McCormack Geraldine, McCormick P Aiden, Hyland John M, O'Donoghue Diarmuid P
Center for Colorectal Disease, St Vincent's University Hospital and University College Dublin, Ireland.
Dis Colon Rectum. 2002 Sep;45(9):1200-5. doi: 10.1007/s10350-004-6393-8.
Cyclosporin is advocated in the treatment of acute severe ulcerative colitis that has failed to respond to high-dose corticosteroid therapy. This approach is controversial, with critics highlighting the temporary nature of remissions and the potential for adverse effects. There have been few reports of the long-term outcome of those patients who do respond. The purpose of this study was to investigate the clinical outcome of all patients treated with cyclosporin at our institution over the past five years.
We conducted a retrospective study of 46 patients who presented to a tertiary referral center. Initial responders were those who avoided colectomy; a sustained response was defined as a remission that lasted while the patient was taking oral cyclosporin and for three months after this therapy was discontinued.
Thirty-two (69 percent) of 46 patients had an initial response to therapy, and 50 percent met criteria for a sustained response. Eleven of 23 sustained responders subsequently relapsed. At a mean of 22 months' follow-up, 26 percent of patients remain well and have never relapsed. Serious infective complications occurred in two patients, possibly attributable to therapy. No factors predictive of a likely response were identifiable on retrospective analysis.
This study confirms the efficacy of cyclosporin in the management of severe ulcerative colitis. Although many initial responders subsequently relapse, such patients may benefit from having even a short time to adjust to the need for surgery. A substantial minority (26 percent) of all patients treated remain in long-term remission.
对于对大剂量皮质类固醇治疗无反应的急性重症溃疡性结肠炎，有人主张使用环孢素进行治疗。这种方法存在争议，批评者强调缓解的短暂性以及不良反应的可能性。关于那些有反应的患者的长期预后的报道很少。本研究的目的是调查过去五年在我们机构接受环孢素治疗的所有患者的临床结局。
我们对一家三级转诊中心的46例患者进行了回顾性研究。初始反应者是那些避免了结肠切除术的患者；持续反应定义为在患者服用口服环孢素期间以及该治疗停止后三个月持续的缓解。
46例患者中有32例（69%）对治疗有初始反应，50%符合持续反应标准。23例持续反应者中有11例随后复发。平均随访22个月时，26%的患者病情良好且从未复发。两名患者发生了严重的感染并发症，可能与治疗有关。回顾性分析未发现可预测可能反应的因素。
本研究证实了环孢素在重症溃疡性结肠炎治疗中的有效性。尽管许多初始反应者随后复发，但这类患者可能会从哪怕只是有很短的时间来适应手术需求中受益。所有接受治疗的患者中有相当一部分少数（26%）保持长期缓解。
