Glazier Kenneth D, Palance Adam L, Griffel Louis H, Das Kiron M
Crohn's and Colitis Center of NJ, Division of Gastroenterology and Hepatology, Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 0893, USA.
J Clin Gastroenterol. 2005 Jan;39(1):21-6.
To report the 10-year experience of a single center in treating patients with refractory inflammatory bowel disease (IBD) with relatively lower dose of 6-mercaptopurine (6-MP).
The charts of 285 patients with IBD (Crohn's disease 160 and ulcerative colitis 125) receiving 6-MP were reviewed. Clinical response, subsequent breakthrough while taking 6-MP, and relapse rates when 6-MP was discontinued and side effects were assessed.
Ninety-three percent of the patients were taking 50 to 75 mg/day of 6-MP. Complete remission was achieved in 62%, partial remission in 14.5%, and failure to achieve remission in 23.5% of the patients. Of complete responders, 27.5% had breakthrough while continuing 6-MP. Nine percent of those that achieved a complete remission experienced a relapse after 6-MP was discontinued. Side effects included leukopenia (11.2%), abnormal liver function tests (3.8%), various infections, including pneumonia (3.1%), pancreatitis (2.5%), nausea (2.1%), headache (2.8%), fever (1.4%), hair loss (1%), and rash (0.7%). Two cancers occurred while taking 6-MP: melanoma on the finger and a fatal colonic lymphoma. Four patients continued 6-MP throughout pregnancies and had normal outcomes.
In our experience 6-MP is relatively safe and appears to be as effective at a lower dosage (0.84 mg/kg per day) compared with the recommended higher dosage (1-1.5 mg/kg per day), when leukopenia was more frequent. Serious side effects, although rare, need to be monitored.
报告单一中心使用相对低剂量6-巯基嘌呤（6-MP）治疗难治性炎症性肠病（IBD）患者的10年经验。
回顾了285例接受6-MP治疗的IBD患者（克罗恩病160例，溃疡性结肠炎125例）的病历。评估了临床反应、服用6-MP期间的后续病情突破、停药后的复发率以及副作用。
93%的患者服用6-MP的剂量为每日50至75毫克。62%的患者实现完全缓解，14.5%的患者部分缓解，23.5%的患者未实现缓解。在完全缓解的患者中，27.5%在继续服用6-MP时出现病情突破。9%实现完全缓解的患者在停用6-MP后复发。副作用包括白细胞减少（11.2%）、肝功能检查异常（3.8%）、各种感染，包括肺炎（3.1%）、胰腺炎（2.5%）、恶心（2.1%）、头痛（2.8%）、发热（1.4%）、脱发（1%）和皮疹（0.7%）。服用6-MP期间发生了两例癌症：手指黑色素瘤和致命性结肠淋巴瘤。4名患者在整个孕期持续服用6-MP，结局正常。
根据我们的经验，6-MP相对安全，与推荐的较高剂量（每日1-1.5毫克/千克）相比，较低剂量（每日0.84毫克/千克）似乎同样有效，而在较高剂量时白细胞减少更为常见。严重副作用虽然罕见，但需要监测。
