Marszk Dominika, Treder Aleksandra, Szlagatys-Sidorkiewicz Agnieszka, Brzeziński Michał
Department of Pediatrics, Copernicus Hospital, 80-803 Gdańsk, Poland.
Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Faculty of Medicine, Medical University of Gdańsk, 80-803 Gdańsk, Poland.
J Clin Med. 2025 Jul 12;14(14):4938. doi: 10.3390/jcm14144938.
: Ulcerative colitis (UC) is increasing in incidence, including among pediatric populations. Treatment aims primarily to induce and maintain remission. For those inadequately responding to 5-aminosalicylic acid, remission may be induced via oral steroids or, in severe instances, intravenous methylprednisolone. This retrospective case series aims to evaluate the efficacy of high-dose intravenous methylprednisolone pulses (30 mg/kg, max 1 g per day for 3-5 days) in inducing remission in moderate and severe pediatric UC cases. : From a cohort of pediatric patients (<18 years) hospitalized in 2018-2021 due to an acute flare of UC, those treated with high doses of methylprednisolone to induce remission were identified. The Pediatric Ulcerative Colitis Activity Index (PUCAI) was used to determine the response to treatment, considering a 20-point reduction or a score below 10 as significant improvement and indicative of remission induction. : Disease activity was severe in most patients (12/15), with 3/15 having moderate but refractory disease. We observed a clinically significant response in 9/15 patients (60%) with a mean PUCAI decrease of 39.4 ± 14.7 points. The median duration to clinical remission was 4 (IQR 3-4) days. For the 6/15 non-responders to methylprednisolone pulses, treatment was escalated. Adverse effects were not observed during the treatment period. : High-dose methylprednisolone may be a viable alternative for inducing remission in pediatric UC. However, the small sample size and retrospective design warrant further prospective studies to validate these findings.
溃疡性结肠炎（UC）的发病率正在上升，包括在儿科人群中。治疗主要旨在诱导和维持缓解。对于那些对5-氨基水杨酸反应不佳的患者，可通过口服类固醇诱导缓解，在严重情况下，可使用静脉注射甲泼尼龙。本回顾性病例系列旨在评估高剂量静脉注射甲泼尼龙脉冲（30mg/kg，最大每日1g，持续3 - 5天）在诱导中度和重度儿科UC病例缓解中的疗效。
从2018 - 2021年因UC急性发作住院的儿科患者（<18岁）队列中，确定那些接受高剂量甲泼尼龙诱导缓解治疗的患者。使用儿科溃疡性结肠炎活动指数（PUCAI）来确定治疗反应，将降低20分或得分低于10分视为显著改善并表明诱导缓解。
大多数患者（12/15）疾病活动严重，3/15患有中度但难治性疾病。我们观察到9/15例患者（60%）有临床显著反应，平均PUCAI降低39.4±14.7分。临床缓解的中位持续时间为4（四分位间距3 - 4）天。对于15例中6例对甲泼尼龙脉冲无反应的患者，治疗升级。治疗期间未观察到不良反应。
高剂量甲泼尼龙可能是诱导儿科UC缓解的一种可行替代方法。然而，样本量小和回顾性设计需要进一步的前瞻性研究来验证这些发现。
