Comparison of the efficiency of different enemas on patients with distal ulcerative colitis
Comparison of the efficiency of different enemas on patients with distal ulcerative colitis
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不同灌肠方法对远端溃疡性结肠炎患者的疗效比较
DOI：
10.1111/cpr.12559
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发表时间：
2019-03-01
影响因子：
8.5
通讯作者：
Liang, Jie
中科院分区：
文献类型：
--
作者：
Zhang, Yujie;Chen, Di;Liang, Jie
目的直肠应用类固醇和5-氨基水杨酸（5-阿萨）治疗左侧结肠炎，副作用少，疗效高。先前的研究表明，直肠给药类固醇和5-阿萨是优于上级一个单一的。然而，一些报道仍然存在争议。因此，有必要探讨这些不同灌肠剂在远端溃疡性结肠炎（UC）患者中的治疗选择和疗效。资料与方法采用问卷调查和回顾性研究方法，在国内各医院对远端活动期UC患者分别采用5-阿萨、氢化可的松/地塞米松或二者联合灌肠治疗的疗效进行调查。还利用右旋糖酐硫酸钠（DSS）诱导的小鼠结肠炎模型来评价体内作用。结果问卷调查结果显示，大多数医生倾向于对远端UC患者口服5-阿萨并外用5-阿萨治疗。但43.01%的医生愿意选择口服5-阿萨和外用氢化可的松/地塞米松联合或不联合5-阿萨灌肠。一项回顾性研究表明，5-阿萨灌肠或5-阿萨联合氢化可的松/地塞米松灌肠治疗在降低C-反应蛋白、红细胞沉降率（ESR）、马约评分以及诱导临床缓解和临床反应方面上级氢化可的松/地塞米松灌肠。在DSS诱导的小鼠结肠炎中，进一步证明了联合治疗无优势。结论虽然43.01%的医师愿意选择氢化可的松/地塞米松联合或不联合5-阿萨灌肠治疗远端UC，但联合用药并不上级5-阿萨灌肠。不建议对远端活动性UC患者使用氢化可的松/地塞米松灌肠联合5-阿萨灌肠。
Objectives Rectal application of steroids and 5-aminosalicylic acid (5-ASA) is associated with few side effects and has a high therapeutic efficacy in left-sided colitis. Previous studies have shown that rectal administration of both steroids and 5-ASA is superior to one single alone. However, some reports are still controversial. Therefore, it is necessary to investigate the treatment choice and efficacy of these different enemas in distal ulcerative colitis (UC) patients. Materials and Methods Questionnaire survey and a retrospective study were carried out in Chinese hospitals to investigate the efficacy of 5-ASA or hydrocortisone/dexamethasone or their combination enema in patients with distal active UC. Dextran sodium sulphate (DSS)-induced colitis model in mice was also utilized to evaluate the effects in vivo. Results The results from questionnaire survey showed that majority of physicians would prefer oral 5-ASA with topical 5-ASA therapy for distal UC patients. However, 43.01% of physicians would like to choose oral 5-ASA and topical hydrocortisone/dexamethasone with or without 5-ASA enema. A retrospective study demonstrated that 5-ASA enema or 5-ASA combined with hydrocortisone/dexamethasone enema therapy was superior to hydrocortisone/dexamethasone enema to decrease C-reactive protein, erythrocyte sedimentation rate (ESR), Mayo score and induce clinical remission and clinical response. No superiority of combination therapy was further proved in DSS-induced colitis in mice. Conclusions Although 43.01% of physicians would like to choose hydrocortisone/dexamethasone with or without 5-ASA enema for the treatment of distal UC, the combination was not superior to 5-ASA enema. Hydrocortisone/dexamethasone enema with 5-ASA enema is not recommended for distal active UC patients.