抗生素治疗克罗恩病的合理选择与应用  

Reasonable selection and application of antibiotics in the treatment of Crohn's disease

作　　者：黄奇[1] 周丽峰[1] 缪应雷[1] 

机构地区：[1]昆明医科大学第一附属医院消化内科,云南省昆明市650032

出　　处：《世界华人消化杂志》2013年第35期3923-3931,共9页World Chinese Journal of Digestology

摘　　要：克罗恩病(Crohn's disease,CD)是一种慢性复发性肠道炎症性疾病,其发病机制至今尚不明确.大量的研究表明肠道细菌参与CD的始动和持续.抗生素通过改变肠道菌群发挥作用,单独或联合其他药物使用,是治疗CD的合理策略.虽然已有研究证实抗生素对活动期CD、静止期CD、预防术后复发、肛周瘘管等都有疗效,但抗生素目前仍只被推荐用于有感染并发症的CD患者.抗生素用于治疗CD仍需大样本、多中心循证医学证据.目前被大家广泛应用于CD治疗的抗生素有甲硝唑、喹诺酮药物和利福昔明等,尽管疗效得到大家的认可,但缺乏足够的理论支撑,且目前药物的不良反应,使得合理规范的使用抗生素治疗CD仍是临床一大难题.Crohn＇s disease （CD） is one of the two major forms of inflammatory bowel disease （IBD）. Although the etiology of CD is unclear, many experimental and clinical observations support the potential role for intestinal microflora in the pathogenesis of CD. Manipulation of the lumi-nal content using antibiotics may therefore rep-resent a potentially effective therapeutic option. Some randomized controlled trials have dem-onstrated the efficacy of these drugs in treating the perianal disease, inducing and maintaining of CD remission and decreasing CD recurrence rates in operated patients. However, the use of antibacterial therapy for CD is also controversial, even this approach is frequently and success-fully adopted in clinical practice. Fairly narrow indications for antibiotics are suggested by cur-rent management guidelines. Large studies are required to better define the role of antibacterial agents and combination regimens in CD. Broad-spectrum antibiotics, such as metronidazole, flu-oroquinolones and rifaximin, are widely used to treat CD, and their effects have been recognized. Because of the lack of adequate theoretical sup-port and adverse drug reactions, the reasonable application of antibiotics to treat CD is still a clinical problem.

关 键 词：抗生素 克罗恩病 肠道菌群 甲硝唑 环丙沙星 利福昔明 

分 类 号：R574[医药卫生—消化系统]