Hinterleitner T A, Petritsch W, Aichbichler B, Fickert P, Ranner G, Krejs G J
Department of Internal Medicine, Karl Franzens University, Graz, Austria.
Z Gastroenterol. 1997 Aug;35(8):603-8.
Fistulas in Crohn's disease remain a difficult clinical challenge. Rapid improvement with cyclosporine followed by deterioration after discontinuation of this drug has been reported. This study aimed to determine whether fast remission and long-term improvement could be achieved when cyclosporine was administered concurrently with azathioprine and low-dose prednisolone and then be discontinued.
Nine patients with fistulas were enrolled in this open study. For the first two weeks cyclosporine was administered intravenously at a dose of 5 mg/kg/day. Azathioprine and low-dose prednisolone were also given during this period. After two weeks cyclosporine was administered orally for a further ten weeks while azathioprine and a tapered dose of prednisolone were continued. Effectiveness was evaluated clinically, by a scoring system and by magnetic resonance imaging.
With intravenous cyclosporine as part of this regimen, all nine patients went into remission within days. There were no recurrences after changing from intravenous to oral cyclosporine. Cyclosporine was terminated after three months while azathioprine and low-dose prednisolone were continued. Thereafter, four patients did not deteriorate, three deteriorated slightly, and two patients had a recurrence. The CDAI (Crohn's Disease Activity Index) improved from 200 (range 85-350) to 136 (range 26-200) by the end of the third month. Serological markers remained stable after discontinuation of cyclosporine. There were no serious side effects during this triple drug regimen.
The combination of cyclosporine, azathioprine and low-dose prednisolone leads to marked improvement of perianal fistulas in Crohn's disease. Remission occurs quickly under cyclosporine. These remissions can be maintained with azathioprine in a majority of patients.
克罗恩病中的瘘管仍是一项棘手的临床挑战。有报道称，使用环孢素后病情迅速改善，但停药后病情恶化。本研究旨在确定环孢素与硫唑嘌呤和低剂量泼尼松龙同时给药然后停药时，是否能实现快速缓解和长期改善。
9例瘘管患者纳入本开放性研究。前两周静脉注射环孢素，剂量为5毫克/千克/天。在此期间也给予硫唑嘌呤和低剂量泼尼松龙。两周后，环孢素改为口服，持续10周，同时继续给予硫唑嘌呤和逐渐减量的泼尼松龙。通过临床、评分系统和磁共振成像评估疗效。
作为该治疗方案的一部分，使用静脉环孢素后，所有9例患者在数天内均进入缓解期。从静脉环孢素改为口服环孢素后无复发。3个月后停用环孢素，继续使用硫唑嘌呤和低剂量泼尼松龙。此后，4例患者病情未恶化，3例略有恶化，2例复发。到第三个月末，克罗恩病活动指数（CDAI）从200（范围85 - 350）改善至136（范围26 - 200）。停用环孢素后血清学标志物保持稳定。在这种三联药物治疗方案期间无严重副作用。
环孢素、硫唑嘌呤和低剂量泼尼松龙联合使用可使克罗恩病肛周瘘管明显改善。在环孢素作用下缓解迅速出现。大多数患者使用硫唑嘌呤可维持缓解。
