中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2012年
8期
613-617
,共5页
冉文斌%欧阳钦%董烈峰%薛林云
冉文斌%歐暘欽%董烈峰%薛林雲
염문빈%구양흠%동렬봉%설림운
结肠炎,溃疡性%硫唑嘌呤%激素依赖
結腸炎,潰瘍性%硫唑嘌呤%激素依賴
결장염,궤양성%류서표령%격소의뢰
Colitis,ulcerative%Azathioprine%Steroid-dependent
目的 评价硫唑嘌呤(AZA)治疗顽固性溃疡性结肠炎(UC)的疗效及安全性.方法 回顾性分析2007年1月至2011年12月四川大学华西医院24例顽固性UC患者使用AZA治疗的临床疗效、内镜改善和黏膜愈合、炎症指标改善情况及安全性.结果 24例患者的中位年龄36岁,中位病程4年,其中中度活动UC 14例,重度活动UC 10例.AZA使用7周～42个月,剂量为(1.23±0.34) ng·kg-1·d-1.根据Mayo活动指数评分判定疗效,治疗3个月、6个月、1年时的有效率分别为73.9％ (17/23)、81.8％ (18/22)和14/16,缓解率分别为17.4％ (4/23)、54.5％ (12/22)和12/16.AZA治疗后6个月及1年时的ESR及C反应蛋白水平较治疗前均明显下降[(9.3±8.9) mm/1h、(10.9±7.3)mm/1h比(22.3±10.7) mm/1h;2.5(1.0 ～ 22.3) mg/L、2.3(1.0 ～ 28.0) mg/L比18.4(3.6 ～ 137.0)mg/L;P值均＜0.05].AZA治疗3个月时糖皮质激素撤停率为16/18,1年时为15/16.AZA治疗6个月和1年时,内镜下有效率分别为85.7％( 18/21)和13/15,缓解率为61.9％ (13/21)和11/15,黏膜愈合率分别为61.9％( 13/21)和11/15.共有8例患者发生不良反应,以白细胞减少最为常见,其次为肝功能损伤、脱发及上腹部不适.结论 小剂量AZA治疗顽固性UC具有较好的临床疗效,尤其是在糖皮质激素撤停、维持缓解和黏膜愈合等方面更明显,且无严重不良反应发生.
目的 評價硫唑嘌呤(AZA)治療頑固性潰瘍性結腸炎(UC)的療效及安全性.方法 迴顧性分析2007年1月至2011年12月四川大學華西醫院24例頑固性UC患者使用AZA治療的臨床療效、內鏡改善和黏膜愈閤、炎癥指標改善情況及安全性.結果 24例患者的中位年齡36歲,中位病程4年,其中中度活動UC 14例,重度活動UC 10例.AZA使用7週～42箇月,劑量為(1.23±0.34) ng·kg-1·d-1.根據Mayo活動指數評分判定療效,治療3箇月、6箇月、1年時的有效率分彆為73.9％ (17/23)、81.8％ (18/22)和14/16,緩解率分彆為17.4％ (4/23)、54.5％ (12/22)和12/16.AZA治療後6箇月及1年時的ESR及C反應蛋白水平較治療前均明顯下降[(9.3±8.9) mm/1h、(10.9±7.3)mm/1h比(22.3±10.7) mm/1h;2.5(1.0 ～ 22.3) mg/L、2.3(1.0 ～ 28.0) mg/L比18.4(3.6 ～ 137.0)mg/L;P值均＜0.05].AZA治療3箇月時糖皮質激素撤停率為16/18,1年時為15/16.AZA治療6箇月和1年時,內鏡下有效率分彆為85.7％( 18/21)和13/15,緩解率為61.9％ (13/21)和11/15,黏膜愈閤率分彆為61.9％( 13/21)和11/15.共有8例患者髮生不良反應,以白細胞減少最為常見,其次為肝功能損傷、脫髮及上腹部不適.結論 小劑量AZA治療頑固性UC具有較好的臨床療效,尤其是在糖皮質激素撤停、維持緩解和黏膜愈閤等方麵更明顯,且無嚴重不良反應髮生.
