Wirth H P, Zala G, Meyenberger C, Jost R, Ammann R, Münch R
Department für Innere Medizin, Universitätsspital Zürich.
Schweiz Med Wochenschr. 1993 Jul 13;123(27-28):1384-8.
4 therapies in 3 patients (1 female, 2 male) suffering from steroid dependent Crohn's disease are described. Interferon alpha-2b was administered for 24 weeks (3 million I.U. per day for 4 weeks, and 3 x 3 million U.I. per week for 20 weeks). Prednisolone dosage at start of therapy depended on initial inflammatory activity (CDAI). The daily dose was reduced stepwise and omitted after 12 weeks. In two courses patients did not respond and therapy had to be halted after 12 and 14 weeks' duration because of increasing disease activity. During the other two treatments a decrease in disease activity of 118 and 70 CDAI units (in both cases after 8 weeks) could be achieved. In particular, the course in one patient with abundant intestinal and extraintestinal inflammatory activity was quite impressive: extraintestinal activity disappeared completely within 10 days, CDAI ameliorated substantially for 30 weeks and the patient could be treated without steroids for a total period of 18 weeks. As a preliminary conclusion from the cases described up to now, it can be speculated that females probably respond more favorably to a combined therapy with interferon alpha and corticosteroids. Moreover, we suggest that the potential of interferon in Crohn's disease might be to overcome a steroid refractory disease state rather than to allow omission of steroid medication which could not be further reduced without exacerbation. Clearly, present experience of interferon therapy in Crohn's disease is still too scarce and more work needs to be done to define the role of interferon in IBD.
本文描述了对3例(1例女性,2例男性)类固醇依赖型克罗恩病患者采用的4种治疗方法。给予α-2b干扰素治疗24周(前4周每天300万国际单位,后20周每周3次,每次300万国际单位)。治疗开始时泼尼松龙的剂量取决于初始炎症活动度(CDAI)。每日剂量逐步减少,12周后停用。在两个疗程中,患者无反应,由于疾病活动度增加,分别在治疗12周和14周后停止治疗。在另外两个疗程中,疾病活动度分别降低了118和70个CDAI单位(均在8周后)。特别是,1例肠道和肠道外炎症活动丰富的患者的治疗过程令人印象深刻:肠道外活动在10天内完全消失,CDAI在30周内显著改善,患者在总共18周的时间里无需使用类固醇进行治疗。根据目前所描述的病例初步得出的结论是,可以推测女性可能对α干扰素和皮质类固醇联合治疗的反应更佳。此外,我们认为干扰素在克罗恩病中的作用可能是克服类固醇难治性疾病状态,而不是允许停用类固醇药物,因为在不加重病情的情况下无法进一步减少类固醇药物的用量。显然,目前干扰素治疗克罗恩病的经验仍然太少,需要开展更多工作来明确干扰素在炎症性肠病中的作用。