284例溃疡性结肠炎患者临床疗效分析

Analysis of therapeutic effects of 284 patients with ulcerative colitis

关键词:  溃疡性结肠炎  临床疗效  回顾性分析

Key words:  [Key words]　ulcerative colitis  therapeutic effects  retrospective analysis

摘要:

[摘要]　目的　比较溃疡性结肠炎（ulcerative colitis, UC）患者不同药物治疗及不同给药途径的临床疗效。　方法　回顾性分析2010年1月1日至2015年1月1日在大连医科大学附属第一医院消化科住院的确诊为UC的284例患者的临床资料，将患者按病情轻重分为轻中度及中重度两组，按用药方案不同划分为6个治疗组：柳氮磺吡啶（Sulfasalazine, SASP）口服治疗组、美沙拉嗪口服治疗组、美沙拉嗪口服+美沙拉嗪灌肠液/栓剂治疗组、美沙拉嗪口服+糖皮质激素（Glucosteroids, GCS）灌肠治疗组、静脉应用GCS治疗组及英夫利昔单抗（Infliximab, IFX）治疗组，主要给药方式包括口服、静脉用药及局部用药（灌肠液、栓剂），比较UC患者不同药物治疗及不同给药途径的临床疗效，其中总有效率=缓解率+有效率。　结果　（1）对轻、中度UC患者，美沙拉嗪总有效率高于SASP（92.06% vs.68.18%，P<0.05）；美沙拉嗪口服+美沙拉嗪灌肠液/栓剂治疗的总有效率最高（95.16%），美沙拉嗪次之（92.06%），美沙拉嗪口服+ GCS灌肠治疗的总有效率最低（90.63%），3组比较及组间两两比较P<0.05。（2）对中、重度UC患者，IFX的总有效率高于GCS（100% vs.90.63%，P<0.05）。（3）24例难治性溃疡性结肠炎（refractory ulcerative colitis, RUC）患者，1例手术，6例加用硫唑嘌呤（Azathioprine, AZA），8例重新规范应用GCS，9例改用IFX，均已过渡至维持治疗阶段。（4）SASP、美沙拉嗪及IFX的副反应发生率分别为27.27%、2.13%和6.67%。　结论　对轻、中度UC患者，美沙拉嗪口服+美沙拉嗪灌肠液/栓剂为最佳治疗方案。对中、重度UC患者，IFX疗效优于GCS。RUC患者可通过延长GCS使用时间、加用免疫抑制剂或生物制剂及手术等方法进行补救治疗。UC药物治疗安全性较高，总体不良反应发生率低。

Abstract:

[Abstract] Objective To analyze the clinical efficacy of different medication and routes of administration on ulcerative colitis (UC) patients. Methods 284 UC patients, who were admitted to the Department of Gastroenterology at the First Affiliated Hospital of Dalian Medical University from 1.1.2010 to 1.1.2015, were included in this study. According to different regimens, patients with mild-to-moderate severity or moderate-to-severe severity were divided into 6 groups: Sulfasalazine (SASP) group, Mesalazine group, oral Mesalazine + Mesalazine enema/suppository group, oral Mesalazine + Glucosteroids (GCS) enema group, intravenous GCS group and Infliximab (IFX) group. Administration methods can be summarized as systemic application (oral/intravenous dosage) and topical usage (enema/ suppository). Comparison of therapeutic effects between different medication and routes of administration were conducted. Overall response rate (ORR) = remission rate + effective rate. Results (1) For mild-to-moderate cases, Mesalazine was better than SASP (92.06%, vs. 68.18%, P<0.01); oral Mesalazine + Mesalazine enema/suppository was the best regimen (95.16%),followed by oral Mesalazine (92.06%); while oral Mesalazine+GSC enema was found least effective (90.63%), P<0.05. (2) For moderate-to-severe cases, IFX was better than GCS (100% vs. 90.63%, P<0.05). (3) Patients with refractory ulcerative colitis (RUC) can be rescued with longer duration of GCS, transition to immunosuppressants/biologicals and surgery. (4) Safety: Incidence of adverse events (AEs) for SASP, Mesalazine and IFX was 27.27%, 2.13% and 6.67%, respectively. Conclusion (1) For mild-to-moderate cases, oral Mesalazine + Mesalazine enema/suppository is the best regimen. (2) IFX is better than GCS for moderate-to-severe cases. (3) RUC patients can be managed with longer duration of GCS, transition to immunosuppressants/biologicals and surgery. (4) Drug therapy is relatively safe, and has low incidence of AEs.