Cyclosporine Treatment of Steroid-Refractory Ulcerative Colitis During Pregnancy
Cyclosporine Treatment of Steroid-Refractory Ulcerative Colitis During Pregnancy
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DOI：
10.1002/ibd.20858
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发表时间：
2009-07-01
影响因子：
4.9
通讯作者：
Colombel, Jean-Frederic
中科院分区：
文献类型：
--
作者：
Branche, Julien;Cortot, Antoine;Colombel, Jean-Frederic
背景：环孢素被认为是治疗严重类固醇难治性溃疡性结肠炎（UC）的安全有效的方法。然而，关于其对孕妇的安全性的数据很少。我们在此报告 5 个 GETAID 中心的经验。 方法：在一项回顾性研究中，从 2001 年至 2007 年间接受治疗的连续患者的病历中提取了妊娠期间接受环孢素治疗的严重 UC 患者的数据。结果：确定了 8 名患者（中位年龄 30.5 岁）。发病时，中位妊娠持续时间为 11.5 周（范围 4-25）。七名患者患有全结肠炎。所有患者均具有 3 种以上常用的临床和生物学严重程度标准。 3 名患者有严重的内镜病变，5 名患者没有。所有患者在使用环孢素之前均接受静脉注射皮质类固醇至少 7 天。两名患者在环孢素治疗期间接受了硫唑嘌呤治疗。未观察到治疗引起的严重感染或其他并发症。 7/8 的患者治疗有效。一名患者因环孢素治疗失败而接受英夫利昔单抗治疗，但结果良好。怀孕期间未进行结肠切除术。七次妊娠均足月，但由于母体缺乏 S 蛋白，导致宫内死亡。 2例新生儿早产，其中1例为营养不良。未观察到畸形。结论：根据我们的经验，妊娠期用环孢素治疗类固醇难治性 UC 被认为是安全有效的。 (炎症性肠病 2009;1.5:1044-1048)
Background: Cyclosporine is considered a safe and effective treatment of severe steroid-refractory ulcerative colitis (UC). However, few data Lire available concerning its safety profile in pregnant I women. We report here the experience of 5 GETAID centers.Methods: In a retrospective study data on patients with severe UC treated with cyclosporine during pregnancy were extracted from medical records of consecutive patients treated between 2001 and 2007.Results: Eight patients (median age 30.5 years old) were identified. At the time of flare-up the median duration of pregnancy was 11.5 weeks of gestation (range 4-25). Seven patients had pancolitis. All patients had more than 3 commonly used clinical and biological severity criteria. Three patients had severe endoscopic lesions and 5 patients had not. All patients received intravenous corticosteroids for at least 7 days before introduction of cyclosporine. Two patients received azathioprine during treatment with cyclosporine. No severe infections or other complications due to treatment were observed. Treatment was effective in 7/8 patients. One patient received infliximab, due to cyclosporine therapy failure with a good outcome. No colectomy was performed during pregnancy. Seven pregnancies were conducted to term, but I in Utero death occurred due to maternal absence of S-protein. Two newborns were premature, including I case of hypotrophy. No malformations were observed.Conclusions: In our experience, treatment with cyclosporine for steroid-refractory UC during pregnancy can be considered safe and effective. (Inflamm Bowel Dis 2009;1.5:1044-1048)