Rapid endoscopic improvement is important for 1-year avoidance of colectomy but not for the long-term prognosis in cyclosporine A treatment for ulcerative colitis
Rapid endoscopic improvement is important for 1-year avoidance of colectomy but not for the long-term prognosis in cyclosporine A treatment for ulcerative colitis
复制标题
快速内镜检查改善对于 1 年内避免结肠切除术很重要，但对于环孢素 A 治疗溃疡性结肠炎的长期预后并不重要
DOI：
10.1007/s00535-010-0273-x
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发表时间：
2010
影响因子：
6.3
通讯作者：
T. Hibi
中科院分区：
文献类型：
--
作者：
Taku Kobayashi;M. Naganuma;S. Okamoto;T. Hisamatsu;N. Inoue;H. Ichikawa;T. Takayama;R. Saito;T. Sujino;H. Ogata;Y. Iwao;T. Hibi
背景静脉注射（IV）环孢素A （CSA）是治疗类固醇难治性严重溃疡性结肠炎（UC）患者的首选方法之一。在这项研究中，我们评估了UC患者CSA治疗的总体经验，从他们的初始反应到长期预后。方法回顾性分析我院1996年11月至2008年10月收治的72例重症UC急性发作患者的临床资料。使用临床活动指数评估对CSA的初始反应，结肠切除术被指定为长期预后的终点。结果总的来说，72例患者中有53例（73.6%）最初对CSA有反应。我们无法确定任何预测初始反应的具体参数。对所有患者的生命表分析显示，54.4%的患者在11年内需要结肠切除术。手术的长期风险与较短的病程、药物不良反应史和缺乏免疫调节剂的使用有关。此外，第14天的内镜改善与1年结肠切除术相关，但与长期预后无关。结论虽然CSA对严重的UC发作有很高的初期疗效，但仍有50%的复发患者需要行结肠切除术。具体来说，内镜评估的粘膜愈合与1年结肠切除术率相关。相反，药物不良反应史与长期结肠切除术率相关。因此，我们建议使用CSA治疗严重UC需要考虑初始缓解和长期维持作为管理目标。
BackgroundIntravenous (IV) cyclosporine A (CSA) is one of the treatments of choice for patients with steroid-refractory severe ulcerative colitis (UC). In this study, we evaluated the overall experience with CSA treatment in UC patients, from their initial response to long-term prognosis.MethodsThe medical records of 72 patients admitted to our hospital with a severe UC flare-up and treated with IV CSA between November 1996 and October 2008 were reviewed retrospectively. The initial response to CSA was assessed using a clinical activity index, and colectomy was assigned as the endpoint for the long-term prognosis.ResultsOverall, 53 of 72 (73.6%) patients responded initially to CSA. We could not determine any specific parameters that predicted an initial response. A life-table analysis for all patients revealed that 54.4% of patients required a colectomy within 11 years. The long-term risk of surgery was associated with a shorter disease duration, history of adverse reactions against medications and lack of immunomodulator use. In addition, endoscopic improvement at day 14 was associated with colectomy at 1 year, but not with the long-term prognosis.ConclusionsAlthough CSA can exert high initial efficacy for severe attacks of UC, >50% of patients who relapse require a colectomy. Specifically, mucosal healing evaluated by endoscopy was associated with the 1-year colectomy rate. In contrast, a history of adverse drug reactions was correlated with the long-term colectomy rate. Therefore, we propose that treatment of severe UC with CSA requires consideration of both initial remission and long-term maintenance as management goals.