Tremaine W J
Inflammatory Bowel Disease Clinic, Mayo Clinic, Rochester MN 55905, USA.
Neth J Med. 1997 Feb;50(2):S12-4. doi: 10.1016/s0300-2977(96)00065-4.
Refractory inflammatory bowel disease (IBD) can be defined as persistent acute symptomatic disease despite anti-inflammatory therapy or as chronically active disease requiring continuous treatment for relief of symptoms. Treatment options include azathioprine (AZA), 6-mercaptopurine (6-MP), methotrexate (MTX), cyclosporine (CYA), and experimental therapies that are cytokines or cytokine antagonists. AZA and 6-MP have identical actions in IBD. 6-MP is effective in about 75% of patients with inflammatory Crohn's disease. The mean time until the onset of action is 3.1 months. AZA is effective in ulcerative colitis as a steroid-sparing agent. Side-effects occur in 10-15% of patients on AZA or 6-MP for IBD. MTX induces symptomatic remission in about 40% of patients with Crohn's disease. The potential for hepatic fibrosis from MTX is a concern. CYA appears effective in the acute management of severe ulcerative colitis. CYA has not proven useful in the long-term management of Crohn's disease. Potentially serious side-effects include hypertension and renal insufficiency. The cytokine antagonist, anti-tumor-necrosis-factor-alpha antibody, and the anti-inflammatory cytokine, interleukin 10, appear promising for the treatment of Crohn's disease.
难治性炎症性肠病（IBD）可定义为尽管进行了抗炎治疗仍持续存在急性症状的疾病，或定义为需要持续治疗以缓解症状的慢性活动性疾病。治疗选择包括硫唑嘌呤（AZA）、6-巯基嘌呤（6-MP）、甲氨蝶呤（MTX）、环孢素（CYA）以及作为细胞因子或细胞因子拮抗剂的实验性疗法。AZA和6-MP在IBD中具有相同的作用。6-MP对约75%的炎症性克罗恩病患者有效。起效的平均时间为3.1个月。AZA作为一种类固醇节省剂对溃疡性结肠炎有效。接受AZA或6-MP治疗IBD的患者中，10%-15%会出现副作用。MTX可使约40%的克罗恩病患者症状缓解。MTX导致肝纤维化的可能性令人担忧。CYA在重度溃疡性结肠炎的急性治疗中似乎有效。CYA尚未被证明对克罗恩病的长期治疗有用。潜在的严重副作用包括高血压和肾功能不全。细胞因子拮抗剂、抗肿瘤坏死因子-α抗体以及抗炎细胞因子白细胞介素10在克罗恩病的治疗中似乎很有前景。
