Benkov K J, Rosh J R, Schwersenz A H, Janowitz H D, LeLeiko N S
Department of Pediatrics, Mount Sinai Hospital and School of Medicine, New York, New York 10029.
J Pediatr Gastroenterol Nutr. 1994 Oct;19(3):290-4. doi: 10.1097/00005176-199410000-00005.
Five children with ulcerative colitis for whom surgery was recommended were treated with cyclosporine. The five had received corticosteroids for 1-24 months. The group included two patients with acute-onset ulcerative colitis and three with acute exacerbations of intractable corticosteroid-dependent chronic ulcerative colitis. The average age at initiation of cyclosporine therapy was 13.8 years (range, 11.5-16); all five patients were boys. Cyclosporine was initiated in the hospital by continuous i.v. infusion. Trough levels of 400-600 ng/dl (measured by radioimmunoassay) were achieved, at which point oral cyclosporine was given and oral dosage was adjusted to similar levels. Significant hypertension requiring medical attention was seen in one patient. Of the two recently diagnosed acute cases, one failed to respond and required subtotal colectomy after 2 weeks of treatment, and the other, despite an initial response, had a subtotal colectomy 10 months later. Of the three corticosteroid-dependent children, none was able to be weaned from corticosteroids and all underwent subtotal colectomy. Our experience emphasizes that the appropriate role of cyclosporine as therapy for children with ulcerative colitis is yet to be determined. Cyclosporine was not effective as an alternative to surgery in our patients.
五名被建议进行手术的溃疡性结肠炎患儿接受了环孢素治疗。这五名患儿接受皮质类固醇治疗1 - 24个月。该组包括两名急性发作性溃疡性结肠炎患者和三名皮质类固醇依赖型慢性溃疡性结肠炎急性加重患者。开始环孢素治疗时的平均年龄为13.8岁（范围11.5 - 16岁）；所有五名患者均为男孩。环孢素在医院通过静脉持续输注开始使用。达到了400 - 600 ng/dl的谷浓度（通过放射免疫测定法测量），此时给予口服环孢素并将口服剂量调整至相似水平。一名患者出现了需要医疗关注的显著高血压。在两名近期诊断的急性病例中，一名无反应，治疗2周后需要进行次全结肠切除术，另一名尽管最初有反应，但10个月后进行了次全结肠切除术。在三名皮质类固醇依赖的儿童中，无人能够停用皮质类固醇，全部接受了次全结肠切除术。我们的经验强调，环孢素作为溃疡性结肠炎患儿治疗方法的恰当作用尚未确定。在我们的患者中，环孢素作为手术替代方法并不有效。
