不同剂量硫唑嘌呤治疗激素依赖型结肠炎的应用体会  

Effects of different doses of azathioprine for steroid-dependent colitis

作　　者：赵思军[1] 

机构地区：[1]旺苍县人民医院消化内科,四川旺苍628200

出　　处：《结直肠肛门外科》2016年第5期502-506,共5页Journal of Colorectal & Anal Surgery

摘　　要：目的 比较不同剂量硫唑嘌呤治疗激素依赖型结肠炎的疗效。方法 选择2011年2月-2014年5月本院收治的82例激素依赖型结肠炎患者为研究对象,随机分为A组（硫唑嘌呤片应用剂量为每天1 mg/lg,n=41）与B组（硫唑嘌呤片应用剂量为每天2 mg/kg,n=41）。两组均予硫唑嘌呤片联合醋酸泼尼松片治疗。临床观察时间为3个月,随访2年。比较两组治疗后3个月总有效率、治疗前及随访结束时血沉（ESR）、超敏反应蛋白（hs-CRP）、CDAI评分以及随访开始前与随访结束时6-硫鸟嘌呤核苷酸（6-TGN）浓度。比较两组不良反应发生率。结果 治疗3个月,A组总有效率为90.2%,B组为95.21%,差异无统计学意义（P〉0.05）。两组治疗前ESR、hs-CRP、CDAI评分差异无统计学意义（P〉0.05）;随访结束两组ESR、hs-CRP、CDAI评分均低于治疗前评分（P〈0.05）,随访结束B组hs-CRP、CDAI评分低于A组（P〈0.05）。B组随访开始前及随访结束的6-TGN浓度分别为（381.63±59.46）pmol/8×10-8RBC、（314.62±40.75）pmol/8×10-8RBC,均高于A组（P〈0.05）。A组不良反应发生率为14.6%（5/41）,B组为19.5%（8/41）,差异无统计学意义（P〉0.05）。结论 治疗剂量为每天2 mg/kg或1 mg/kg硫唑嘌呤治疗激素依赖型结肠炎的近期疗效相当,但前者可维持较高6-TGN有效浓度,且并未明显增加严重不良反应发生率,远期效果更佳。Objective To Compare the effects among different doses of azathioprine in steroid-dependent colitis. Methods Eighty-two patients with steroid-dependent colitis were recruited from our hospital from February 2011 to May 2014 and were randomized into group A and group B, with 41 patients in each group. Both groups were treated with tablets of azathioprine combined with tablets of prednisone acetate. The dose of azathioprine in group A and group B were 1 mg/kg per day and 2 mg/kg per day, respectively. Evalua-tion was performed at month 3, and patients were followed up for 2 years. The overall effectiveness rate in month 3 after treatment, ery- throcyte sedimentation rate （ESR）, high-sensitivity C-reactive protein （hs-CRP） and CDAI scores were compared between the two groups. The concentration of 6- thioguanosine （6-TGN） before treatment and at the end of follow-up was compared between the two groups. Incidence of adverse reactions was also compared between the two groups. Results The overall short-term effectiveness rate in group A （90.2%） was similar to that in group B （95.21%） （P 〉 0.05）. There were no significant differences in ESR, hs-CRP and CDAI scores between the two groups before treatment （P 〉 0.05 ）. At the end of follow-up, ESR, hs-CRP and CDAI scores were lower than those before treatment in both groups （P 〈 0.05）. hs-CRP and CDAI score were lower in group B than in group A （P 〈 0.05）. Before treatment and at the end of follow-up, the concentrations of 6-TGN [ （381.63±59.46） pmol/8x10SRBC, （314.62±40.75） pmol/ 8xl0sRBC, respectively] were higher in group B than those in group A （P 〈 0.05）. The incidence of adverse reactions in group A [ 14.6% （5/41） ] was similar to that in group B [ 19.5% （8/41） ] （P 〉 0.05）. Conclusion The effects of 2 mg/kg or 1 mg/kg per day of azathioprine are similar in steroid-dependent colitis. However, the lower dose can maintain relatively higher concentration of 6-TGN, and does not increase the incidenc

关 键 词：激素依赖 结肠炎 硫唑嘌呤 

分 类 号：R574.62[医药卫生—消化系统]