巴柳氮钠治疗活动性溃疡性结肠炎的疗效观察

目的探讨巴柳氮钠（商品名：贝乐司）治疗活动性溃疡性结肠炎（UC）的临床疗效。方法收集2005年10月-2006年6月在河南省16家医院治疗的活动性UC患者139例，随机分为治疗组（n=78）和对照组（n=61）。治疗组患者服用巴柳氮钠片剂每天6g，连续4周，缓解后改为每天2g，继续4周；对照组服用柳氮磺胺吡啶（SASP）片剂每天4g，连续4周，缓解后改为每天2g，继续4周。比较治疗前后两组患者的临床症状（腹痛、腹泻、脓血便）、生化和免疫学指标（肝功能、肾功能、红细胞沉降率、C反应蛋白），以及结肠镜下黏膜和组织学表现。结果治疗后8周，发现巴柳氮钠与SASP均可有效控制UC患者的病情发作（总有效率为84．2％比76．7％，P〉0．05）。在治疗2周后，巴柳氮钠比SASP能更迅速地缓解患者的临床症状，如腹痛（42．1％比69．8％）、腹泻（23．1％比55．6％）和脓血便（58．3％比76．5％），并可改善内镜下黏膜炎症表现及降低黏膜组织炎症分级（P〈0．05）。患者服用巴柳氮钠的依从性好。该药对患者的肝、肾功能无影响，治疗后血细胞沉降率和C反应蛋白的水平均显著降低（P〈0．05），且不良反应发生率亦明显低于SASP（P〈0．01）。结论巴柳氮钠是一种良好的控制UC活动性的药物，能维持病情缓解，不良反应少。     

美沙拉嗪、柳氮磺胺吡啶对溃疡性结肠炎的疗效对照观察

目的探究美沙拉嗪治疗溃疡性结肠炎的临床疗效。方法选取2010年1月至2013年1月到我院进行治疗的51例溃疡性结肠炎患者为研究对象,按照治疗方式的不同,将患者分为治疗组26例与对照组25例。治疗组给予美沙拉嗪进行治疗,对照组给予柳氮磺胺吡啶治疗,观察两组患者的临床治疗效果、症状的改善情况及不良反应的发生情况。结果治疗组总有效率96.2%显著高于对照组72.0%(P0.05),治疗组症状改善优于对照组(P0.05),治疗组不良反应发生率少于对照组(P0.05)。结论美沙拉嗪治疗溃疡性结肠炎效果显著,能快速改善患者的临床症状,不良反应少,值得临床推广使用。     

高压氧联合柳氮磺吡啶治疗溃疡性结肠炎82例

溃疡性结肠炎的病因和发病机理尚未完全阐明 ,治疗困难 ,易于复发。我们在柳氮磺胺吡啶治疗的基础上加用高压氧治疗 ,观察了其疗效、复发情况及对体液免疫、细胞免疫的影响。1　病例与方法1.1　病例　溃疡性结肠炎患者 82例按就诊顺序随机分为治疗组与对照组。治疗组 4 2例 ,男 2 0例 ,女 2 2例 ,平均年龄 35 .4岁 ;对照组 4 0例 ,男 18例 ,女 2 2例 ,平均年龄 34岁。两组性别、年龄情况统计学处理无显著性差异。1.2　方法　病例诊断标准按 1993年太原会议标准[1] 。治疗方法 :对照组口服柳氮磺胺吡啶 ,每次 1ｇ ,每日 3次 ,共用 30天。治疗…     

美沙拉嗪栓塞肛治疗活动性溃疡性结肠炎疗效观察

目的探讨美沙拉嗪栓塞肛治疗活动性溃疡性结肠炎（UC）的临床疗效。方法将76例轻中度活动性UC患者随机分为两组各38例,观察组行美沙拉嗪栓塞肛1枚/次、1次/d,对照组口服水杨酸偶氮磺胺吡啶（SASP）1.0 g/次、4次/d;治疗8周后,比较其临床疗效和不良反应。结果观察组、对照组总有效率分别为94.74%、68.42%,不良反应发生率分别为10.53%、55.26%;两组总有效率、不良反应发生率比较均有统计学差异（P均〈0.05）。结论美沙拉嗪栓塞肛治疗轻中度活动性UC临床疗效好,不良反应少。     

