在类固醇治疗中添加白细胞去除术：对中重度溃疡性结肠炎复发有益吗？
Addition of leukocytapheresis to steroid therapy: is it beneficial in recurrence of moderate-to-severe ulcerative colitis?
作者信息
Jo Yukihiko, Matsumoto Takayuki, Mibu Ryuichi, Iida Mitsuo
机构信息
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
出版信息
Dis Colon Rectum. 2003 Oct;46(10 Suppl):S3-9. doi: 10.1097/01.DCR.0000088851.79497.9B.
PURPOSE
In Japan, leukocytapheresis has become an accepted therapy for ulcerative colitis. The purpose of this retrospective study was to determine the efficacy of additional leukocytapheresis in patients with moderate-to-severe recurrence of ulcerative colitis.
METHODS
From 1998 to 2002, 35 patients with moderate-to-severe recurrence of ulcerative colitis were treated by intravenous prednisolone only or prednisolone plus leukocytapheresis once per week. Previous clinical features of ulcerative colitis, activity index at four weeks, and subsequent course were compared between patients with leukocytapheresis and those without.
RESULTS
Sixteen patients were treated with prednisolone only (prednisolone group), and 19 patients were treated with prednisolone plus leukocytapheresis (leukocytapheresis group). Previous prednisolone dose (13.6 +/- 10.4 g vs. 7.9 +/- 9.8 g; P < 0.05) was higher in the leukocytapheresis group than the prednisolone group. Clinical response rate at four weeks was not different between the two groups (leukocytapheresis group, 68.4 percent vs. prednisolone group, 75 percent). However, ulcerative colitis activity index at four weeks was significantly higher in the leukocytapheresis group than the prednisolone group (180.5 +/- 44.2 vs. 142.5 +/- 45.3; P < 0.05). During the subsequent clinical course, 15 of 35 patients required proctocolectomy (leukocytapheresis group, 11 patients vs. prednisolone group, 4 patients). Proctocolectomy rate was significantly different when patients were divided by previous prednisolone dose (P = 0.0029) and ulcerative colitis activity index at four weeks (P = 0.002), but it was not different according to the application of leukocytapheresis. Cox proportional hazards model revealed previous prednisolone dose to be the only independent risk factor for proctocolectomy.
CONCLUSIONS
Addition of leukocytapheresis to prednisolone therapy does not seem beneficial in ulcerative colitis patients with moderate-to-severe recurrence.
目的
在日本，白细胞去除术已成为治疗溃疡性结肠炎的一种公认疗法。这项回顾性研究的目的是确定在中重度复发性溃疡性结肠炎患者中额外进行白细胞去除术的疗效。
方法
1998年至2002年，35例中重度复发性溃疡性结肠炎患者接受了仅静脉注射泼尼松龙或泼尼松龙加每周一次白细胞去除术的治疗。对接受白细胞去除术的患者和未接受该治疗的患者的溃疡性结肠炎既往临床特征、四周时的活动指数及后续病程进行了比较。
结果
16例患者仅接受泼尼松龙治疗（泼尼松龙组），19例患者接受泼尼松龙加白细胞去除术治疗（白细胞去除术组）。白细胞去除术组既往泼尼松龙剂量（13.6±10.4g对7.9±9.8g；P<0.05）高于泼尼松龙组。两组四周时的临床缓解率无差异（白细胞去除术组为68.4%，泼尼松龙组为75%）。然而，白细胞去除术组四周时的溃疡性结肠炎活动指数显著高于泼尼松龙组（180.5±44.2对142.5±45.3；P<0.05）。在随后的临床病程中，35例患者中有15例需要行全结肠直肠切除术（白细胞去除术组11例，泼尼松龙组4例）。根据既往泼尼松龙剂量（P=0.0029）和四周时的溃疡性结肠炎活动指数（P=0.002）对患者进行分组时，全结肠直肠切除率有显著差异，但根据是否应用白细胞去除术则无差异。Cox比例风险模型显示既往泼尼松龙剂量是全结肠直肠切除术的唯一独立危险因素。
结论
在中重度复发性溃疡性结肠炎患者中，泼尼松龙治疗加用白细胞去除术似乎并无益处。
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