Houben M H, van Wijk H J, Driessen W M, van Spreeuwel J P
Catharina Ziekenhuis, afd. Inwendige Geneeskunde, Eindhoven.
Ned Tijdschr Geneeskd. 1994 Dec 17;138(51):2552-6.
To determine the value of low dose methotrexate therapy in chronic inflammatory bowel disease.
Catharina Hospital and Diaconessenhuis, Eindhoven, and St. Joseph Hospital, Veldhoven.
Descriptive.
From 1988 until 1993 we treated 15 patients 16 times (one patient was treated twice) with methotrexate 25 mg i.m. once a week during 12 weeks, followed by a tapering oral dose. Our population consisted of 4 men and 11 women with a mean age of 31 year. The diagnosis was Crohn ileitis (1 patient), Crohn colitis (8), ileocolitis (4) and ulcerative colitis (2). The indication for methotrexate was resistance to therapy (9) and steroid dependency (7). Retrospectively the disease activity was determined after 1, 2 and 3 months of therapy.
The mean defaecation frequency went down from 7 to 2 times daily after 12 weeks, the ESR from 47 to 17 mm/1st hour, the thrombocytes from 436 x 10(9)/l to 325 x 10(9)/l and the prednisone dose could be lowered from 22 mg to 15 mg after 3 months. In 13/16 treatment cases there was a subjective positive response to methotrexate. Initial response was seen within 4 weeks. No serious side effects were seen. After 10 of the 13 response episodes the disease recurred.
Methotrexate 25 mg once a week i.m. was associated with a subjective and objective improvement in 12/15 patients, but the risk of recurrence after tapering appears to be large.
确定低剂量甲氨蝶呤治疗慢性炎症性肠病的价值。
埃因霍温的卡塔里娜医院和迪阿科内斯huis医院，以及韦尔德霍芬的圣约瑟夫医院。
描述性研究。
从1988年至1993年，我们对15例患者（1例患者接受了两次治疗）进行了16次治疗，给予甲氨蝶呤25毫克，每周一次肌肉注射，共12周，随后逐渐减少口服剂量。我们的研究对象包括4名男性和11名女性，平均年龄为31岁。诊断为克罗恩回肠炎（1例）、克罗恩结肠炎（8例）、回结肠型克罗恩病（4例）和溃疡性结肠炎（2例）。使用甲氨蝶呤的指征为对治疗耐药（9例）和依赖类固醇（7例）。回顾性地在治疗1、2和3个月后确定疾病活动度。
12周后，平均排便频率从每天7次降至2次，血沉从47降至17毫米/第1小时，血小板从436×10⁹/升降至325×10⁹/升，3个月后泼尼松剂量可从22毫克降至15毫克。在16例治疗病例中的13例中，患者对甲氨蝶呤有主观上的积极反应。在4周内可见初始反应。未观察到严重副作用。在13例有反应的病例中，有10例疾病复发。
每周一次肌肉注射25毫克甲氨蝶呤使15例患者中的12例有主观和客观上的改善，但逐渐减量后复发风险似乎很大。
