Nishioka Chiharu, Aoyama Nobuo, Maekawa Shuji, Shirasaka Daisuke, Nakahara Takako, Tamura Takao, Fukagawa Masashi, Umezu Michio, Abe Takaya, Kasuga Masato
Division of Diabetes, Digestive and Kidney Diseases, Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
J Gastroenterol Hepatol. 2005 Oct;20(10):1567-71. doi: 10.1111/j.1440-1746.2005.03907.x.
Steroid administration currently plays a central role in the medical management of ulcerative colitis (UC); however, long-term steroid usage causes adverse effects, which necessitates stoppage of drug intake, leading to worsening of the disease. A steroid-sparing, well-tolerated treatment is therefore required. As several investigators have reported the efficacy of leukocytapheresis (LCAP) combined with steroid therapy, we investigated the clinical usefulness and safety of LCAP for steroid-naïve patients with active UC for comparison with those of conventional steroid therapy.
Twenty-nine Japanese patients with active UC without a history of steroid usage were selected to be treated with LCAP (n = 9) or prednisolone (PSL) (n = 20). LCAP administration continued for 10 weekly cycles. In the PSL group, patients with moderately severe disease received 0.5 mg/kg per day of PSL and those with severe disease 1.0 mg/kg per day. The PSL dosage was gradually tapered in accordance with improvement.
Eight (88.9%) of the LCAP group and 16 (80.0%) of the PSL group showed clinical improvement and three (33.3%) of the LCAP group and seven (35.0%) of the PSL group achieved remission. As for the treatment complications, three major adverse effects were observed in the PSL group, but none were observed in the LCAP group.
The results of this study suggest that the efficacy and safety of LCAP are equivalent, and in terms of severe adverse effects, superior to those of steroid therapy. LCAP therapy may thus be a promising candidate therapy for steroid-naïve patients with active UC.
目前，类固醇给药在溃疡性结肠炎（UC）的药物治疗中起着核心作用；然而，长期使用类固醇会产生不良反应，这就需要停药，从而导致病情恶化。因此，需要一种能减少类固醇用量且耐受性良好的治疗方法。由于一些研究人员报告了白细胞去除术（LCAP）联合类固醇疗法的疗效，我们研究了LCAP对初治活动性UC患者的临床有效性和安全性，并与传统类固醇疗法进行比较。
选取29例无类固醇使用史的日本活动性UC患者，分别接受LCAP治疗（n = 9）或泼尼松龙（PSL）治疗（n = 20）。LCAP治疗持续10个每周周期。在PSL组中，中度严重疾病患者每天接受0.5 mg/kg的PSL，重度疾病患者每天接受1.0 mg/kg。PSL剂量根据病情改善情况逐渐减少。
LCAP组8例（88.9%）和PSL组16例（80.0%）显示临床改善，LCAP组3例（33.3%）和PSL组7例（35.0%）实现缓解。关于治疗并发症，PSL组观察到3例主要不良反应，而LCAP组未观察到。
本研究结果表明，LCAP的有效性和安全性相当，且在严重不良反应方面优于类固醇疗法。因此，LCAP疗法可能是初治活动性UC患者一种有前景的候选疗法。