목적 평개류서표령(AZA)치료완고성궤양성결장염(UC)적료효급안전성.방법 회고성분석2007년1월지2011년12월사천대학화서의원24례완고성UC환자사용AZA치료적림상료효、내경개선화점막유합、염증지표개선정황급안전성.결과 24례환자적중위년령36세,중위병정4년,기중중도활동UC 14례,중도활동UC 10례.AZA사용7주～42개월,제량위(1.23±0.34) ng·kg-1·d-1.근거Mayo활동지수평분판정료효,치료3개월、6개월、1년시적유효솔분별위73.9％ (17/23)、81.8％ (18/22)화14/16,완해솔분별위17.4％ (4/23)、54.5％ (12/22)화12/16.AZA치료후6개월급1년시적ESR급C반응단백수평교치료전균명현하강[(9.3±8.9) mm/1h、(10.9±7.3)mm/1h비(22.3±10.7) mm/1h;2.5(1.0 ～ 22.3) mg/L、2.3(1.0 ～ 28.0) mg/L비18.4(3.6 ～ 137.0)mg/L;P치균＜0.05].AZA치료3개월시당피질격소철정솔위16/18,1년시위15/16.AZA치료6개월화1년시,내경하유효솔분별위85.7％( 18/21)화13/15,완해솔위61.9％ (13/21)화11/15,점막유합솔분별위61.9％( 13/21)화11/15.공유8례환자발생불량반응,이백세포감소최위상견,기차위간공능손상、탈발급상복부불괄.결론 소제량AZA치료완고성UC구유교호적림상료효,우기시재당피질격소철정、유지완해화점막유합등방면경명현,차무엄중불량반응발생.
Objective To evaluate the efficacy and safety of azathioprine (AZA) in the treatment of refractory ulcerative colitis (UC).Methods Retrospective analysis of the clinical improvement,endoscopic improvement and mucosal healing rate,inflammation marker improvement after AZA administration and its safety in 24 refractory UC patients were performed,who were recruited between January 2007 and December 2011 in West China Hospital,Sichuan University,China.Results Twenty-four patients were enrolled,with a median age of 36 years old and a median course of 4 years.Among them,14 cases were moderate UC and 10 cases were severe UC.The patients were treated with AZA in a dose of (1.23 ±0.34) mg· kg-1 · d-1 from 7 weeks to 42 months.Efficacy was judged by Mayo disease activity index.At 3 months,6 months and 1 year after treatment,the effective rates were 73.9％ ( 17/23),81.8％(18/22) and 14/16 respectively,and the remission rates were 17.4％ (4/23),54.5％ (12/22) and 12/16respectively.Both ESR and C reactive protein level after treatment for 6 months and 1 year were significantly lower than those before treatment [ (9.3 ±8.9) mrn/1h,(10.9 ±7.3) mm/1h vs (22.3 ± 10.7) mm/1h;2.5(1.0-22.3) mg/L,2.3(1.0-28.0) mg/L vs 18.4(3.6-137.0) mg/L; all P ＜0.05].Corticosteroid withdrawal rates at 3 months and 1 year after AZA treatment were 16/18 and 15/16,respectively.At 6 months and 1 year after AZA treatment,the endoscopic improvement rates were 85.7％ ( 18/21 ) and 13/15 respectively; the cndoscopic remission rates were 61.9％ ( 13/21 ) and 11/15 respectively; and the mucosal healing rates were 61.9％ ( 13/21 ) and 11/15 respectively.Adverse effects were occurred in 8 patients.Leukopenia was the most common adverse effect,followed by liver function injury,alopecia and epigastric discomfort.Conclusions AZA is effective in the treatment of refractory UC patients with a low dose of ( 1.23 ± 0.34) mg· kg - 1 · d - 1,especially in the steroid withdrawing,maintaining remission and mucosal healing without severe adverse effects.
