摘要
目的 总结联合应用环孢菌素A(CysA)治疗 7例炎症性肠病 (IBD)的临床特点、CysA用法、疗效和不良反应。方法 回顾性分析 2 0 0 0年 1月至 2 0 0 2年 1 2月北京协和医院应用CysA治疗的 7例IBD患者并复习相关文献资料。结果 ①临床特点 :均为难治性病例或合并并发症 ,4例为重症溃疡性结肠炎 (UC) ,均为常规药物治疗复发且再治疗疗效不佳者 ,3例为克罗恩病 (CD) ,均因合并内瘘、肠梗阻或消化道出血而行手术 ,术后病情活动。②CysA用法 :2～ 4mg·kg-1 ·d-1 静脉滴注 7～ 1 1d ,之后换为 6～ 8mg·kg-1 ·d-1 口服 ,或直接口服CysA ,起效 1个月后逐渐减量 ,总疗程 4～ 7个月。③CysA对重症UC有显著疗效 ,平均起效时间 5 .2 5d(3～ 1 2d) ,随诊 5个月至 2年 1 1个月 ,病情稳定。④静脉应用CysA和大剂量CysA口服 (>5mg·kg-1 ·d-1 )可控制CD病情活动 ,平均起效时间 5 .6 7d(3～ 7d) ,随诊 7个月至 1年 5个月 ,2例复发。⑤CysA的不良反应 :3例有肝功能损害 ,1例有骨髓抑制 ,1例有血尿酸升高 ,均在 1个月内恢复。结论 CysA对激素治疗无效或依赖的重症UC有效 ;CysA可作为活动期CD ,特别是手术后患者的过渡用药。监测CysA血药浓度 ,使之小于 2 5 0ng/ml,可取得较好疗效 。
Objective To investigate the role of cyclosporin A(CysA) combined therapy in 7 cases of inflammatory bowel disease (IBD), their clinical features, the efficacy, the way of using CysA, and the side effects were analyzed. Methods Retrospective study was performed in 7 cases of IBD treated with CysA during Jan. 2000 and Dec. 2002 in Peking Union Medical College Hospital. Results ① The clinical features: 4 of 7 cases were severe refractory ulcerative colitis (US) resistant to aminosalicylates, corticosteroid and immunosuppressants (azathioprine, AZA). The other 3 cases were active Crohn's disease (CD) and had received surgery for symptomatic fistula, bowel obstruction or gastrointestinal bleeding. ② The use of CysA: all patients were treated with intravenous CysA 2 4 mg·kg -1 ·d -1 switching to oral 6 8 mg·kg -1 ·d -1 after 7 11 days, or started with oral CysA straightly. The drug tapered off at 4 7 months. ③ CysA had favourable effect on severe UC patients without recurrence during 5 35 months follow up. The onset time of the effect was 3 12 days(mean 5.25 days). ④ Intravenous or high dose oral CysA (>5 mg·kg -1 ·d -1 ) was effective in the management of active CD, the onset time of the effect was 3 7 days(mean 5.67 days). However 2 of 3 cases relapsed during 7 17 months follow up. ⑤ The side effects: 3 of 7 patients had hepatotoxicity, and 1 of 7 had bone marrow suppression, 1 of 7 had elevation of blood uric acid. All the side effects were recovered within a month. Conclusion CysA is an effective drug for the patients with steroid refractory attacks of UC, however the long term efficacy needs further study. CysA is a good choice for short term use in patients with active CD, especially for those who had after operations to afford time for slow acting agents taking effect. Keeping the blood CysA level lower than 250 ng/ml may maintain positive effects without severe side effects.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2004年第6期337-340,共4页
Chinese Journal of Digestion