英夫利昔治疗溃疡性结肠炎临床疗效的荟萃分析

目的采用荟萃分析的方法,探讨英夫利昔(Infliximab,IFX)治疗溃疡性结肠炎(ulcerative colitis,UC)的疗效。方法全面检索并收集研究IFX治疗UC的临床随机对照试验。纳入7篇文献,共有7个随机对照实验(RCT)。质量评价、独立提取资料后以RevMan 4.2分析。结果荟萃分析显示:比较IFX与安慰剂治疗UC的长期、短期疗效,结果均有显著差异。比较IFX 5 mg、10mg与安慰剂组短期、长期的疗效,结果有显著差异。IFX的短期及长期疗效与激素相比,结果无显著差异。IFX与安慰剂的不良反应结果无显著差异。结论 IFX可以诱导UC的临床缓解及维持,而且对于难治性中重度UC,IFX可以使患者减少结肠切除率,提高生活质量。但是仍然需要大样本多中心的随机对照试验来进一步验证。     

Ⅰ型干扰素治疗溃疡性结肠炎有效性的荟萃分析

目的:采用荟萃分析的方法对Ⅰ型干扰素治疗溃疡性结肠炎(ulcerative colitis,UC)的有效性进行系统评价.方法:检索Pub Med、EMBASE、CNKI中国期刊全文数据库、CBM中国生物医学文献数据库、万方数据库中所有关于Ⅰ型干扰素治疗UC的随机对照研究.应用比值比(odds ratio,OR)及其95%CI为疗效分析统计量,采用Rev Man5.1进行荟萃分析,比较干扰素与安慰剂治疗UC的有效缓解率及严重不良反应发生率.结果:共4篇文献纳入荟萃分析.结果显示,Ⅰ型干扰素治疗UC与安慰剂相比,有效缓解率无明显差异(OR=1.23,95%CI:0.76-2.01,P=0.40),严重不良反应发生率无明显差异(OR=1.44,95%CI:0.21-9.82,P=0.71).结论:应用Ⅰ型干扰素治疗UC患者,其疗效不优于安慰剂.     

缓解柳氮磺吡啶治疗溃疡性结肠炎引起胃肠道反应15例分析

回顾分析SASP治疗溃疡性结肠炎引起胃肠道不良反应15例患者的临床表现。给予降低SASP剂量；恶心、食欲不振或上腹胀者用多潘立酮；上腹不适或烧灼感者用PPI；二者皆有给予多潘立酮及PPI两种药物治疗等。15例患者中发生恶心、食欲不振11例，上腹不适7例，上腹烧灼感2例，上腹胀1例。降低SASP剂量5例，给予多潘立酮3例，雷贝拉唑等PPI2例，多潘立酮及PPI治疗5例，15例患者皆症状减轻更好耐受治疗。降低剂量、用多潘立酮或／及质子泵抑制，可能缓解SASP引起的胃肠道不良反应，溃疡性结肠炎患者更易耐受治疗。     

美沙拉嗪与柳氮磺胺吡啶治疗轻中度左半结肠型溃疡性结肠炎的疗效对比观察

目的对比观察美沙拉嗪与柳氮磺胺吡啶治疗轻中度溃疡性结肠炎病人的疗效。方法采用随机对照研究方案,将入组的64例溃疡性结肠炎患者随机分为美沙拉嗪治疗组和柳氮磺胺吡啶治疗组,前者服用美沙拉嗪缓释颗粒剂,后者服用柳氮磺胺吡啶,疗程均为6周。记录治疗过程中出现的不良事件,根据改良Mayo评分系统评估两组治疗前后评分,判断治疗效果。结果美沙拉嗪治疗组有效率为90.6%,柳氮磺胺吡啶治疗组有效率为70.0%,两组有显著性差异(P0.05);美沙拉嗪治疗组不良事件发生率显著低于柳氮磺胺吡啶治疗组。结论美沙拉嗪治疗轻中度左半结肠型溃疡性结肠炎疗效显著而又安全。     

柳氮磺吡啶联合白头翁汤灌肠治疗溃疡性结肠炎32例

[目的]观察柳氮磺毗啶(SASP)联合白头翁汤灌肠治疗溃疡性结肠炎(UC)的临床疗效.[方法]62例UC患者随机分为2组,对照组30例,单用SASP治疗,治疗组32例,采用SASP联合白头翁汤灌肠治疗,治疗9周后,2组均行结肠镜检查,观察比较疗效.[结果]治疗组总有效率为93.75%,对照组66.70%,2组比较差异有统讳学意义(P<0.05).[结论]SASP联合白头翁汤灌肠治疗UC比单用SASP更能控制急性发作,维持缓解,巩固和提高疗效的作用.     

