重症溃疡性结肠炎的内科治疗

参照1973年全国慢性非感染肠道疾病学术研讨会制定的溃疡性结肠炎的诊断标准,对北京协和医院1974年1月至1995年1月的溃疡性结肠炎住院病人共148例进行了分析,着重探讨了我院对重症溃疡性结肠炎的药物治疗经验。结果显示:21年间溃疡性结肠炎在内科消化病的年住院率呈上升趋势,重症患者占 72.3 ％。其临床治疗仍以激素,水杨酸偶氮磺胺吡啶和免疫抑制剂为主要治疗药物。本病在我院内科治疗的临床缓解率达95.9 ％,其中重症的临床缓解率达95,3 ％,死亡率为6.08 ％。我们提出对溃疡性结肠炎的内科治疗应遵循尽早控制症状、维持缓解、预防复发、防治并发症和掌握手术时机的原则;并根据病变的范围、疾病的活动性和严重程度、病程、病人的全身情况、以前用药情况和有无并发症等进行综合治疗。     

溃疡性结肠炎的综合治疗体会

溃疡性结肠炎 ( U C)以结直肠粘膜及粘膜下层 ,发生慢性、非特异性炎症为特征 ,出现脓血便、里急后重、腹痛、发热等。至今未能阐明这种肠粘膜炎症的病因 ,故其治疗效果不尽如意。1996～ 2 0 0 0年 ,我院采用中西医综合疗法治疗 UC取得较好疗效。现报告如下。一般资料 :87例患者中 ,男 5 2例 ,女 3 5例 ;年龄 18～ 62岁。所有患者均经结肠镜及活组织检查证实。有腹痛—腹泻—腹痛缓解的规律 ,里急后重感 3 6例 ,高热 7例 ,外周关节炎 3例 ,口腔溃疡 1例。病情分型参考 Edwards和 Truelove综合分类法 ,重度 14例、中度 45例、轻度 2 8例。…     

奥沙拉嗪与SASP灌肠治疗溃疡性结肠炎的疗效对比观察

目的观察用奥沙拉嗪灌肠方法治疗活动期溃疡性结肠炎的治疗效果，比较奥沙拉嗪与水扬酸偶氮磺胺吡啶（SASP）用灌肠方法治疗活动期溃疡性结肠炎的疗效和不良反应。方法采用随机双盲双模拟方法观察40例活动期溃疡性结肠炎的疗效和不良反应，疗程为4周。结果治疗4周末奥沙拉嗪组的总体疗效评价其显效率为70％，临床症状、体征消失率、内镜完全缓解率和组织学完全缓解率分别为60％、45％、75％及60％，对照组总体疗效评价其显效率为50％，临床症状、体征消失率、内镜完全缓解率和组织学完全缓解率分别为50％、30％、55％及50％，其疗效与对照组相比有明显差异（P〈0．05）。结论用奥沙拉嗪灌肠方法治疗活动期溃疡性结肠炎有较好的疗效，其疗效优于SASP组，且奥沙拉嗪的主要不良反应腹泻明显减少。     

中度溃疡性结肠炎的治疗策略

我国对中度活动溃疡性结肠炎(ulcerative colitis，以下简称溃结或UC)的治疗迄今尚未规范化，一般以5-氨基水杨酸(5-ASA)或柳氮磺胺吡啶(SASP)为首选药物，但多年来的实践证明这一治疗方法并未取得预期效果。笔者应用口服泼尼松 硫唑嘌呤 中药溃结方三联疗法治疗UC患者．并进行前瞻性观察和研究。取得了良好的疗效。     

