Tung Jeanne, Loftus Edward V, Freese Deborah K, El-Youssef Mounif, Zinsmeister Alan R, Melton L Joseph, Harmsen W Scott, Sandborn William J, Faubion William A
Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Inflamm Bowel Dis. 2006 Dec;12(12):1093-100. doi: 10.1097/01.mib.0000235835.32176.85.
The goal of this study was to examine the 1-year outcome after the first course of systemic corticosteroids in an inception cohort of pediatric patients with inflammatory bowel disease.
All Olmsted County (Minnesota) residents diagnosed with Crohn's disease (n = 50) or ulcerative colitis (n = 36) before 19 years of age from 1940 to 2001 were identified. Outcomes at 30 days and 1 year after the initial course of corticosteroids were recorded.
Twenty-six patients with Crohn's disease (65%) and 14 with ulcerative colitis (44%) were treated with corticosteroids before age 19. Thirty-day outcomes for corticosteroid-treated Crohn's disease were complete remission in 16 (62%), partial remission in 7 (27%), and no response in 3 (12%), with 2 of these patients requiring surgery. Thirty-day outcomes for treated ulcerative colitis were complete remission in 7 (50%), partial remission in 4 (29%), and no response in 3 (21%). One-year outcomes for Crohn's disease were prolonged response in 11 (42%) and corticosteroid dependence in 8 (31%), whereas 7 (27%) were postsurgical. One-year outcomes for ulcerative colitis were prolonged response in 8 (57%) and corticosteroid dependence in 2 (14%), whereas 4 (29%) were postsurgical.
Most pediatric patients with inflammatory bowel disease initially responded to corticosteroids. However, after 1 year, 58% of pediatric patients with Crohn's disease and 43% of pediatric patients with ulcerative colitis either were steroid dependent or required surgery. This finding emphasizes the need for early steroid-sparing medications in pediatric inflammatory bowel disease.
本研究的目的是在一组初发的小儿炎症性肠病患者中，观察首次全身性使用皮质类固醇激素治疗后的1年结局。
确定了1940年至2001年间所有在明尼苏达州奥尔姆斯特德县诊断为19岁前克罗恩病（n = 50）或溃疡性结肠炎（n = 36）的居民。记录了首次使用皮质类固醇激素治疗后30天和1年的结局。
26例（65%）克罗恩病患者和14例（44%）溃疡性结肠炎患者在19岁前接受了皮质类固醇激素治疗。接受皮质类固醇激素治疗的克罗恩病患者30天的结局为：16例（62%）完全缓解，7例（27%）部分缓解，3例（12%）无反应，其中2例患者需要手术。接受治疗的溃疡性结肠炎患者30天的结局为：7例（50%）完全缓解，4例（29%）部分缓解，3例（21%）无反应。克罗恩病患者1年的结局为：11例（42%）反应延长，8例（31%）皮质类固醇激素依赖，7例（27%）接受了手术。溃疡性结肠炎患者1年的结局为：8例（57%）反应延长，2例（14%）皮质类固醇激素依赖，4例（29%）接受了手术。
大多数小儿炎症性肠病患者最初对皮质类固醇激素有反应。然而，1年后，58%的小儿克罗恩病患者和43%的小儿溃疡性结肠炎患者要么依赖类固醇激素，要么需要手术。这一发现强调了在小儿炎症性肠病中尽早使用保留类固醇药物的必要性。
