Chun A, Chadi R M, Korelitz B I, Colonna T, Felder J B, Jackson M H, Morgenstern E H, Rubin S D, Sacknoff A G, Gleim G M
Department of Medicine, Lenox Hill Hospital, New York, New York 10021-1883, USA.
Inflamm Bowel Dis. 1998 Aug;4(3):177-81. doi: 10.1097/00054725-199808000-00001.
Adrenocorticotrophic hormone (ACTH) and corticosteroids have no maintenance values for inflammatory bowel disease but serve to reduce the severity of disease. The effectiveness of intravenous corticotrophin versus hydrocortisone in ulcerative colitis has been determined including whether previous steroid therapy influenced the better response to one rather than the other, but no such studies have ever been done in Crohn's disease. Eighty-eight patients hospitalized with moderate-to-severe Crohn's disease (Present-Korelitz [P-K] Index -3 to -2 and the International Organisation for the Study of Inflammatory Bowel Disease-Crohn's & Colitis Foundation of America [IOIBD-CCFA] Index, mean 14, range 5-23) were treated in a prospective, randomized, double-blind clinical trial to receive either continuous intravenous infusion of 120 U/day of ACTH (44 patients) or hydrocortisone 300 mg/day (44 patients). Patients were also subdivided into those who received oral steroids during the 30 days prior to intravenous therapy and those who had not. Response was followed on a daily basis and tabulated at 3, 5, and 10 days. Patients were followed from 1-3 years to determine the later status. After 10 days of intravenous therapy 36 of 44 patients (82%) who received ACTH and 41 of 44 patients (93%) who received hydrocortisone fully responded (P-K index +3 and IOIBD-CCFA Index mean of 3). At the end of the study, response to intravenous ACTH and hydrocortisone was not statistically different whether or not patients received oral steroids during the 30 days prior to admission, although the response to IV ACTH tended to be faster at 3 days in those who had received previous steroid therapy. Intravenous ACTH and hydrocortisone are equally effective in achieving therapeutic goals in patients with Crohn's disease who have not achieved results with oral medications. Moreover the response rate was high (mean 88%), serving to buy time for establishment of successful maintenance programs of treatment with oral 5-ASA and immunosuppressive drugs for 69% of patients at 1-3 years.
促肾上腺皮质激素（ACTH）和皮质类固醇对炎症性肠病并无维持治疗价值，但可减轻疾病的严重程度。已确定静脉注射促肾上腺皮质激素与氢化可的松在溃疡性结肠炎中的疗效，包括既往使用类固醇治疗是否会影响对其中一种药物而非另一种药物的更好反应，但从未在克罗恩病中进行过此类研究。88例中度至重度克罗恩病住院患者（普雷斯-科雷利茨[P-K]指数为-3至-2，国际炎症性肠病研究组织-美国克罗恩病和结肠炎基金会[IOIBD-CCFA]指数，平均为14，范围为5至23）参与了一项前瞻性、随机、双盲临床试验，接受每日120 U的ACTH持续静脉输注（44例患者）或300 mg/天的氢化可的松（44例患者）治疗。患者还被分为在静脉治疗前30天内接受口服类固醇治疗的患者和未接受口服类固醇治疗的患者。每天跟踪反应情况，并在第3、5和10天列表记录。对患者进行1至3年的随访以确定后期状况。静脉治疗10天后，接受ACTH的44例患者中有36例（82%）、接受氢化可的松的44例患者中有41例（93%）完全缓解（P-K指数为+3，IOIBD-CCFA指数平均为3）。在研究结束时，无论患者在入院前30天内是否接受口服类固醇治疗，静脉注射ACTH和氢化可的松的反应在统计学上并无差异，尽管既往接受过类固醇治疗的患者在第3天对静脉注射ACTH的反应往往更快。静脉注射ACTH和氢化可的松在未通过口服药物取得疗效的克罗恩病患者中实现治疗目标方面同样有效。此外，缓解率很高（平均88%），为1至3年时69%的患者建立成功的口服5-氨基水杨酸和免疫抑制药物维持治疗方案争取了时间。