国产5-氨基水杨酸肠溶片治疗溃疡性结肠炎多中心临床研究

目的　评价国产 5 氨基水杨酸 (5 ASA)肠溶片治疗溃疡性结肠炎 (UC)的疗效和安全性及该药的口服吸收情况。方法　采用多中心、随机、双盲、双模拟和对照方案 ,将 1 2 9例UC患者随机分为5 ASA肠溶片试验组 (6 5例 ,2 .4 g/d)和水杨酸偶氮磺胺吡啶 (SASP)对照组 (6 4例 ,4 .0g/d) ,疗程均为6周。治疗第 8天 ,随机抽取试验组 1 3例和对照组 1 2例UC患者血清 ,应用高效液相色谱分析法检测血清 5 ASA及其代谢产物Ac 5 ASA的稳态血药浓度。对两组患者治疗前后的临床症状、粪便检查和肠镜检查的情况进行比较 ,并记录治疗过程中的不良反应。结果　实际完成研究者 1 2 0例 (5 ASA组 6 1例 ,SASP组 5 9例 ) ,两组各有 4例失访 ,SASP组有 1例因严重胃肠道不良反应中途退出。 5 ASA肠溶片组和SASP组治疗UC的总有效率分别为 70 .0 5 %和 6 7.79% ,两组间差异无显著性 (P >0 .0 5 ) ,5 ASA肠溶片的完全缓解率明显高于SASP (2 9.5 1 %比 1 3.31 % ,P <0 .0 5 )。 5 ASA肠溶片组和SASP组的不良反应分别为 1 1 .4 8%和 2 3.33%。 5 ASA组和SASP组的血清 5 ASA浓度分别为 (0 .0 32± 0 .0 0 8) μg/ml和 (0 .0 4 1± 0 .0 0 5 ) μg/ml(P >0 .0 5 )。 结论　 5 ASA肠溶片治疗UC总有效率与SASP相仿 ,但对UC的完     

氨基水杨酸制剂治疗溃疡性结肠炎的临床应用

氨基水杨酸（aminosalicylic acid）制剂用于溃疡性结肠炎（ulcerative colitis，UC）的治疗已有50余年的历史。迄今，氨基水杨酸盐已成为轻-中度UC诱导与维持缓解治疗的第一线药物剐。目前，临床上常用的氨基水杨酸制剂主要包括两大类：①前药，包括最常用的水杨酸偶氮磺胺吡啶（salicylazosulfapyridine。SASP）及近年来发展的偶氮键前药奥柳氮与巴柳氮等（表1）；②美沙拉秦制。现简述如下：     

溃疡性结肠炎97例的治疗

1981年6月—1994年11月共收治经确诊为溃结的患者97例,按照1978年全国消化系统疾病学术会议拟定的诊断标准,以及1993年全国慢性非感染性肠道疾病学术研讨会关于溃结诊断及治疗标准修订后的标准,选其主要用药如激素、柳氮磺胺吡啶(SASP)及中药等治疗效果作一初步报告。 1 对象和方法 1.1 对象 男53例,女44例,男女之比1.2:1,发病年龄14—69岁,平均年龄37.5±1.6岁,其中轻型50例,中度36例,重症型9例,暴发型2例(并发中毒性巨结肠)。 1.2 方法 给药方法轻型选用口服SASP 0.5g,4次/d,为避免副作用,从小剂量开始,首剂0.5g,以后每天增加0.5g     

肠炎清治疗溃疡性结肠炎的临床研究

为开拓一种治疗溃疡性结肠炎的中药制剂，将78例溃疡性结肠炎（UC）分层随机分为两组，治疗组以肠炎清治疗，对照组以柳氮磺胺吡院治疗。治疗60d后结果发现，治疗组临床证候总显效率为84．61％，对照组为35．90％（P＜0．01），总有效率治疗组为89．74％，对照组58．97％（P＜0．01）；两组肠粘膜的总显效率治疗组为69．23％，对照组15．38％（P＜0．01），总有效率治疗组为87．18％，对照组56．41％（P＜0．01）。认为不论轻、中、重型的UC患者，肠炎清的疗效均优于柳氮磺胺吡啶。     

