环孢菌素A治疗重度溃疡性结肠炎的临床观察  

Clinical observation of cyclosporin A in treatment of severe ulcerative colitis

作　　者：陈莹[1] 谭华[2] 刘文天[3] 韩玉山[2] 杨健[2] 

机构地区：[1]天津医科大学 [2]天津市人民医院消化科,天津300121 [3]天津医科大学总医院消化科,天津300052

出　　处：《临床荟萃》2008年第1期19-22,共4页Clinical Focus

摘　　要：目的探讨环孢菌素A对糖皮质激素治疗效果不良的重度溃疡性结肠炎的临床疗效及不良反应。方法7例重度溃疡性结肠炎患者使用糖皮质激素治疗效果不良，改用环孢菌素A治疗，根据溃疡性结肠炎活动指数（Southerland）对临床症状进行评分，每天予环孢菌素A 4～6mg／kg，经静脉或口服给药，同时监测患者血药浓度和肝、肾功能，并根据患者症状缓解情况及血药浓度调整用药量。结果7例重度溃疡性结肠炎患者使用环孢菌素A治疗1周、2周后，其Southerland评分较入院时、常规治疗1周以及常规治疗2周均有明显改善（P〈0．05），临床症状基本消失，监测血药浓度在200～300μg／L时治疗效果明显且不良反应小。随访6例患者，随访6～22个月，最长用药时间5个月，5例再复发，1例手术。结论环孢菌素A对糖皮质激素治疗效果不良的重度溃疡性结肠炎患者治疗有效，静脉及口服给药均可，在监测血药浓度的情况下用小剂量的药物能保证疗效，并可减少不良反应的发生。Objective The therapeutic effect of cyclosporin A on the patients with severe ulcerative colitis who had no better effect with glucocorticoid therapy was evaluated. Methods Seven patients with severe ulcerative colitis were treated by cyclosporin A because dissatisfactory therapeutic effect on them was required by use of glucocorticoid. The therapeutic effect was accessed by Southerland index. Cyclosporin A was applied by oral or intravenous route with a daily dose of 4-6 mg/kg. The serum concentration of cyclosporin A,liver function and renal function were monitored. Results After one week and two weeks treatment with cyclosporine A, the Sutherland indexes of these patients, compared with those at the beginning of their hospitalization and after one and two weeks of conventional treatment, were improved significantly （P 〈 0.05）. The symptom of the patients disappeared basically. When the serum concentration of cyclosporin A was at 200-300 μg/L,better therapeutic efficacy and less adverse effect were observed. Six patients were followed up from 6 to 22 months. One patient took cyclosporin A for 5 months. Five patients had recurrence,one patient had operation. Conclusion Cyclosporin A was effective in treatment of patients with severe ulcerative colitis who had no better effect by glucocorticoid therapy. Cyclosporin A could be applied by both oral and intravenous routes. It is meaningful for clinical medication to monitor the serum concentration of the drug.

关 键 词：结肠炎 溃疡性 环孢菌素A 

分 类 号：R574.6[医药卫生—消化系统]