潰瘍性大腸炎における急性発作の予後-とくに予後不良の予知について

概要

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Thirty-eight patients with ulcerative colitis were studied to determine the indication for surgery in cases with poor prognosis. Disease activity was evaluated according to the activity index, which is quantitatively assessed by utilizing multiple regression analysis. The prognosis was highly correlated with clinical severity and the extent of disease before treatment ; the more severe and extensive the disease, the poorer the prognosis. Four patients who underwent elective surgery and one patient who died of status DIC due to severe disease were classified into a poor prognosis group. We compared the clinical course of this poor prognosis group with that of a remission group. In the latter group, the activity index declined gradually after the beginning of therapy in patients with mild disease severity. However, the activity index of severely affected patients in the latter group did not show any significant decrease until three weeks after the beginning of therapy. In contrast, the activity index of the former group remained unchanged during the subsequent clinical course. We conclude that it may be possible to predict the clinical course after acute attacks by employing the activity index at three weeks of therapy, and that patients satisfying this criterion may be considered suitable candidates for surgery.
日本大腸肛門病学会の論文