Leukocytapheresis Therapy for Severe Ulcerative Colitis

Abstract: Severe attacks of ulcerative colitis are medical emergencies, and surgical treatment is indicated when glucocorticoid therapy is not effective. We have carried out an open clinical study of patients with severe attacks of ulcerative colitis to find out whether leukocytapheresis (LCAP) therapy can improve their outcomes. Nine patients were enrolled in this study. Seven of the nine patients had failed to respond to an intensive intravenous regimen before LCAP. LCAP was performed once a week for 4–5 weeks as intensive therapy using a leukocyte apheresis filter. Six of the 9 patients had an overall improvement after intensive therapy. Three patients reached the remission stage. The percentages of HLA-DR+, HLA-DR+ CD3+, HLA-DR+ CD4+, and HLA-DR+ CD8+ cells in the peripheral blood were higher in the responders than in the nonresponders, but there were no significant differences. In conclusion, LCAP therapy is useful for patients with severe attacks of ulcerative colitis, even those patients who failed to respond to glucocorticoid therapy.     

Acute Severe Ulcerative Colitis: Optimal Strategies for Drug Therapy

Acute severe ulcerative colitis (ASUC) is a life-threatening medical emergency with considerable morbidity (30% to 40%). Patients with ASUC require hospitalization for prompt medical treatment, and colectomy is considered if medical therapy fails. Corticosteroids remain the primary initial therapy, although one-third of patients do not respond to treatment. Clinical data have indicated that cyclosporine, tacrolimus, and infliximab can be used to treat patients with ASUC who do not respond to intravenous corticosteroids. The effectiveness and safety of sequential therapy have recently been reported; however, the data are not convincing. Importantly, timely decision-making with rescue therapy or surgical treatment is critical to manage ASUC without compromising the health or safety of the patients. In addition, risk stratification and the use of predictive clinical parameters have improved the clinical outcome.of ASUC. Multidisciplinary teams that include inflammatory bowel disease experts, colorectal surgeons, and other medical staff contribute to the better management of patients with ASUC. In this review, we introduce current evidence and present a clinical approach to manage ASUC. (Gut Liver, Published online November 14, 2022)     

Leukocytapheresis with Leukocyte Removal Filter as New Therapy for Ulcerative Colitis

Abstract: Leukocytapheresis (LCAP) with a leukocyte removal filter column was administered for 45 patients with ulcerative colitis (UC). We evaluated changes in the leukocyte count and the differential percentages during LCAP. Cytokine production was assessed from each patient's peripheral mononuclear cells or monocytes. Flow cytometry was performed to assess the removal rates of activated cells and adhesion molecule positive cells by LCAP. Clinical improvement was recognized in 35 of 45 patients during intensive LCAP therapy, and it continued throughout maintenance therapy in 32 patients (71.1%). The leukocyte count was decreased to about 40% during the first 30 min, but it increased to approximately 170% at 20 min after the completion of LCAP. The concentration of tumor necrosis factor (TNF)α before LCAP in the effective group was higher than it was in either the ineffective group or the control group. Its level decreased to near normal range after LCAP. In the effective group, the concentrations of interleukin (1L)-1β, IL-2, interferon (IFN)γ, and IL-8 were near the normal upper limits before LCAP; however, they had decreased after LCAP. The concentration of IL-4 increased after LCAP. In the ineffective group, in contrast, the concentrations had been at or near normal before the initial LCAP treatment. Flow cytometry study revealed that LCAP could remove the activated cells and adhesion molecule positive cells more effectively. The clinical improvement and the changes observed before and after LCAP therapy suggest that LCAP is able to intervene in the causal mechanism(s) of UC.     

