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우측 대장에 국한된 허혈성 대장염은 불향한 예후의 예측인자 인가?
전형구 ( Hyung Ku Chon ),박경택 ( Kyung Taek Park ),정종환 ( Jong Hwan Chong ),정범수 ( Beon Su Jeong ),유혜민 ( Hye Min Yu ),안대선 ( Dea Sun An ),윤해은 ( Hae Eun Youn ),김선민 ( Sun Min Kim ),양희찬 ( Hee Chan Yang ),이수택 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.1
Background/Aims: Ischemic colitis is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply. In general, the patients with ischemic colitis have a wide spectrum of severity; most of them are treated supportively and then recovered fully, while a minority of them in critical condition may develop sepsis and become severely ill. But, there have been few studies analyzing the factors associated with poor prognosis in ischemic colitis. As the blood supply of colon, we suppose that when ischemia affects the right side of the colon in an isolated fashion, the prognosis may not be so favorable. After comparison between isolated right colon ischemia and the others, we would recognize the clinical meaning of that and doubt whether significant factor related to the prediction of poor prognosis. Methods and Materials: Patients with ischemic colitis were enrolled in a retrospective study at Chonbuk National University Hospital during interval January 2003 to June 2009. They were identified using computerized searches of ICD-9 codes for colon ischemia, that were diagnosed by colonoscopy( or sigmoidoscopy), MDCT (multidirectional computed tomography). And then, divided into two groups, one with isolated right colon ischemia (IRCI) and the other with colon ischemia not involving the right colon in an isolated fashion (non-IRCI). We analyzed age, gender, underlying diseases [e.g diabetis mellitus, hypertension, chronic kidney disease, arrhythmia(atrial fibrillation or atrial flutter), cerebral vascular disease, ischemic heart disease, previous cancer history, abdominal operation history], clinical symptoms and signs, blood test (hemoglobin, white blood cell count and basic biochemical profile) , CT findings, treatment and mortality. Results: A total 89 patients were identified colon ischemia. IRCI group was composed of 18 patients (11 females and 7 males, average age of 66.83±2.81). The mortality of patients with IRCI was 27.8% compared with a mortality of 1.4% in patients with non-IRCL(p=0.001) Moreover, they had a more underlying DM (44.4% vs 31.0%. p=0.281), hypertension (61.1% vs 36.6 %, p=0.060), vascular disorder(IHD or CVA) (27.8% vs 15.5%, p=0.225), previous cancer history (27.8% vs 18.3%, p=0.372), previous abdomen operation history (50.5% vs 11.3%, p=0.003) than non-IRCI group. Arrival at hospital, IRCI group had more abdominal pain (94.4% vs 81.7%, p=0.184) and tenderness (88.9% vs 63.4%, p=0.037), more frequency of fever, chills(33.3% vs 14.1 %, p=0.057), and higher heart rate (93.77±5.63 vs 83.07 ±1.81, p=0.021) but less diarrhea (27.8% vs. 29.6%, P =0.881), hematochezia (44.4% vs. 52.1%, P =0.561) and lower hemoglobin level (11.28±0.52 vs 12.63 ±0.21, p=0.008) compared with non IRCI group. Among CT findings, wall thickening (80.0% vs. 20.0% p =0.012), attenuation (27.8% vs. 5.0% p=0.005), enhancement (27.8% vs 5.0%, p=0.005) and thrombosis/porto-mesenteric gas (44.4% vs. 3.3% p =.001) were significantly different between two groups. Hospital duration of IRCI group was longer (17.94±6.08 vs 13.93± 1.92, p=0.413) and more recurrence(22.2% vs 9.9% p=0.155) than non IRCI group. During admission, 4 patients(22.2%) of IRCI group suffered from abdomen operation for their appropriate treatment; but 2 patients(2.8%) of non IRCI group did.(p=0.014) Odds ratio for mortality and surgery with IRCI compared With Non-IRCI is 26.9 (95% CI=2.9~249.7,p=0.001), 9.857 (95% CI= 9.6~59.2,p=0.014), respectively Conclusions: Patients with IRCI significantly undergone more surgery and had a higher mortality. Although statistically meaningless, they had a higher recurrence rate and longer hospital stay.
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