Teich Niels, Mohl Wolfgang, Bokemeyer Bernd, Bündgens Burkhard, Büning Jürgen, Miehlke Stephan, Hüppe Dietrich, Maaser Christian, Klugmann Tobias, Kruis Wolfgang, Siegmund Britta, Helwig Ulf, Weismüller Joseph, Drabik Attyla, Stallmach Andreas
Internistische Gemeinschaftspraxis Leipzig Germany
Gemeinschaftspraxis - Endoskopiezentrum Saarbrücken Germany.
J Crohns Colitis. 2016 Jan;10(1):61-8. doi: 10.1093/ecco-jcc/jjv188. Epub 2015 Oct 13.
Azathioprine [AZA] is recommended for maintenance of steroid-free remission in inflammatory bowel disease IBD. The aim of this study has been to establish the incidence and severity of AZA-induced pancreatitis, an idiosyncratic and major side effect, and to identify specific risk factors.
We studied 510 IBD patients [338 Crohn's disease, 157 ulcerative colitis, 15 indeterminate colitis] with initiation of AZA treatment in a prospective multicentre registry study. Acute pancreatitis was diagnosed in accordance with international guidelines.
AZA was continued by 324 [63.5%] and stopped by 186 [36.5%] patients. The most common cause of discontinuation was nausea [12.2%]. AZA-induced pancreatitis occurred in 37 patients [7.3%]. Of these: 43% were hospitalised with a median inpatient time period of 5 days; 10% had peripancreatic fluid collections; 24% had vomiting; and 14% had fever. No patient had to undergo nonsurgical or surgical interventions. Smoking was the strongest risk factor for AZA-induced acute pancreatitis [p < 0.0002] in univariate and multivariate analyses.
AZA-induced acute pancreatitis is a common adverse event in IBD patients, but in this study had a mild course in all patients. Smoking is the most important risk factor.
硫唑嘌呤（AZA）被推荐用于维持炎症性肠病（IBD）患者无类固醇缓解状态。本研究旨在确定AZA诱发的胰腺炎（一种特异质性且严重的副作用）的发生率和严重程度，并识别特定风险因素。
在一项前瞻性多中心注册研究中，我们对510例开始接受AZA治疗的IBD患者（338例克罗恩病、157例溃疡性结肠炎、15例未定型结肠炎）进行了研究。急性胰腺炎的诊断依据国际指南。
324例（63.5%）患者继续使用AZA，186例（36.5%）患者停用。最常见的停药原因是恶心（12.2%）。37例患者（7.3%）发生了AZA诱发的胰腺炎。其中：43%的患者住院，中位住院时间为5天；10%的患者有胰周积液；24%的患者有呕吐；14%的患者有发热。没有患者需要接受非手术或手术干预。在单因素和多因素分析中，吸烟是AZA诱发急性胰腺炎的最强风险因素（p<0.0002）。
AZA诱发的急性胰腺炎是IBD患者常见的不良事件，但在本研究中所有患者病情均较轻。吸烟是最重要的风险因素。
