Van Gossum A, Schmit A, Adler M, Chioccioli C, Fiasse R, Louwagie P, D'Haens G, Rutgeerts P, De Vos M, Reynaert H, Devis G, Belaiche J, Van Outryve M
Université Libre de Bruxelles.
Acta Gastroenterol Belg. 1997 Jul-Sep;60(3):197-200.
Cyclosporin (CsA) has been proposed in the management of patients with acute ulcerative colitis (UC) in whom standard therapy failed and who were candidates for colectomy. Seven academic hospitals contributed to this retrospective study that included 29 patients (median age: 33 y. (15-74 y.); 12 females and 17 males). The median duration of the disease was 4 y. (0.3 to 33 y.). Before initiating CsA, patients were unresponsive to treatment including i.v. corticosteroids (n = 29), 5-ASA or salazopyrine (n = 19), azathioprine (n = 3), antibiotics (n = 14). The i.v. mean dose was 4 mg/kg/day and was adapted to blood level. Concomitant treatment included corticosteroids (n = 27). The median duration of i.v. CsA administration was 10 days (4 to 41 days). At the end of CsA administration, a global improvement was described in 20 patients while a surgery had to be performed immediately in 8 patients because of exacerbation of symptoms (n = 7) or perforation (n = 1). One other patient (74 y.) died because of Pneumocystis carinii infection. For the responders, maintenance therapy included: tapering dose of steroids (n = 12), azathioprine (n = 12), 5-ASA or salazopyrine (n = 10), methotrexate (n = 1) or oral CsA (n = II). The median duration of follow-up was 12 months (4 to 48 months). Among the 20 responders, 7 were subsequently referred for colectomy either electively (n = 3) or because of recurrence of the disease (n = 4). Among the 12 patients treated by azathioprine as a maintenance therapy, only 3 had to be referred for surgery (25%). Among the 8 patients who did not receive azathioprine, 4 were subsequently referred for a colectomy (50%) (NS). In patients with acute refractory UC who received CsA, the short-term efficacy (avoidance of immediate colectomy) was obtained in 20 out of 29 patients (69%). However, after a median follow-up of 12 months, only 13 patients were colectomy free (45%).
环孢素（CsA）已被用于治疗标准治疗失败且有结肠切除术指征的急性溃疡性结肠炎（UC）患者。七家学术医院参与了这项回顾性研究，该研究纳入了29例患者（中位年龄：33岁（15 - 74岁）；女性12例，男性17例）。疾病的中位病程为4年（0.3至33年）。在开始使用CsA之前，患者对包括静脉注射皮质类固醇（n = 29）、5 - 氨基水杨酸或柳氮磺胺吡啶（n = 19）、硫唑嘌呤（n = 3）、抗生素（n = 14）在内的治疗均无反应。静脉注射的平均剂量为4mg/kg/天，并根据血药浓度进行调整。同时治疗包括皮质类固醇（n = 27）。静脉注射CsA的中位持续时间为10天（4至41天）。在CsA治疗结束时，20例患者病情总体改善，而8例患者因症状加重（n = 7）或穿孔（n = 1）不得不立即进行手术。另1例患者（74岁）因卡氏肺孢子虫感染死亡。对于有反应的患者，维持治疗包括：逐渐减量的类固醇（n = 12）、硫唑嘌呤（n = 12）、5 - 氨基水杨酸或柳氮磺胺吡啶（n = 10）、甲氨蝶呤（n = 1）或口服CsA（n = 11）。中位随访时间为12个月（4至48个月）。在20例有反应的患者中，7例随后因择期手术（n = 3）或疾病复发（n = 4）而接受结肠切除术。在12例接受硫唑嘌呤维持治疗的患者中，只有3例需要进行手术（25%）。在8例未接受硫唑嘌呤治疗的患者中，4例随后接受了结肠切除术（50%）（无统计学差异）。在接受CsA治疗的急性难治性UC患者中，29例患者中有20例（69%）获得了短期疗效（避免立即进行结肠切除术）。然而，中位随访12个月后，只有13例患者未进行结肠切除术（45%）。
