Efficacy of salvage therapy and its effect on operative outcomes in patients with ulcerative colitis.
Efficacy of salvage therapy and its effect on operative outcomes in patients with ulcerative colitis.
复制标题
溃疡性结肠炎患者挽救治疗的疗效及其对手术结果的影响。
作者：
Saito E;Nagahori M;Fujii T;Otsuka K;Watanabe M
AimsTo评估挽救治疗的有效性和安全性，并确定手术并发症的危险因素住院溃疡性结肠炎（UC）patientsand MethodsWe评估了88例UC患者在我中心住院2010年4月至2012年11月。我们比较了使用钙调磷酸酶抑制剂和使用英夫利西单抗作为二线治疗的皮质类固醇难治性患者的特征。此外，我们还比较了手术和非手术患者的特点。围手术期治疗和并发症之间的关联也investigated.ResultsCalcineurin抑制剂和英夫利西单抗分别用于42和22例患者。我们发现他们之间的临床背景没有差异。有效率分别为67%和50%。每种治疗的10例无应答者中有8例接受了另一种药物作为三线治疗。钙调磷酸酶抑制剂和英夫利西单抗作为三线治疗的有效率分别为75%和50%。手术患者病情重（87.5 vs. 31%，p< 0.01），Lichtiger评分较高（14.1 vs. 11.5，p< 0.01），较高的Rachmilewitz内镜指数（10.5 vs. 8.4，p< 0.01），C-反应蛋白（7.6 vs. 4.0，p= 0.015）和血清白蛋白（3.1 vs. 3.6，p= 0.014）均高于非手术患者。16例手术患者中有7例（44%）观察到并发症。即使患者接受二线或三线治疗，术后并发症也没有增加。然而，并发症发生率在皮质类固醇用户为54.5%（6/11）和20%（1/5）在nonusers. ConclusionsThird线挽救治疗是有效的，在精心挑选的UC患者的耐受性。围手术期使用皮质类固醇可能导致更多不良结局。
AimsTo evaluate the efficacy and safety of salvage therapy, and to identify risk factors of operative complications among hospitalized ulcerative colitis (UC) patients.Patients and MethodsWe evaluated 88 UC patients hospitalized at our center between April 2010 and November 2012. We compared characteristics of corticosteroid-refractory patients treated with calcineurin inhibitor and those with infliximab as second-line therapy. Furthermore, we compared the characteristics of operative and nonoperative patients. The association between perioperative treatments and complications was also investigated.ResultsCalcineurin inhibitor and infliximab were used in 42 and 22 patients, respectively. We found no difference in the clinical background between them. Efficacy rates were 67 and 50%, respectively. Eight out of 10 nonresponders of each treatment were treated with the other drug as third-line therapy. The efficacy rates of calcineurin inhibitor and infliximab as the third-line therapy were 75 and 50%, respectively. Operative patients had more severe disease (87.5 vs. 31%, p< 0.01), higher Lichtiger score (14.1 vs. 11.5, p< 0.01), higher Rachmilewitz endoscopic index (10.5 vs. 8.4, p< 0.01), higher C-reactive protein (7.6 vs. 4.0, p= 0.015) and lower serum albumin (3.1 vs. 3.6, p= 0.014) than nonoperative patients. Complications were observed in 7 out of 16 (44%) operative patients. Postoperative complications were not increased even when patients were treated with second-or third-line therapy. However, the complication rate in corticosteroid users was 54.5 (6/11) and 20%(1/5) in nonusers.ConclusionsThird-line salvage therapy is effective and tolerable in carefully selected UC patients. Perioperative use of corticosteroids may lead to more adverse outcomes.