中青年和老年缺血性结肠炎的临床特点比较

Clinical characteristics of ischemic colitis between elderly and young/middle-aged patients

摘要:

目的 分析中青年和老年缺血性结肠炎(IC)的临床特点。方法 回顾性分析复旦大学附属华东医院消化内科2010年6月至2016年12月收治的200例IC患者,按照年龄分为<60岁的中青年组78例和≥60岁的老年组122例,比较两组患者的基线资料、临床特点、实验室指标、内镜下表现及临床治疗转归等。采用SPSS 13.0统计软件进行数据分析,根据数据类型,组间比较采用t检验或χ²检验。结果 中青年组有便秘史、腹部手术史、脂肪肝比例显著高于老年组,高血压、冠心病比例显著低于老年组,差异均有统计学意义(P＜0.05)。中青年组恶心呕吐比例明显低于老年组,差异有统计学意义(P<0.01)。实验室指标检查示中青年组血小板(PLT)、纤维蛋白原(Fg)明显低于老年组,活化部分凝血酶原时间(APTT)明显高于老年组,差异均有统计学意义(P＜0.05)。内镜检查结果示中青年组与老年组的左半结肠受累比例[92.3%(72/78) vs 73.0%(89/122)]、右半结肠受累比例[7.7%(6/78) vs 27.0%(33/122)]差异均有统计学意义(P＜0.01)。两组肠镜下黏膜充血水肿、散在糜烂溃疡出血及肠腔狭窄比例差异均无统计学意义(P>0.05)。中青年组黏膜完全愈合占96.2%(75/78),老年组黏膜完全愈合占91.0%(111/122),两组比较差异无统计学意义(P=0.162)。结论 肠道因素是中青年IC患者的重要病因,血管因素是老年IC患者的重要病因。老年IC患者存在明显血液高凝状态。

Abstract:

Objective To summarize the clinical characteristics of ischemic colitis (IC) between the elderly and young/middle-aged patients. Methods Clinical data of 200 IC patients with definite diagnosis from June 2010 to December 2016 in our department were collected and retrospectively analyzed. The patients were divided into young/middle-aged group (<60 years old, n=78) and elderly group (≥60 years, n=122). The baseline data, clinical manifestations, laboratory examination results, endoscopic findings, clinical course and outcomes after treatment were analyzed and compared between the 2 groups. SPSS statistics 13.0 was used to perform the statistical analysis. Student’s t test or Chi-square test was employed for comparison between the 2 groups based on different data types. Results When compared with the elderly group, the young/middle-aged group took obviously higher ratios of the subjects with fatty liver and histories of constipation and abdominal operation, while notably lower ratios of hypertension and coronary heart disease (P＜0.05), and remarkably lower ratio of nausea and vomiting (P＜0.01). The levels of platelet (PLT) and fibrinogen (Fg) were significantly lower, while activated partial prothrombin time (APTT) was obviously longer in the young/middle-aged group than in the elderly group (P＜0.05). The endoscopic findings showed that the bowel lesions in the left colon was remarkably higher in the young/middle-aged group than in the elderly group [92.3% (72/78) vs 73.0% (89/122)], while those in the right colon was opposite [7.7% (6/78) vs 27.0% (33/122),P＜0.01]. There was no significant difference between the 2 groups in mucosal congestion and edema, scattered erosion, ulcer and bleeding, and ratio of intestinal stricture (P>0.05). The percentage of completely healed mucosa was 96.2% (75/78) in the young/middle-aged group, and was 91.0% (111/122) in the elderly group (P=0.162). Conclusion The major causes of IC are intestinal factors for young/middle-aged patients, while vascular factors for the elderly. Blood hypercoagulability is common in elderly IC patients.