Preoperative Steroid-Related Complications in Japanese Pediatric Patients With Ulcerative Colitis
Preoperative Steroid-Related Complications in Japanese Pediatric Patients With Ulcerative Colitis
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DOI：
10.1007/s10350-005-0213-7
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发表时间：
2006-01
影响因子：
3.9
通讯作者：
K. Uchida;T. Araki;Y. Toiyama;S. Yoshiyama;M. Inoue;H. Ikeuchi;H. Yanagi;C. Miki;T. Yamamura;M. Kusunoki
中科院分区：
文献类型：
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作者：
K. Uchida;T. Araki;Y. Toiyama;S. Yoshiyama;M. Inoue;H. Ikeuchi;H. Yanagi;C. Miki;T. Yamamura;M. Kusunoki
本研究旨在通过分析溃疡性结肠炎患者术前激素相关的主要并发症，明确激素治疗的限度，并明确儿童溃疡性结肠炎患者何时应进行包括手术在内的替代治疗。方法回顾分析28例儿童和57例成人溃疡性结肠炎患者行全结肠切除回肠J袋肛管吻合术的临床资料。结果儿童患者生长迟缓、骨质疏松症、青光眼和白内障的发生率显著高于成人患者。在儿童患者中，术前糖皮质激素总剂量/体重(mg/kg)或术前糖皮质激素总剂量/体表面积(mg/m2)显著低于成人患者。在儿童和成人患者中都进行了类似的外科手术。主要类固醇相关并发症的存在会降低患者的长期生活质量。结论根据体重或体表面积推荐糖皮质激素剂量的循证指南是必要的。为了让患者感觉良好并保持良好的生活质量，应该考虑及早引入替代治疗，包括手术。
PurposeThis study was designed to clarify a limit for steroid therapy in patients with ulcerative colitis through analyzing the preoperative major steroid-related complications and to define when alternative therapies, including surgery, should be performed in pediatric ulcerative colitis patients.MethodsThe medical records of 28 pediatric and 57 adult patients with ulcerative colitis who underwent total proctocolectomy and ileal J-pouch-anal anastomosis were reviewed. The relationship between the preoperative dose of glucocorticoids and major steroid-related complications, as well as the surgery variables, was evaluated.ResultsSignificantly higher incidences of growth retardation, osteoporosis, glaucoma, and cataracts were noted in pediatric patients than in adult patients. In pediatric patients, major steroid-related complications occurred at a significantly lower preoperative total dosage of glucocorticoids/body weight (mg/kg) or preoperative total dosage of glucocorticoids/body surface area (mg/m2) than in adult patients. A similar surgical procedure was performed in both pediatric and adult patients. The presence of major steroid-related complications can lower a patient's long-term quality of life.ConclusionsEvidence-based guidelines for the recommended dose ofglucocorticoids according to body weight or body surface area are needed. To allow patients to feel well and maintain a good quality of life, early introduction of alternative treatments, including surgery, should be considered.