老年发病和成人发病溃疡性结肠炎的临床特征和预后差异：一项双中心回顾性队列研究

摘要(中文译文)

老年起病溃疡性结肠炎（EO-UC）的发病率呈逐渐上升趋势。与成年起病溃疡性结肠炎（AO-UC）患者相比，EO-UC患者在临床表现、治疗策略及预后方面的独特特征尚不明确。我们回顾性分析了2010年3月至2024年6月期间在北京大学第三医院和北京大学国际医院住院的溃疡性结肠炎（UC）患者。共纳入68例EO-UC患者（诊断年龄≥60岁）和136例AO-UC患者（诊断年龄<60岁，匹配比例=1:2）。随访时间自UC诊断之日起至以下两个终点中较早者：2025年1月31日或在我中心末次临床就诊日期。随后，我们分析了两组在临床表现、治疗策略及预后方面的差异。EO-UC组的男女比例为1.8:1，与AO-UC组相比，该组临床表现较轻（腹痛58.5% 对 75.0%，P=0.022；黏液血便50.0% 对 74.3%，P<0.001），合并症负担更高（P<0.001）。两组病变部位分布差异有统计学意义（P=0.001），EO-UC组直肠炎和左半结肠炎比例更高（14.7% 对 2.2%和22.1% 对 18.4%）。EO-UC组住院前糖皮质激素和生物制剂的使用率显著低于AO-UC组（13.2% 对 42.6%，P<0.001；0.0% 对 13.2%，P=0.002）。两组在合并感染、临床缓解率、复发模式、再住院或并发症发生方面均未观察到显著差异。随访期间，成年起病组发生6例手术病例，老年起病组发生2例院内全因死亡病例。EO-UC组以男性为主，与AO-UC组相比，其合并症和合并用药率更高、临床表现更轻，给临床诊断带来挑战。5-氨基水杨酸（5-ASA）仍是一线治疗方案，EO-UC组免疫抑制剂和生物制剂的使用率低于AO-UC组，这可能与老年患者不同的治疗考量有关，但并未转化为两组之间可观察到的临床结局差异。本研究为初步探索性研究，未来需要更大样本量的前瞻性研究来验证这些发现。

Abstract

The incidence of elderly-onset ulcerative colitis (EO-UC) has been gradually increasing. The unique characteristics of clinical manifestations, therapeutic strategies, and prognosis in EO-UC patients compared with adult-onset ulcerative colitis (AO-UC) patients remain unclear. We retrospectively analyzed hospitalized ulcerative colitis (UC) patients from March 2010 to June 2024 at Peking University Third Hospital and Peking University International Hospital. We recruited 68 EO-UC patients (age at diagnosis≥60 years) and 136 AO-UC patients (age at diagnosis <60 years, matched ratio = 1:2). Follow-up lasted from the date of UC diagnosis to the earlier of two endpoints: January 31, 2025, or the date of the last clinical visit at our center. Subsequently, we analyzed the differences in clinical manifestations, therapeutic strategies, and prognosis between the two groups. The male-to-female ratio in the EO-UC group was 1.8:1, and this group had milder clinical manifestations (abdominal pain 58.5% 75.0%, = 0.022; mucous bloody stool 50.0% 74.3%, < 0.001) and a higher comorbidity burden ( < 0.001) than the AO-UC group. The distribution of lesion locations differed significantly between the two groups ( = 0.001), with higher proportions of proctitis and left-sided colitis in the EO-UC group (14.7% . 2.2% and 22.1% . 18.4%). The use of corticosteroids and biologics before hospitalization was significantly lower in the EO-UC group than in the AO-UC group (13.2% 42.6%, < 0.001; 0.0% 13.2%, = 0.002). No significant differences were observed between the two groups in terms of concurrent infections, clinical remission rates, relapse patterns, rehospitalization, or complication occurrence. During follow-up, six surgical cases occurred in the adult-onset group, and two in-hospital all-cause mortality cases occurred in the elderly-onset group. The EO-UC group was predominantly male, and it exhibited higher comorbidity and concomitant medication rates and milder clinical manifestations than the AO-UC group, presenting challenges for clinical diagnosis. 5-Aminosalicylic acid (5-ASA) remains the first-line therapeutic regimen, and the EO-UC group demonstrated lower utilization rates of immunosuppressants and biologics than the AO-UC group, which may be related to distinct treatment considerations in elderly patients, although this did not translate into observable differences in clinical outcomes between the two groups. This study is preliminary and exploratory, and larger prospective studies with adequate sample sizes are needed to validate these findings in the future.

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