The economics of mesalazine in active ulcerative colitis and maintenance in the Netherlands

Background: In this study we investigate the costs and benefits of topical mesalazine combined with oral mesalazine therapy for active ulcerative colitis (UC), and once daily (OD ) mesalazine 2 grams versus twice daily (BID ) for maintaining UC remission. Methods: Two decision analytic models were constructed to evaluate treatment costs and quality-adjusted life years (QALYs) associated with mesalazine. The first model explored 4 g oral mesalazine in combination with 1 g topical mesalazine during active UC compared with 4 g oral mesalazine monotherapy for achieving clinical remission. The second model compared remission rates at one year for OD 2 g oral mesalazine compared with BID 1 g adjusted for compliance. All direct costs were obtained from established treatment costs in the Netherlands. Results: The average cost of treatment to transition an active UC patient into remission using oral plus topical mesalazine or oral mesalazine monotherapy was v2207 (95% CI: v1402 to v3332) and v2945 (95% CI: v1717 to v4592), respectively. The annual average cost-saving of adding topical mesalazine delivered for four weeks during active UC was v738. The average annual costs of maintenance of remission with OD and BID therapy were v1293 (95% CI: v1062 to v1496) and v1502 (95% CI: v1262 to 1708), respectively with an annual average per person savings of v209. Conclusion: Topical mesalazine during acute UC flares results in lower costs due to reduced healthcare consumption attributed to faster symptom resolution. Furthermore, as a result of lower costs and modest QALY gains, maintenance therapy using OD mesalazine is the dominant treatment option if compared with BID mesalazine.     

Glomerular and tubular renal functions after long-term medication of sulphasalazine, olsalazine, and mesalazine in patients with ulcerative colitis

To date there are only few reports evaluating the potential nephrotoxic reactions of the new 5-aminosalicylic acid (5-ASA) preparations in patients with ulcerative colitis (UC). The aim of this study was to screen the tubular and glomerular functions in patients with UC in maintenance treatment with either 5-ASA azo-compounds (sulphasalazine and olsalazine) or mesalazine. Patients with UC in clinical remission treated with either sulphasalazine, olsalazine, or mesalazine for more than 1 year were included in an open, single-blind retrospective Norwegian multicenter study. Serum and urine creatinine, serum and urine beta2-microglobulin, urine N-acetyl-beta-glucoseamidase (NAG), urine alkaline phosphatase, urine microalbumin, urine alanine amino peptidase, and urine beta2-microglobulin were measured. Fifty-two females and 75 males (n = 127), ages 20-69, were evaluated. Thirty-six patients were treated with sulphasalazine (mean treatment time 10.1+/-6.6 years [mean +/- SD]), 32 patients were treated with olsalazine (2.3+/-1.4 years), and 59 patients with mesalazine (3.2+/-2.0 years). At inclusion, there were no significant differences in the serum or urine values between the groups. In 17 patients (1 patient [3%] in the sulphasalazine group, 4 patients [13%] in the olsalazine group, and 12 patients [20%] in the mesalazine group), at least one abnormal serum and/or urine value was detected. After 10 years of treatment, only one abnormal value was found among the 19 patients in the sulphasalazine group. The abnormal values observed in the other groups indicated minor glomerular or tubular renal damage. In conclusion, long term sulphasalazine treatment appears to be safe and free of nephrotoxic side effects, whereas minor glomerular and tubular impairment are observed in a few patients treated with olsalazine and mesalazine.     

Comparison of delayed release 5 aminosalicylic acid (mesalazine) and sulphasalazine in the treatment of mild to moderate ulcerative colitis relapse.

Oral formulations of 5-aminosalicylic acid (mesalazine) appear less toxic than sulphasalazine. We have therefore compared sulphasalazine, low dose mesalazine and high dose mesalazine in the treatment of mild to moderate relapse of ulcerative colitis. Sixty one patients (32 men, aged 20-78 years) were randomly allocated to sulphasalazine 2 g daily, mesalazine 800 mg daily, or mesalazine 2.4 g daily in a double blind, double dummy, four week trial. Groups were comparable for age, sex, extent of disease, and pretrial sulphasalazine intake. Four patients were unable to complete the study because of treatment failure (two taking sulphasalazine and two high dose mesalazine). A further two patients taking sulphasalazine developed side effects necessitating withdrawal. Within treatment comparisons revealed significant improvement of: sigmoidoscopic grade in the sulphasalazine group; rectal bleeding, sigmoidoscopic and histological grade in the low dose mesalazine group; stool frequency, rectal bleeding and sigmoidoscopic grade in the high dose mesalazine group. Greater improvement in rectal bleeding (p less than 0.05) and sigmoidoscopic appearances (p less than 0.05) occurred in patients taking high dose mesalazine than in those taking sulphasalazine. In two patients taking high dose mesalazine minor rises of plasma creatinine concentrations occurred, suggesting the need to monitor renal function.     

