摘要
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uc14例，重度活动uc10例。AzA使用7周-42个月，剂量为（1．23±0．34）mg·k-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）mHl／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〈O．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％（18／2】）和13／15，缓解率为61．9％（13／21）和l】／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。
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 i . d l 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 12/16 respectively. 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） mm/lh, （10. 9±7.3） mm/lh vs （22. 3±10. 7） mm/lh; 2.5（1.0-22.3） rag/L, 2.3（1.0±28.0） mg/Lvs 18.4（3.6±137.0）mg/L; allP〈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 I year after AZA treatment, the endoscopic improvement rates were 85.7% （18/21） and 13/15 respectively; the endoscopic 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 mucosalhealing without severe adverse effects.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2012年第8期613-617,共5页
Chinese Journal of Internal Medicine
关键词
结肠炎
溃疡性
硫唑嘌呤
激素依赖
Colitis,ulcerative
Azathioprine
Steroid-dependent
