重度溃疡性结肠炎治疗.ppt

重症溃疡性结肠炎的治疗 Introduction  IBD是一种病因尚不十分清楚的慢性非特异性肠道炎症，包括UC和CD 。 其发病率呈逐年上升趋势，且多为青壮年发病，临床表现复杂，并发症严重，肠外表现多样，严重影响个人生活质量和社会生产力。 此外，因其有癌变的风险，备受广大医生的重视。 近年来在国内外IBD基础与临床研究高潮迭起，基础研究的成果直接指向临床治疗，取得了划时代的进展。 探讨和摸索适合国人的治疗方案以降低重症UC的并发症和死亡率显得十分重要。 Rescue Therapy Approximately 15% of patients with ulcerative colitis will have a severe attack requiring hospitalisation for intravenous steroids at some stage in their illness. Sixty per cent of patients treated with corticosteroids will be symptom free by the end of five days, 15% will have significant improvement, and 25% will not improve. Steroid resistance was defined as unresponsiveness to oral or intravenous corticosteroid therapy (equivalent to a daily dose of more than 30 mg of prednisolone) over at least two weeks. Those who fail to improve may be treated with intravenous cyclosporin, infliximab, oral tacrolimus or undergo colectomy. Caprilli R，Viscido A，Latella G．Current management of severe ulcerative colitis．Nat CIin Pract Gastroenterol Hepatol，2007，4：92-101． CsA There have been four controlled studies of intravenous cyclosporin in patients with severe ulcerative colitis. Intravenous cyclosporin (with or without continued intravenous corticosteroids) is effective in 50–80% of patients with severe ulcerative colitis. An initial dose of 2 mg/kg/day intravenous cyclosporin appears to be as effective as 4 mg/kg/day and is thus preferred from the standpoint of safety. Long term response rates following short term treatment with intravenous cyclosporin in controlled trials ranged from 45% (without azathioprine maintenance) to 78% (with azathioprine). There is a small risk of opportunistic infection and death (1–2%) during combined cyclosporin, corticosteroid, and azathioprine therapy, but lower doses of cyclosporin may improve the safety profile. Toxicity may be reduced at a dose of 2 mg/kg/day intravenous cyclosporin. Loftus CG，Loftus EV Jr，Sandborn WJ．Cyclosporin for refractory ulcerative colitis．GUt．2003，52; 172—173． Cheifetz A