Therapy with budesonide in patients with refractory sprue
Therapy with budesonide in patients with refractory sprue
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DOI：
10.1159/000092639
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发表时间：
2006-01-01
期刊：
影响因子：
3.2
通讯作者：
Ullrich, R
中科院分区：
文献类型：
--
作者：
Daum, S;Ipczynski, R;Ullrich, R
简介：难治性口炎性腹泻（RS）是一种罕见的吸收不良综合征，通常需要长期皮质类固醇治疗。局部作用的布地奈德可以替代全身皮质类固醇治疗并减少 RS 患者的毒性。目的：评估布地奈德对 RS 患者的疗效和毒性。患者和方法：对接受布地奈德治疗的 RS 患者的临床和组织学数据进行了分析。 RS被定义为尽管严格无麸质饮食持续> 6个月或需要早期治疗干预，但绒毛萎缩和吸收不良。结果：我们确定了 9 名患者（1 名患有自身免疫性肠病，4 名患有 RS 型 I 型，无早期 T 细胞淋巴瘤体征，3 名患有 RS 型 II 型，有早期 T 细胞淋巴瘤体征，1 名患有 CD4 阳性口炎性腹泻样肠 T 细胞淋巴瘤），他们接受 9 毫克/天的布地奈德（范围 6-12）治疗 24 个月（160 名），其中 7 名患者初始治疗为 40 毫克/天的泼尼松龙(30-60) 持续 4 个月 (1-144)。初始体重指数为 18 (13.1-22.8)，在泼尼松龙 [21.5 (14.9-26.7)，p < 0.05] 和布地奈德治疗 [21 (18-27.2)，p < 0.05] 下同样增加。在泼尼松龙和布地奈德治疗下，每日大便次数也类似地分别从 6 (2-8) 次减少到 2 (1-3) 次和 2 (1-5) 次，每个 p < 0.05。两名 II 型 RS 患者没有反应，7 名患者（包括所有 4 名 I 型 RS）患者在接受布地奈德治疗后临床情况稳定。 1 名患者的皮肤脆弱是布地奈德治疗的唯一不良反应。结论：布地奈德可能是 I 型 RS 患者的有效治疗选择，与泼尼松龙类似，可以稳定临床病情。版权所有 (c) 2006 S. Karger AG，巴塞尔。
Introduction: Refractory sprue (RS) is a rare malabsorption syndrome, which often requires long-term corticosteroid treatment. Locally acting budesonide could replace systemic corticosteroid therapy and reduce toxicity in patients with RS. Aims: To evaluate the efficacy and toxicity of budesonide in patients with RS. Patients and Methods: Clinical and histological data from patients with RS who received budesonide were analyzed. RS was defined as villous atrophy and malabsorption in spite of a strict gluten-free diet persisting for > 6 months or requiring earlier therapeutic intervention. Results: We identified 9 patients (1 with autoimmune enteropathy, 4 with RS type I without and 3 with RS type II with signs of early T cell lymphoma and 1 with CD4-positive sprue-like intestinal Tcell lymphoma), who received 9 mg/day of budesonide (range 6-12) for 24 months (160), and 7 of whom had an initial treatment with 40 mg/day of prednisolone (30-60) for 4 months (1-144). The initial body mass index was 18 (13.1-22.8) and increased similarly under prednisolone [21.5 (14.9-26.7), p < 0.05] and budesonide therapy [21 (18-27.2), p < 0.05]. The stool frequency per day also decreased similarly from 6 (2-8) to 2 (1-3) and 2 (1-5), each p < 0.05, under prednisolone and budesonide therapy, respectively. Two patients with RS type II did not respond and 7, including all 4 with RS type I, were clinically stable with budesonide therapy. Skin fragility in 1 patient was the only adverse effect of budesonide therapy. Conclusions: Budesonide may be an effective treatment option in patients with RS type I, which can stabilize the clinical condition similar to prednisolone. Copyright (c) 2006 S. Karger AG, Basel.