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低分子量肝素治疗激素难治性溃疡性结肠炎:临床结局及对黏膜毛细血管血栓的影响。

Low molecular weight heparin treatment in steroid refractory ulcerative colitis: clinical outcome and influence on mucosal capillary thrombi.

作者信息

Vrij A A, Jansen J M, Schoon E J, de Bruïne A, Hemker H C, Stockbrügger R W

机构信息

Dept. of Gastroenterology, Academic Hospital Maastricht, The Netherlands.

出版信息

Scand J Gastroenterol Suppl. 2001(234):41-7. doi: 10.1080/003655201753265091.

Abstract

BACKGROUND

In ulcerative colitis, a state of hypercoagulation has frequently been observed. Unfractionated heparin has shown beneficial effects as an adjuvant treatment of steroid refractory ulcerative colitis in open trials and in one placebo-controlled trial. Low molecular weight heparin (LMWH) offers advantages in the method of administration, but it has not been evaluated in severe ulcerative colitis. We therefore assessed the tolerability, safety and potential therapeutical effects of LMWH in hospitalized patients with steroid refractory ulcerative colitis.

METHODS

Twenty-five patients with severely active ulcerative colitis were included in an open-labelled trial. All patients had a flare-up of disease under glucocorticosteroid treatment. Nadroparine calcium 5.700 IE anti-Xa/0.6 mL s.c. was self-administered twice daily for 8 weeks. Patients were monitored for possible adverse events, and changes in clinical symptoms and in laboratory, endoscopical and histological results were analysed.

RESULTS

Tolerability and compliance were excellent and no serious adverse events occurred. In 20 of 25 patients, a good clinical and laboratory response was observed. Also, the endoscopic and histological signs of inflammation were found to be significantly improved. However, this was not accompanied by a significant reduction in the number of mucosal microvascular thrombi after 8 weeks of LMWH treatment.

CONCLUSION

LMWH may be a safe adjuvant therapy for patients with active, glucocorticosteroid refractory ulcerative colitis.

摘要

背景

在溃疡性结肠炎中,常观察到高凝状态。在开放试验和一项安慰剂对照试验中,普通肝素作为类固醇难治性溃疡性结肠炎的辅助治疗已显示出有益效果。低分子量肝素(LMWH)在给药方法上具有优势,但尚未在重度溃疡性结肠炎中进行评估。因此,我们评估了低分子量肝素在住院的类固醇难治性溃疡性结肠炎患者中的耐受性、安全性和潜在治疗效果。

方法

25例重度活动性溃疡性结肠炎患者纳入一项开放标签试验。所有患者在糖皮质激素治疗下病情均有发作。皮下注射那屈肝素钙5700抗Xa国际单位/0.6毫升,每日两次,共8周。监测患者可能出现的不良事件,并分析临床症状以及实验室、内镜和组织学结果的变化。

结果

耐受性和依从性良好,未发生严重不良事件。25例患者中有20例观察到良好的临床和实验室反应。此外,炎症的内镜和组织学征象也有显著改善。然而,低分子量肝素治疗8周后,黏膜微血管血栓数量并未显著减少。

结论

对于活动性、糖皮质激素难治性溃疡性结肠炎患者,低分子量肝素可能是一种安全的辅助治疗方法。

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