral administration with enema method. The adverse drug reactions were mainly toxic reactions of the blood system, damage of liver and kidney functions, and gastrointestinal reactions. The total effective rate accounted for 90.5%. |
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