预防克罗恩病术后复发需要美沙拉嗪在黏膜达到足够的浓度。意大利结直肠研究组。

Prevention of post-operative recurrence of Crohn's disease requires adequate mucosal concentration of mesalazine. Gruppo Italiano per lo Studio del Colon e del Retto.

作者信息

Frieri G, Pimpo M T, Andreoli A, Annese V, Comberlato M, Corrao G, Palumbo G, Sturniolo G C, Tonelli F, Caprilli R

机构信息

Cattedra di Gastroenterologia Università di L'Aquila, Italy.

出版信息

Aliment Pharmacol Ther. 1999 May;13(5):577-82. doi: 10.1046/j.1365-2036.1999.00501.x.

DOI:10.1046/j.1365-2036.1999.00501.x

PMID:10233180

Abstract

BACKGROUND

Surgical resection of Crohn's disease is followed by early recurrence in a high percentage of patients. Mesalazine has been shown to be effective in the prevention of post-operative recurrence, but some 50% of patients under treatment recur at 3 years of follow-up.

AIM

To establish whether the mucosal concentration of mesalazine might affect the development of post-operative recurrence.

METHODS

Colon-ileoscopy was performed in 25 consecutive patients resected for Crohn's disease. The mean time from surgery was 14 months. After the operation, all patients were taking oral mesalazine (Asacol, 2.4 g/day). Ten patients showed signs of endoscopic recurrence (apthae, ulcers, narrowing of the lumen) in the neoterminal ileum, five of whom also showed juxta-anastomotic colonic involvement. Fifteen patients were free of recurrence. At endoscopy, four biopsies were taken from the perianastomotic area (two specimens at the ileal site and two specimens at the colonic site of the anastomosis). The specimens were weighed and immediately frozen at -80 degrees C. Mesalazine concentration (ng/mg) was measured in tissue homogenates by high- performance liquid chromatography with electrochemical detection. Fisher's exact test was used for the statistical analysis.

RESULTS

The mean value of mucosal mesalazine concentration, expressed as ng/mg of tissue, was significantly lower in patients with recurrence than in those without recurrence both in the ileum (mean +/- s.d.: 21.6+/-28.3 vs. 70.9+/-47.4; P = 0.007) and in the colon (25.8+/-26.4 vs. 60.3+/-32.5; P = 0.010).

CONCLUSIONS

The mucosal concentration of mesalazine in the juxta-anastomatic area is significantly lower in patients with recurrence than in those free of recurrence. These data could suggest an association between mucosal mesalazine concentrations and the clinical effectiveness of the drug.

摘要

背景

克罗恩病手术切除后，很大比例的患者会出现早期复发。美沙拉嗪已被证明在预防术后复发方面有效，但在接受治疗的患者中，约50%在随访3年时复发。

目的

确定美沙拉嗪的黏膜浓度是否会影响术后复发的发生。

方法

对25例因克罗恩病接受手术切除的连续患者进行结肠-回肠内镜检查。距手术的平均时间为14个月。术后，所有患者均口服美沙拉嗪（艾迪莎，2.4克/天）。10例患者在回肠末端出现内镜复发迹象（阿弗他溃疡、溃疡、管腔狭窄），其中5例还出现吻合口旁结肠受累。15例患者无复发。在内镜检查时，从吻合口周围区域取4块活检组织（吻合口回肠部位2块标本，吻合口结肠部位2块标本）。称取标本重量并立即在-80℃冷冻。通过高效液相色谱-电化学检测法测定组织匀浆中美沙拉嗪浓度（纳克/毫克）。采用Fisher精确检验进行统计分析。