Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain.
Dig Liver Dis. 2012 Mar;44(3):206-10. doi: 10.1016/j.dld.2011.10.004. Epub 2011 Nov 11.
Although the early outcomes of ulcerative colitis after a first course of corticosteroids are well known, data on long-term disease evolution in patients responding to a first corticosteroid course are scarce.
To evaluate the long-term clinical evolution in ulcerative colitis patients responding to a first course of corticosteroids and to identify those factors associated with a poorer outcome.
Retrospective review of 114 patients diagnosed with ulcerative colitis who responded to the first corticosteroid course, and did not start thereafter maintenance therapy with thiopurines were included.
Corticosteroids were prescribed because of a moderate (78%) or a severe flare (22%). All but two patients followed maintenance treatment with mesalazine after corticosteroid discontinuation. After a median follow-up of 83 months (7-156), 72% of patients suffered new relapses leading to corticosteroid reintroduction in 65% of patients. The earlier corticosteroids were introduced in the course of ulcerative colitis, the higher the risk of relapse and corticosteroid reintroduction. Thiopurines were started in 51%, and infliximab in 19%. Eleven percent of patients underwent colectomy. No predictors of thiopurine use or colectomy were found.
Half of the ulcerative colitis patients responding to a first course of corticosteroids will require immunosuppressors mainly because of steroid-dependence.
虽然人们对溃疡性结肠炎患者首次接受皮质类固醇治疗后的早期结局了解较多，但对于皮质类固醇治疗有效的患者的长期疾病演变数据却相对较少。
评估对皮质类固醇首次治疗有反应的溃疡性结肠炎患者的长期临床转归，并确定与不良结局相关的因素。
回顾性分析了 114 例接受皮质类固醇首次治疗且未随后开始硫嘌呤维持治疗的溃疡性结肠炎患者。
皮质类固醇是因中度（78%）或重度发作（22%）而开具的。除了两名患者之外，所有患者在停用皮质类固醇后均继续使用美沙拉嗪维持治疗。在中位随访 83 个月（7-156）后，72%的患者出现新的复发，导致 65%的患者重新开始使用皮质类固醇。在溃疡性结肠炎病程中更早使用皮质类固醇，复发和重新使用皮质类固醇的风险越高。51%的患者开始使用硫嘌呤，19%的患者开始使用英夫利昔单抗。11%的患者接受了结肠切除术。未发现硫嘌呤使用或结肠切除术的预测因素。
对皮质类固醇首次治疗有反应的溃疡性结肠炎患者中有一半将需要免疫抑制剂治疗，主要是因为对皮质类固醇的依赖。
