重度溃疡性结肠炎的治疗.ppt

《重度溃疡性结肠炎的治疗.ppt》由会员上传分享，免费在线阅读，更多相关内容在行业资料-天天文库。

1、重症溃疡性结肠炎的治疗IntroductionIBD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。RescueTherapyApproximately15%ofpatientswithulcerativecolitiswillh

2、aveasevereattackrequiringhospitalisationforintravenoussteroidsatsomestageintheirillness.Sixtypercentofpatientstreatedwithcorticosteroidswillbesymptomfreebytheendoffivedays,15%willhavesignificantimprovement,and25%willnotimprove.Steroidresistancewasdefinedasunresponsivenesstooralorintrav

3、enouscorticosteroidtherapy(equivalenttoadailydoseofmorethan30mgofprednisolone)overatleasttwoweeks.Thosewhofailtoimprovemaybetreatedwithintravenouscyclosporin,infliximab,oraltacrolimusorundergocolectomy.CaprilliR，ViscidoA，LatellaG．Currentmanagementofsevereulcerativecolitis．NatCIinPractG

4、astroenterolHepatol，2007，4：92-101．CsATherehavebeenfourcontrolledstudiesofintravenouscyclosporininpatientswithsevereulcerativecolitis.Intravenouscyclosporin(withorwithoutcontinuedintravenouscorticosteroids)iseffectivein50–80%ofpatientswithsevereulcerativecolitis.Aninitialdoseof2mg/kg/da

5、yintravenouscyclosporinappearstobeaseffectiveas4mg/kg/dayandisthuspreferredfromthestandpointofsafety.Longtermresponseratesfollowingshorttermtreatmentwithintravenouscyclosporinincontrolledtrialsrangedfrom45%(withoutazathioprinemaintenance)to78%(withazathioprine).Thereisasmallriskofoppor

6、tunisticinfectionanddeath(1–2%)duringcombinedcyclosporin,corticosteroid,andazathioprinetherapy,butlowerdosesofcyclosporinmayimprovethesafetyprofile.Toxicitymaybereducedatadoseof2mg/kg/dayintravenouscyclosporin.LoftusCG，LoftusEVJr，SandbornWJ．Cyclosporinforrefractoryulcerativecolitis．GUt

7、．2003，52;172—173．CheifetzAS，SternJ．GarudS．ela1．Cyclosporineissafeandeffectiveinpatientswithsevereulcerativecolitis．JClinGastroenter01．20ll，45．107-112．InfliximabJarnerotG,HertervigE,Friis-LibyIetal.Infliximabasrescuetherapyinseveretomoderatelysevereulcerativecolitis:arandomized,placeb