Ban Hiromitsu, Bamba Shigeki, Nishida Atsushi, Inatomi Osamu, Shioya Makoto, Takahashi Ken-Ichiro, Imaeda Hirotsugu, Murata Masaki, Sasaki Masaya, Tsujikawa Tomoyuki, Andoh Akira
Division of Endoscopy, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
Division of Gastroenterology, Shiga University of Medical Science, Ōtsu, Shiga 520-2192, Japan.
Exp Ther Med. 2016 Aug;12(2):829-834. doi: 10.3892/etm.2016.3341. Epub 2016 May 16.
Calcineurin inhibitors (CNIs) such as cyclosporine A (CSA) and tacrolimus (FK506) are often used as a second-line drug for steroid-refractory or steroid-dependent patients with ulcerative colitis (UC). The aim of the present study was to determine the prognostic factors for early colectomy. A total of 85 hospitalized patients with UC (CSA, 50 patients; FK506, 35 patients) were enrolled. Colectomy carried out within 60 days of starting CNI therapy was defined as 'early colectomy'. To assess the prognostic factors affecting early colectomy, clinical practical variables, including the Onodera-prognostic nutritional index (O-PNI): 10xAlb+0.005× (total lymphocyte count), were analyzed. The results demonstrated that the significant factors predicting early colectomy were i) disease severity, ii) immunomodulator-naïve history, iii) lower serum hematocrit, iv) lower serum albumin and v) lower O-PNI. In addition, the significant factors predicting overall colectomy were as follows: i) C7-HRP positivity and ii) >10,000 mg of prednisolone used prior to the initiation of CNI treatment. The combination of hematocrit and O-PNI enhanced the prediction of early colectomy. Clinical variables such as hematocrit and O-PNI were the significant factors predicting colectomy. These results may be used as a guide to predict the outcome of patients with UC in clinical settings.
环孢素A（CSA）和他克莫司（FK506）等钙调神经磷酸酶抑制剂常被用作溃疡性结肠炎（UC）激素难治性或激素依赖性患者的二线药物。本研究的目的是确定早期结肠切除术的预后因素。共纳入85例住院UC患者（CSA组50例；FK506组35例）。在开始使用钙调神经磷酸酶抑制剂治疗后60天内进行的结肠切除术被定义为“早期结肠切除术”。为评估影响早期结肠切除术的预后因素，分析了包括小野寺预后营养指数（O-PNI）：10×白蛋白+0.005×（淋巴细胞总数）在内的临床实际变量。结果表明，预测早期结肠切除术的显著因素为：i）疾病严重程度，ii）未使用过免疫调节剂的病史，iii）较低的血清血细胞比容，iv）较低的血清白蛋白，以及v）较低的O-PNI。此外，预测全结肠切除术的显著因素如下：i）C7-HRP阳性，以及ii）在开始使用钙调神经磷酸酶抑制剂治疗前使用过>10000mg泼尼松龙。血细胞比容和O-PNI的联合使用增强了对早期结肠切除术的预测。血细胞比容和O-PNI等临床变量是预测结肠切除术的显著因素。这些结果可作为临床环境中预测UC患者预后的指南。
