Warman Jonathan I, Korelitz Burton I, Fleisher Mark R, Janardhanam Ram
Department of Medicine, Lenox Hill Hospital, New York, New York 10021, USA.
J Clin Gastroenterol. 2003 Sep;37(3):220-5. doi: 10.1097/00004836-200309000-00006.
The efficacy of 6-mercaptopurine (6-MP) in the treatment and long-term maintenance of remission of inflammatory bowel disease and prevention of recurrence after resection in Crohn's disease have been established. Concern about 6-MP toxicity remains, especially the development of neoplasm. The aim of this study is to determine the incidence of all short- and long-term toxicity by follow-up of all patients with inflammatory bowel disease treated with 6-MP over a 20-year period.
We reviewed the office and hospital records and also determined the recent status of 410 patients with inflammatory bowel disease treated with 6-MP from 1980 to 1999. All toxicity was recorded.
There was a low incidence of early drug-related allergic reactions (3.9%) and pancreatitis (1.2%). Desensitization to either 6-MP or azathioprine is often successful with the same or the other drug. Significant leukopenia (<or=3500) was observed in 11.5%. In some cases, this was caused purposefully. Infectious complications occurred at different times during treatment with 6-MP in 14%, including pneumonia in 3.9% and herpes zoster in 3%. We now establish diabetes as a 6-MP-related complication. No significant difference in the incidence of neoplasm was seen from our earlier study or from patients not treated with 6-MP. We have now seen three lymphomas and two leukemias, again not greater in incidence than the overall inflammatory bowel disease population.
Our data support the long-term safety of 6-MP in the management of patients with inflammatory bowel disease. Earlier development of a neoplasm in a patient predisposed, without a change in incidence, remains possible.
6-巯基嘌呤（6-MP）在炎症性肠病的治疗及长期缓解维持，以及克罗恩病切除术后复发预防中的疗效已得到证实。对6-MP毒性的担忧依然存在，尤其是肿瘤的发生。本研究的目的是通过对20年间接受6-MP治疗的所有炎症性肠病患者进行随访，确定所有短期和长期毒性的发生率。
我们查阅了门诊和医院记录，并确定了1980年至1999年期间410例接受6-MP治疗的炎症性肠病患者的近期状况。记录了所有毒性反应。
早期药物相关过敏反应（3.9%）和胰腺炎（1.2%）的发生率较低。对6-MP或硫唑嘌呤脱敏通常对其中一种或另一种药物有效。11.5%的患者出现显著白细胞减少（≤3500）。在某些情况下，这是故意造成的。6-MP治疗期间不同时间发生感染并发症的患者占14%，包括肺炎3.9%和带状疱疹3%。我们现在确定糖尿病是一种与6-MP相关的并发症。肿瘤发生率与我们早期研究或未接受6-MP治疗的患者相比无显著差异。我们目前已发现3例淋巴瘤和2例白血病，其发生率同样不高于整体炎症性肠病患者群体。
我们的数据支持6-MP在炎症性肠病患者管理中的长期安全性。对于易感患者，仍有可能在肿瘤发生率不变的情况下更早发生肿瘤。
