P087 The study of the related risk factors of steroid resistance with Ulcerative Colitis in the Chinese Han polulation
H. Yang*, J. Qian
Peking Union Medical College Hospital, Department of Gastroenterology, Beijing, China
Ulcerative colitis (UC) is a chronic non-specific colonic inflammatory disease with uncertain etiologies. Recently, the incidence of IBD in China has increased rapidly. The trerapy strategy of UC has been got more and more attention especially about steroid resistance. However, the related risk factors of steroid resistance in patients with UC are uncertain. With this aim, we detected the association between gene polymorphism, disease phenotype, infection etc and steroid resistance.
165 UC patients from Peking Union Medical College Hospital were enrolled in this study, with 83 males (50.3%) and 82 females (49.7%). The median age at diagnosis was 39 (31-51). A total of 137 patients had used oral or intravenous corticosteroid, among which 43.8% were steroid-effective, 39.4% steroid-dependent, and 16.8% steroid-resistant. We also enrolled 199 healthy controls, matching for age and gender. Genotypes of C3435T, C1236T loci of MDR1 and -173G/C locus of MIF were detected.
Multivariate analysis showed patients with MDR1 3435TT and 3435CT genotypes had decreased risk of steroid dependence (OR=0.183, 95%CI: 0.039~0.856; P=0.031; OR=0.268, 95%CI: 0.094~0.768). Patients with extensive UC had higher of steroid dependence than proctitis and left-sided colitis (OR=7.602, 95%CI: 2.223~26.001; P=0.001). Patients with elevated ESR had decreased risk of steroid dependence by two thirds (OR=0.312, 95%CI: 0.119~0.818; P=0.018).
Comparing between steroid-resistant group and steroid-effective group, all these three loci were associated with steroid resistance by univariate and multivariate analysis. Multivariate analysis showed that patients with extensive UC had higher risk of steroid resistance than patients with proctitis and left-sided colitis (OR=6.604, 95%CI: 1.104~ 39.510; P=0.039). patients complicated by CMV infection had increased risk of steroid resistance（OR=10.681, 95%CI: 1.490~76.549; P=0.006）. Moderate anemia was also a risk factor for steroid resistance（OR=3.247, 95%CI: 1.066~9.890; P=0.006）.
1. C3435T locus of MDR1 and -173G/C locus of MIF were associated with steroid-dependent UC, not associated with steroid-resistant UC. There was no significant association between C1236T locus of MDR1 and steroid dependence or resistance.
2. Patients with extensive UC had increased risk of steroid dependence. Patients with extensive colitis, CMV infection and moderate anemia had higher risk of steroid resistance.