溃疡性结肠炎的并发症

溃疡性结肠炎是慢性复发性疾病,其并发症直接影响该病的预后。本文以1993年全国慢性非感染肠道疾病学术研讨对本病会制定的诊断标准,对北京协和医院1974年1月至1995年1月溃疡性结肠炎住院和门诊病人483例进行了分析,着重探讨并发症的种类与疾病严重程度的关系以及对预后的影响。本组病人并发症的发生率为6.2％(30/483)。重症患者并发症的发生率为24.3％。并发症的种类,按其发生频率的多少依次排列如下:严重电解质紊乱(9.01％)、肠梗阻(8.11％)、人出血、菌群失调,肠穿孔(各3.60％)、败血症(2.70％)、肠瘘、癌变(各1.80％).中毒性肠扩张(0.90％)。本组溃疡性结肠炎早期并发症,除电解质紊乱外尚有大出血、中毒性肠扩张、败血症多见,随病程迁延则以肠梗阻、肠瘘、肠穿孔和癌变为主。并发症多发生于重度活动期(24.3％);其中病变累及全结肠为82％,左半结肠仅为18％。住院病人中该病病死率为6.08％,并发症组为23.08％,高于无并发症组(2％)。因此,对溃疡性结肠炎的并发症,要提请广大临床医师注意:需早期诊断,积极治疗,以减少病死率。     

溃疡性结肠炎的并发症

目的:探讨溃疡性结肠炎并发症的种类与疾病严重程度的关系以及对预后的影响.方法:以1993年全国慢性非感染肠道疾病学术研讨会制定的对本病的诊断标准,分析了北京协和医院1974年1月至1995年1月溃疡性结肠炎住院和门诊病人483例.结果:本组病人并发症的发生率为6.2%(30/483).重症患者并发症的发生率为24.3%.并发症的种类按其发生频率的多少依次为:严重的电解质紊乱(9.01%)、肠梗阻(8.11%)、大出血、菌群失调、肠穿孔(各3.6%)、败血症(2.70%)、肠瘘、癌变(各1.80%)、中毒性肠扩张(0.90%).本组溃疡性结肠炎早期并发症,除电解质紊乱外尚有大出血、中毒性肠扩张、败血症多见,随病程迁延则以肠梗阻、肠瘘、肠穿孔和癌变为主.并发症多发生于重度活动期(24.3%);其中病变累及全结肠为82%,左半结肠仅为18%.住院病人中该病病死率为6.08%,并发症组为23.08%,高于无并发症组(2%).结论:溃疡性结肠炎的并发症需早期诊断,积极治疗以减少病死率.     

A Meta-Analysis of Antibiotic Therapy for Active Ulcerative Colitis

To systematically evaluate the efficacy of antibacterial therapy in ulcerative colitis, we carried out a meta-analysis of controlled clinical trials. Within the time period 1966 through September 2006, PUBMED, EMBASE, and SCOPUS were searched for clinical trial studies that investigated the efficacy of antibiotics in ulcerative colitis. We considered clinical remission as our key outcome of interest. Of 122 studies, 10 randomized placebo-controlled clinical trials matched our criteria and were included in the analysis (530 patients). All the studies used antibiotics as an adjunct therapy to conventional treatment of ulcerative colitis (i.e., corticosteroids and 5-aminosalycilic acid). Pooling of these trials yielded odds ratio (OR) of 2.14 (95% confidence interval [CI], 1.48–3.09; P<0.0001) in favor of antimicrobial therapy. Meta-analysis of short-term trials (5–14 days) showed a higher rate of clinical remission in patients treated with antibiotics (OR, 2.02; 95% CI, 1.36–3). These results suggest that adjunctive antibacterial therapy is effective for induction of clinical remission in ulcerative colitis.     

Predictive Factors of Response to Leukocytapheresis Therapy for Ulcerative Colitis

Abstract. Leukocytapheresis (LCAP) using a leukocyte removal filter was performed for 8 patients with moderate to severe ulcerative colitis (UC). Significant clinical improvement was attained in 5 of 8 patients (62.5%). All of them had been suffering from moderately active colitis and Received corticosteroid therapy. On the other hand, 3 patients with severely active disease and treated with little or no corticosteroid were resistant to LCAP. This result indicates that LCAP is an effective treatment for steroid-resistant cases of UC when combined with steroid therapy. LCAP alone, however, seems to have little efficacy for severely active UC.