Seah D, De Cruz P
Department of Medicine, The University of Melbourne, Melbourne, Vic., Australia.
Department of Gastroenterology, Austin Health, Melbourne, Vic., Australia.
Aliment Pharmacol Ther. 2016 Feb;43(4):482-513. doi: 10.1111/apt.13491. Epub 2016 Jan 4.
Acute severe ulcerative colitis (ASUC) is a life-threatening condition for which optimal management strategies remain ill-defined.
To review the evidence regarding the natural history, diagnosis, monitoring and treatment of ASUC to inform an evidence-based approach to management.
Relevant articles addressing the management of ASUC were identified from a search of MEDLINE, the Cochrane Library and conference proceedings.
Of ASUC, 31-35% is steroid-refractory. Infliximab and ciclosporin salvage therapies have improved patient outcomes in randomised controlled trials. Short-term response rates (within 3 months) have ranged from 40% - 54% for ciclosporin and 46-83% for infliximab. Long-term clinical response rates (≥1 year) have ranged from 42%-50% for ciclosporin and 50-65% for infliximab. Short-term and long-term colectomy rates have been respectively: 26-47% and 36-58% for ciclosporin, and 0-50% and 35-50% for infliximab. Mortality rates for ciclosporin and infliximab-treated patients have been: 0-5% and 0-2%, respectively. At present, management challenges include the selection, timing and assessment of response to salvage therapy, utilisation of therapeutic drug monitoring and long-term maintenance of remission.
Optimal management of acute severe ulcerative colitis should be guided by risk stratification using predictive indices of corticosteroid response. Timely commencement and assessment of response to salvage therapy is critical to reducing morbidity and mortality. Emerging pharmacokinetic models and therapeutic drug monitoring may assist clinical decision-making and facilitate a shift towards individualised acute severe ulcerative colitis therapies.
急性重症溃疡性结肠炎（ASUC）是一种危及生命的疾病，其最佳管理策略仍不明确。
回顾有关ASUC自然史、诊断、监测和治疗的证据，为基于证据的管理方法提供依据。
通过检索MEDLINE、Cochrane图书馆和会议论文集，确定了有关ASUC管理的相关文章。
ASUC中，31%-35%对类固醇难治。在随机对照试验中，英夫利昔单抗和环孢素挽救疗法改善了患者的预后。环孢素的短期缓解率（3个月内）为40%-54%，英夫利昔单抗为46%-83%。环孢素的长期临床缓解率（≥1年）为42%-50%，英夫利昔单抗为50%-65%。环孢素的短期和长期结肠切除术率分别为26%-47%和36%-58%，英夫利昔单抗分别为0%-50%和35%-50%。环孢素和英夫利昔单抗治疗患者的死亡率分别为0%-5%和0%-2%。目前，管理挑战包括挽救疗法反应的选择、时机和评估、治疗药物监测的应用以及缓解的长期维持。
急性重症溃疡性结肠炎的最佳管理应以使用皮质类固醇反应预测指标进行风险分层为指导。及时开始并评估挽救疗法的反应对于降低发病率和死亡率至关重要。新兴的药代动力学模型和治疗药物监测可能有助于临床决策，并促进向个体化急性重症溃疡性结肠炎治疗的转变。
