Kim S G, Kim J S, Jung H C, Song I S
Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
Aliment Pharmacol Ther. 2003 Jul 1;18(1):85-91. doi: 10.1046/j.1365-2036.2003.01599.x.
Tuberculosis has increased in parallel with the acquired immunodeficiency syndrome epidemic and the use of immunosuppressive therapy, and the growing incidence of extra-pulmonary tuberculosis, especially with intestinal involvement, reflects this trend. However, the duration of anti-tuberculous therapy has not been clarified in intestinal tuberculosis.
To compare the efficacy of different treatment durations in tuberculous enterocolitis in terms of response and recurrence rates.
Forty patients with tuberculous enterocolitis were randomized prospectively: 22 patients into a 9-month and 18 into a 15-month group. Diagnosis was made either by colonoscopic findings of discrete ulcers and histopathological findings of caseating granuloma and/or acid-fast bacilli, or by clinical improvement after therapeutic trial. Patients were followed up with colonoscopy every other month until complete response or treatment completion, and then every 6 months for 1 year and annually. Complete response was defined as a resolution of symptoms and active tuberculosis by colonoscopy.
Complete response was obtained in all patients in both groups. Two patients in the 9-month group and one in the 15-month group underwent operation due to intestinal obstruction and perianal fistula, respectively. No recurrence of active intestinal tuberculosis occurred during the follow-up period in either group.
Tuberculous enterocolitis can be managed by 9-month chemotherapy without disease recurrence. Further investigations are needed in immunocompromised patients.
结核病的增加与获得性免疫缺陷综合征的流行以及免疫抑制治疗的使用同步，肺外结核病发病率的上升，尤其是肠道受累情况，反映了这一趋势。然而，肠结核的抗结核治疗疗程尚未明确。
比较不同治疗疗程对结核性小肠结肠炎的疗效，以反应率和复发率为指标。
40例结核性小肠结肠炎患者前瞻性随机分组：22例进入9个月疗程组，18例进入15个月疗程组。诊断依据为结肠镜检查发现散在溃疡、组织病理学检查发现干酪样肉芽肿和/或抗酸杆菌，或经治疗试验后临床症状改善。患者每隔一个月进行结肠镜随访，直至完全缓解或治疗结束，之后每6个月随访1年，每年随访一次。完全缓解定义为症状消失且结肠镜检查显示活动性结核病消失。
两组所有患者均获得完全缓解。9个月疗程组有2例患者因肠梗阻接受手术，15个月疗程组有1例患者因肛周瘘管接受手术。随访期间两组均未出现活动性肠结核复发。
结核性小肠结肠炎采用9个月化疗可有效治疗且无疾病复发。免疫功能低下患者还需要进一步研究。