Optimum dose of sulphasalazine for maintenance treatment in ulcerative colitis.

Sulphasalazine is widely used in the maintenance treatment of ulcerative colitis but the optimum dose is not known. In the present study, 170 patients were allotted at random to three treatment groups, in which the daily dose was 1, 2 and 4 g respectively, and the trial period of treatment lasted for six months. A daily dose of 2 g was found to be much more efficacious than 1 g. A daily dose of 4 g was more efficacious than 2 g but at the price of fairly frequent symptomatic side-effects. Haematological abnormalities were observed at all dosage levels, but they occurred chiefly among the patients on 4 g daily. Both symptomatic and the haematological side-effects were usually associated with high concentrations of serum sulphapyridine and these high levels occurred chiefly among the slow acetylators. It is concluded that, for general use, a daily dose of 2 g sulphasalazine is satisfactory for the maintenance treatment of ulcerative colitis. If a patient does not do well on 2 g daily, it is worth trying a larger dose but in this case the patient's condition should be monitored by blood film, haemoglobin, MCV, and reticulocyte count.     

A randomized,double blind,dose-response comparison of balsalazide (6.75 g), balsalazide (2.25 g), and mesalamine (2.4 g) in the treatment of active,mild-to-moderate ulcerative colitis

OBJECTIVE: Balsalazide is a new innovative, mesalamine-containing prodrug that is activated by bacteria in the colon. Balsalazide has been shown previously to be well tolerated and effective in the treatment of acute ulcerative colitis. The aim of this study was to determine the dose-response of balsalazide for efficacy and safety in active, mild-to-moderate ulcerative colitis and to compare this profile with that of mesalamine, pH-dependent, delayed-release tablets. METHODS: A multicenter, randomized, active control, double-blind, double-dummy, dose-response, parallel-group study was performed comparing balsalazide (6.75 g daily), balsalazide (2.25 g daily), and mesalamine (2.4 g daily), administered for 8 wk to 154 patients with active, mild-to-moderate ulcerative colitis as verified by sigmoidoscopy. RESULTS: Eight weeks of treatment with 6.75 g of balsalazide daily provided significantly greater improvement than did balsalazide (2.25 g daily) in rectal bleeding (64.7% [6.75-g balsalazide] vs 32.4% [2.25-g balsalazide], p < 0.006), stool frequency (58.8% vs 29.4%, p < 0.006), sigmoidoscopic score (78.9% vs 52.5%, p < 0.015), and Physician's Global Assessment (73.7% vs 51.3%, p < 0.03). The efficacy of balsalazide showed a significantly more rapid onset of action than that of mesalamine (2.4 g daily) (2-wk sigmoidocopic score improvement, 54.7% [6.75-g balsalazide] vs 29.4% [2.4-g mesalamine], p = 0.006) with numerically greater improvement at 8 wk in five of seven measured signs and symptoms. Balsalazide (6.75 g daily) was well tolerated, and the safety profile did not differ significantly from that of balsalazide (2.25 g daily) or mesalamine. CONCLUSIONS: Eight weeks of treatment with balsalazide (6.75 g daily) is significantly more effective than balsalazide (2.25 g daily) and more rapid in onset than mesalamine (2.4 g daily) in improving signs and symptoms of acute ulcerative colitis. Balsalazide (6.75 g daily) is well tolerated, and the safety profile does not differ from that of balsalazide (2.25 g daily) and mesalamine (2.4 g daily).     

Controlled trial comparing olsalazine and sulphasalazine for the maintenance treatment of ulcerative colitis.

One hundred and sixty four patients with ulcerative colitis in remission were entered into a double blind, double dummy trial comparing olsalazine 500 mg bd and sulphasalazine 1 g bd. Clinical examination, sigmoidoscopy and rectal biopsy were performed at 0, three, and six months. Sixteen of 82 (19.5%) patients relapsed on olsalazine and 10/82 (12.2%) relapsed on sulphasalazine. The difference was not statistically significant (p = 0.1632). Adverse events were minor and were similar in both groups. No haematological or biochemical abnormalities were detected. Thus, olsalazine is as effective as sulphasalazine for preventing a relapse of ulcerative colitis.