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硫唑嘌呤治疗溃疡性结肠炎:对照治疗试验的最终报告

Azathioprine in ulcerative colitis: final report on controlled therapeutic trial.

作者信息

Jewell D P, Truelove S C

出版信息

Br Med J. 1974 Dec 14;4(5945):627-30. doi: 10.1136/bmj.4.5945.627.

Abstract

Eighty patients, all of whom were suffering from a frank clinical attack of ulcerative colitis, were admitted to the trial. The attack was treated with a standard course of corticosteroids and the patients were immediately placed on treatment with either azathioprine in a dose of 2.5 mg/kg body weight or dummy tablets. The trial tablets were continued for one year while the patients were maintained under regular clinical, sigmoidoscopic, histological, haematological, and biochemical surveillance. If a patient relapsed during such maintenance treatment he or she was treated with a further course of corticosteroids without interrupting maintenance treatment.In the treatment of an actual attack of ulcerative colitis the results in the attacks which brought the 80 patients into the trial show that no benefit came from the addition of azathioprine to a standard course of corticosteroid therapy.Patients admitted in their first attack of ulcerative colitis showed no benefit from the one-year maintenance treatment with azathioprine, the benefits of which were confined to patients admitted in a relapse of established disease. Even in these the difference between the treated group and the control group failed to reach statistical significance, but the difference was big enough to suggest that there is a prima facie case for regarding azathioprine as of some benefit in this group of patients.

摘要

80名均患有溃疡性结肠炎明显临床发作的患者被纳入该试验。发作期采用标准疗程的皮质类固醇进行治疗,随后患者立即开始接受以下治疗:服用剂量为2.5毫克/千克体重的硫唑嘌呤或安慰剂。试验药片持续服用一年,在此期间患者接受定期的临床、乙状结肠镜、组织学、血液学和生化监测。如果患者在维持治疗期间复发,则在不中断维持治疗的情况下,接受另一疗程的皮质类固醇治疗。

在溃疡性结肠炎实际发作的治疗中,导致80名患者进入试验的发作期治疗结果表明,在标准疗程的皮质类固醇治疗中添加硫唑嘌呤并无益处。首次发作溃疡性结肠炎时入院的患者,接受硫唑嘌呤为期一年的维持治疗并无益处,其益处仅限于病情已确诊且复发时入院的患者。即便在这些患者中,治疗组与对照组之间的差异也未达到统计学意义,但差异已足够大,足以表明初步有理由认为硫唑嘌呤对这组患者有一定益处。

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