Xu Jin, Yang Chuan-Hua, Chen Xiao-Yu, Li Xu-Hang, Dai Min, Xiao Shu-Dong
Department of Internal Medicine, Division of Gastroenterology, Shanghai Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiaotong University School of Medicine, 145 Shandong Zhong Road, Shanghai 200001, China.
World J Gastroenterol. 2008 Dec 7;14(45):7012-5. doi: 10.3748/wjg.14.7012.
A small subset of patients with active ulcerative colitis is non-responsive to major known non-biological therapies. We reported 5 patients with positive serum proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANCA) and tried to (1) identify the common clinical features of these patients; (2) investigate the efficacy of a novel therapy using a Chinese medicine compound; and (3) attract more gastroenterologists to be engaged in further study of this subset of patients. The common manifestations of disease in these 5 patients included recurrent bloody diarrhea and inflammatory lesions involving the entire colorectal mucosa. Initial treatment with intravenous methylprednisolone successfully induced remission. Four of these 5 patients were steroid-dependence, and immunosuppressants, such as azathioprine and cyclophosphamide, were ineffective. In 3 patients, only the particular Chinese medicine compound could induce and maintain remission. One patient underwent colectomy. No vascular inflammatory lesions were found by histopathological examination. Although more cases are needed for confirmation, our study indicates that ulcerative colitis with positive PR3-ANCA may belong to a subtype of refractory ulcerative colitis. The particular Chinese medicine compound used in our study is by far the most effective in the management of these patients, with additional advantages of having no noticeable side-effects and less financial burden.
一小部分活动性溃疡性结肠炎患者对主要的已知非生物疗法无反应。我们报告了5例血清蛋白酶3抗中性粒细胞胞浆抗体（PR3-ANCA）阳性的患者，并试图（1）确定这些患者的共同临床特征；（2）研究一种中药复方新疗法的疗效；（3）吸引更多胃肠病学家对这一亚组患者进行进一步研究。这5例患者的常见疾病表现包括反复血性腹泻和累及整个结直肠黏膜的炎症性病变。静脉注射甲泼尼龙初始治疗成功诱导缓解。这5例患者中有4例对类固醇依赖，硫唑嘌呤和环磷酰胺等免疫抑制剂无效。3例患者仅特定的中药复方可诱导并维持缓解。1例患者接受了结肠切除术。组织病理学检查未发现血管炎性病变。尽管需要更多病例来证实，但我们的研究表明PR3-ANCA阳性的溃疡性结肠炎可能属于难治性溃疡性结肠炎的一个亚型。我们研究中使用的特定中药复方是目前治疗这些患者最有效的方法，还具有无明显副作用和经济负担较小的额外优势。
