克罗恩病长期免疫抑制治疗的疗效  

The efficacy of medium-and long-term immunosuppressive therapy in Crohn＇s disease

作　　者：周洁[1] 钟捷[1] 王正廷[1] 袁洁璐[1] 俞骁珺[1] 范嵘[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院消化科,200025

出　　处：《中华消化杂志》2012年第5期312-315,共4页Chinese Journal of Digestion

摘　　要：目的研究中国汉族人群克罗恩病的临床表现特征和中长期免疫抑制剂治疗的疗效。方法分析2003年至2010年178例克罗恩病患者的相关临床特征数据及诊断方法。所有患者均采用泼尼松和免疫抑制剂（硫唑嘌呤）治疗。每2周进行临床随访，每4周复查红细胞沉降率和C反应蛋白，每3～6个月行克罗恩病活动指数（cDAI）评分。结果克罗恩病的发病高峰在18～30岁，从出现症状到确诊的平均时间为（8．3±3．7）个月，确诊时有34．8％（62／178例）的患者已因病情进展而出现相应的并发症。硫唑嘌呤平均剂量为（1．24±0．16）mg／kg，不良反应的总停药率为15％（25／167）。长期随访中的手术干预率为15．1％（22／146）。治疗后3个月，患者红细胞沉降率、C反应蛋白明显下降并趋于正常，6个月后CDAI评分也明显降低。结论大部分中国克罗恩病患者对免疫抑制剂有良好的耐受性，且在低于欧美推荐剂量的情况下，仍能获得较好的中长期临床疗效。Objective To investigate the clinical features and the efficacy of medium-and longterm immune suppression in the treatment of Crohn＇s disease （CD） in Chinese Han nationality. Methods The clinical data and diagnosis methods of 178 CD patients between 2003 and 2010 were analyzed. All patients received predinisone and immune suppression （azathioprine） treatment. The patients were followed up every 2 weeks. Erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） were reviewed every 4 weeks. CD activity index （CDAI） was scored every 3 to 6 months. Results The peak age for onset of CD was between 18 to 30 years old, and the mean time from the appearance of symptoms to diagnosis was （8.3＋3.7） months. About 34.8% （62/178 cases） patients had corresponding complications at time of diagnosis due to the progress of the disease. The average dosage of azathioprine was （1.24±0.16） mg/kg, and the total withdrawal rate due to adverse effect was 15% （25/167 cases）. The surgical intervention rate was 15.1% （22/146 cases） during long-term follow-up. ESR and CRP of patients decreased obviously and tended to normal after 3 months treatment. The CDAI score significantly decreased after 6 months treatment. Conclusions Most Chinese patients had a good tolerance of immune suppression and achieved better medium- and long- term clinical efficacy at the dosage lower than that recommended by European and United States guidelines.

关 键 词：克罗恩病 药物耐受性 免疫抑制剂 硫唑嘌呤 

分 类 号：R574[医药卫生—消化系统]