6-MERCAPTOPURINE IN THE MANAGEMENT OF INFLAMMATORY BOWEL-DISEASE - SHORT-TERM AND LONG-TERM TOXICITY
6-MERCAPTOPURINE IN THE MANAGEMENT OF INFLAMMATORY BOWEL-DISEASE - SHORT-TERM AND LONG-TERM TOXICITY
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DOI：
10.7326/0003-4819-111-8-641
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发表时间：
1989-10-15
影响因子：
39.2
通讯作者：
KORELITZ, BI
中科院分区：
文献类型：
--
作者：
PRESENT, DH;MELTZER, SJ;KORELITZ, BI
我们通过报告我们对396例患者（120例溃疡性结肠炎患者，276例克罗恩病患者）进行了18年的观察，评估了6-巯基嘌呤治疗炎症性肠病的相关毒性。90%的患者获得了平均60.3个月的随访数据。6-巯基嘌呤直接引起的毒性包括胰腺炎13例（3.3%），骨髓抑制8例（2%），过敏反应8例（2%），药物性肝炎1例（0.3%）。这些并发症在所有病例中均可逆，无死亡。在我们的经验中，大多数骨髓抑制病例发生在早期，当时使用的初始药物剂量较高。29例患者（7.4%）出现感染性并发症，其中7例（1.8%）为严重并发症，包括1例带状疱疹脑炎。所有感染均可逆，无死亡。观察到12例肿瘤（3.1%），但只有1例（0.3%），即脑弥漫性组织细胞淋巴瘤，可能与使用6-巯基嘌呤有关。我们的数据显示，396例患者的毒性发生率较低，再加上先前证明的6-巯基嘌呤治疗炎症性肠病的疗效，表明该药物是治疗难治性炎症性肠病患者的合理选择。
We assess toxicity related to 6-mercaptopurine in the treatment of inflammatory bowel disease by reporting our experience with 396 patients (120 patients with ulcerative colitis, 276 with Crohn disease) observed over 18 years. Follow-up data for a mean period of 60.3 months were obtained for 90% of the patients. Toxicity directly induced by 6-mercaptopurine included pancreatitis in 13 patients (3.3%), bone marrow depression in 8 (2%), allergic reactions in 8 (2%), and drug hepatitis in 1 (0.3%). These complications were reversible in all cases with no mortality. Most cases of marrow depression occurred earlier in our experience, when the initial drug doses used were higher. Infectious complications were seen in 29 patients (7.4%), or which 7 (1.8%) were severe, including one instance of herpes zoster encephalitis. All infections were reversible with no deaths. Twelve neoplasms (3.1%) were observed, but only 1 (0.3%), a diffuse histiocytic lymphoma of the brain, had a probable association with the use of 6-mercaptopurine. Our data, showing a low incidence of toxicity in 396 patients, coupled with the previously demonstrated efficacy of 6-mercaptopurine in the treatment of inflammatory bowel disease, indicate that the drug is a reasonable alternative in the management of patients with intractable inflammatory bowel disease.