Retrospective Analysis Of Clinical And Pathological Characteristics Of 285 Cases With UC

Background:Ulcerative colitis(UC),which of whose etiology has not been fully elucidated,is characterized by chronic inflammatory infiltration of colorectal mucosa.UC is a common disease in western countries.It was not frequently reported in China but the incidence of UC is increasing in our country recently.Ulcerative colitis-associated colorectal cancer(UC-CRC)is one of the most severe complications of UC.There is no large-scale investigation of dysplasia in UC and the following UC-CRC in China.Objectives:To retrospectively analyze clinical data of inpatients with UC,summarize clinical features of UC patients,focus on cases with dysplasia and provide reference for early detection and treatment for patients with dysplasia and UC-CRC.Methods:285 cases of hospitalized UC patients admitted in Shandong Provincial Hospital from January 1996 to September 2016 were enrolled in this study.Their data,including gender,age,course of disease,clinical manifestations,family history,smoking history,involved areas,severity,laboratory examinations,endoscopic and pathological manifestations were analyzed and summarized by SPSS 20.0.Results:1.General features:Of the 285 UC patients,male-female ratio is 1.26:1.Patients with course of disease less than one year are most frequently found(46.3%).Age of onset peaks at 40-49.Common clinical manifestations include abdominal pain(69.5%),bloody purulent stool(65.3%)and diarrhea(61.4%).3.5%have positive family history.22.8%have smoking history.As for lesion locations,6.7%are rectitis,20.0%are left-sided colitis while 73.3%are pancolitis.Patients in remission and in active stage account for 11.6%and 88.4%,respectively.In the latter group,17.1%(43/252)are mild cases,25.4%(64/252)are moderate cases while 57.5%(145/252)are severe cases.As for clinical types,30.9%are initial onset type and 69.1%are chronic recurrence type.Extra-intestinal manifestations(EIM)include joint pain(15cases),gangrenous pyoderma(1 case),iridocyclitis(1 case)and thrombosis in bilateral lower extremities(1 case).Complications are seen in 6 cases(2.1%).2.Colonoscopic manifestations:mainly include mucosal hyperemia and edema(87.0%),erosions(89.1%),ulcerations(73.7%)and pseudopolyps(37.2%).Pathological results of colonoscopic biopsies mainly include chronic mucosal inflammation(67.0%).ulcerations(22.1%),crypt abscess(9.8%)and inflammatory polyps(7.7%).3.Dysplasia and carcinogenesis are found in 70 cases(24.6%),including mild dysplasia(16.1%),moderate dysplasia(6.7%),severe dysplasia(1.4%)and adenoma(0.4%).Of patients with dysplasia or carcinogenesis,68.6%have pancolitis,74.1%are chronic recurrence type.42.9%are severe type and 47.1%have courses of disease less than a year.Patients with dysplasia or carcinogenesis have no significant difference from those without in terms of smoking history,age of onset,clinical type-involved areas,severity and courses of disease4.Treatment:aminosalicylates(93.0%)were most frequently used,followed by glucocorticoid(76.8%).immunosuppressants(1.8%),and biological drugs(1.1%).7 cases(2.5%)underwent surgical treatment because of poor medical outcome(5 cases),intestinal perforation(1 case)and severe dysplasia(1 case).Conclusions:1.Generally,patients with UC in this study have severe clinical manifestations and extensive lesion areas.Female patients' condition is severer than that of male patients.The level of HGB?ALB and ESR can indicate the extension of colitis.Quinquagenarians and patients in mild active stage have a higher ratio of smoking history.Patients in the youth group and moderate-severe stage show a higher ratio of using glucocorticoid.2.This study shows a lower rate of dysplasia or carcinogenesis compared to that in western countries.There is no significant difference for patients with different degrees of dysplasia and carcinogenesis in terms of age,gender,clinical type,involved areas.severity,smoking history,family history,course of disease,complications,EIM,medical and surgical treatment.3.5-ASA is the basic first-line medicine for UC treatment.Rectitis patients commonly received enema or suppository treatment,while left-sided colitis and pancolitis patients usually use glucocorticoid.Only small part of UC patients were treated by immunosuppressants,biological drugs or surgeries.