Department of Gastroenterology, Box 201A, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
J Crohns Colitis. 2011 Apr;5(2):91-4. doi: 10.1016/j.crohns.2010.10.004. Epub 2010 Nov 5.
Approximately 15% of patients with ulcerative colitis will have a severe flare requiring hospitalisation at some stage. For those who fail to respond to intravenous steroids Cyclosporin A (CyA) therapy is one option. We have evaluated the management of such patients in our centre and present the long term colectomy avoidance rates.
38 consecutive patients receiving CyA for an acute, steroid-refractory flare of colitis were retrieved from our database. Records were unavailable for 2 patients and 2 received therapy twice, hence 38 episodes were analysed.
24/36 patients were male; median age 37 years. On admission 20 patients were taking oral steroids; 8 were taking a thiopurine and 7 patients were on no treatment. CyA was started a median of 8 days after admission (range 1-28) and most patients (32/38) received this orally at doses of 4.5-8.3mg/kg. 15 patients have undergone colectomy, 11 of these during the same admission for lack of response to CyA. Of the patients who were discharged without surgery, 84% have still not required colectomy after a median follow-up of 3.8 years. Adverse effects were mostly minor, though two patients developed neutropenia on dual immunosuppression.
CyA can be administered orally with good tolerability. We use it as a bridging therapy to Azathioprine. In our population, 84% of those who responded to CyA have not required surgery.
约 15%的溃疡性结肠炎患者在某个阶段会出现严重的发作，需要住院治疗。对于那些对静脉注射类固醇反应不佳的患者，环孢素 A（CyA）治疗是一种选择。我们评估了我们中心此类患者的治疗方法，并提出了长期结肠切除回避率。
从我们的数据库中检索了 38 例因急性、类固醇难治性结肠炎发作而接受 CyA 治疗的连续患者。有 2 例患者的记录不可用，有 2 例患者接受了两次治疗，因此分析了 38 个发作。
36 例患者中有 24 例为男性；中位年龄为 37 岁。入院时，20 例患者正在服用口服类固醇；8 例正在服用硫嘌呤，7 例患者未接受治疗。CyA 在入院后中位时间 8 天（范围 1-28 天）开始，大多数患者（38 例中的 32 例）以 4.5-8.3mg/kg 的剂量口服给药。15 例患者接受了结肠切除术，其中 11 例因对 CyA 无反应而在同一入院期间进行。在没有手术的出院患者中，84%的患者在中位随访 3.8 年后仍无需结肠切除术。不良反应大多较轻，但有 2 例患者在双重免疫抑制下发生中性粒细胞减少。
CyA 可以口服给药，具有良好的耐受性。我们将其用作与硫唑嘌呤的桥接治疗。在我们的人群中，84%对 CyA 有反应的患者无需手术。
