联合用药保留灌肠治疗溃疡性结肠炎26例疗效观察

溃疡性结肠炎主要采用内科治疗，其目的是控制急性发作，维持缓解，减少复发，防治并发症。药物治疗常选用氨基水杨酸制剂、糖皮质激素及免疫抑制剂，多采用口服及静脉给药。我们2002-03／2004-01应用联合用药保留灌肠治疗溃疡性结肠炎26例，取得了较好的临床效果，现总结报告如下。     

中药保留灌肠治疗溃疡性结肠炎疗效的系统评价

[目的]运用系统评价方法,综合评价中药保留灌肠治疗溃疡性结肠炎的临床疗效.[方法]计算机检索1990～2010年中国生物医学文献数据库(sinomed)、CNKI数据库和万方数据知识服务平台,收集中药保留灌肠与西药灌肠治疗溃疡性结肠炎的随机对照试验( RCT),按照纳入与排除标准选择文献、评价质量并提取资料后,采用RevMan 5.1软件进行Meta分析.[结果]最终纳入15篇RCT试验,除1篇中质量外,其余14篇均属低质量文献.中药保留灌肠治疗溃疡性结肠炎的临床疗效优于西药对照组,2组差异有统计学意义.敏感性分析显示评价结果较为稳定;漏斗图图形不对称,提示存在发表性偏倚.共有9篇文献描述了不良反应.[结论]中药保留灌肠治疗溃疡性结肠炎有一定疗效,但因纳入试验的方法学质量存在一些不足之处,可能影响到结果的真实性,因此尚需开展更多设计严谨,大样本、多中心的随机对照试验来确认.     

三黄汤加地塞米松保留灌肠治疗溃疡性结肠炎疗效观察

溃疡性结肠炎(UC)是一种以大肠黏膜和黏膜下层炎症为特点的原因不明的慢性炎症性疾病。近年来发病有上升的趋势，由于其反复发作，所以根治比较困难，对其治疗效果各家报道不一。我院自1992年1月至2002年12月对54例溃疡性结肠炎住院患者采用了三黄汤加地塞米松保留灌肠的治疗方法，取得较好疗效，现报告如下。     

经结肠途径治疗仪保留灌肠治疗溃疡性结肠炎疗效观察

[目的]探讨经结肠途径治疗仪保留灌肠治疗溃疡性结肠炎的疗效。[方法]将120例溃疡性结肠炎患者分为治疗组和对照组,各60例。对照组行常规治疗,美沙拉嗪每日4g口服;治疗组在此基础上加用结肠途径治疗仪予甲硝唑100ml(0.5g)+硫糖铝4g+地塞米松5mg+庆大霉素8万U保留灌肠,每日1次;2组均15d为一疗程,共2个疗程。[结果]2个疗程后治疗组临床症状及内镜下表现明显优于对照组。[结论]经结肠途径治疗仪保留灌肠治疗溃疡性结肠炎疗效好,值得推广。     

结肠途径治疗机配合保留灌肠治疗溃疡性结肠炎疗效观察

目的观察思密达、柳氮磺胺吡啶（SASP）经结肠途径治疗机保留灌肠治疗溃疡性结肠炎（uc）的疗效。方法将60例UC患者随机分为治疗组和对照组各30例，分别给予思密达、SASP配合结肠途径保留灌肠治疗和口服思密达、SASP治疗。结果治疗组和对照组总有效率分别为96％和76．7％（P〈0．05）。结论思密达、SASP配合结肠途径保留灌肠治疗uc能有较好的效果。     

药物保留灌肠治疗溃疡性结肠炎84例的效果观察

目的探讨药物保留灌肠治疗溃疡性结肠炎的,临床效果。方法随机选取84例溃疡性结肠炎者给予药物保留灌肠治疗（观察组）,同期选取85例给予常规口服药物治疗（对照组）,对两组患者临床治疗效果、临床症状消失时间和疾病活动指数等相关指标进行观察比较分析。结果观察组治疗总有效率（90．5％）高于对照组（64．7％）;与对照组比较,观察组患者临床症状消失时间缩短,疾病活动指数减少,差异均有统计学意义（P均〈0．05）。结论药物保留灌肠是治疗溃疡性结肠炎的有效方法,操作简便,值得临床推广应用。     

中药保留灌肠治疗溃疡性结肠炎100例

慢性溃疡性结肠炎是一种原因不明的弥漫性大肠非特异性炎症，有复发、缓解、反复发作的特点。病变以粘膜为主，常有糜烂和浅溃疡形成。临床症状为腹泻、粘液脓血便和不同程度周身症状，如病程长，严重可累及全结肠易有癌变倾向，治疗比较困难。我院在3700例结肠镜检查中发现溃疡性结肠炎212例，占被检6％，用中药保留灌肠治疗100例，获得明显疗效。现报告如下：     

中药保留灌肠联合针刺抗焦虑治疗溃疡性结肠炎临床观察

[目的]探索溃疡性结肠炎（UC）的治疗方法。[方法]将56例UC患者随机分为2组,治疗组29例,采用乾坤肠康液保留灌肠联合针刺抗焦虑治疗;对照组27例,采用乾坤肠康液保留灌肠法治疗。治疗前后观察特质焦虑量表（T-AI）积分,中医症状学、结肠镜下表现积分。[结果]治疗组治疗前T-AI、中医症候学积分及结肠镜下表现积分值分别为（46．2±17．8）、（13．42±3．12）及（11．55±2．98）分,治疗后为（41．2±7．8）、（5．02±3．83）、（4．52±3．01）分;对照组治疗前为（46．9±17．5）、（12．96±3．23）、（12．11±3．01）分,治疗后为（42．3±7．6）、（8．15±4．67）、（5．88±3．99）分。2组治疗前后比较差异均有统计学意义（均P〈0．01）。[结论]乾坤肠康液保留灌肠联合针刺抗焦虑和乾坤肠康液保留灌肠治疗UC均有显著疗效,且前者优于后者。     

柳氮磺吡啶口服联合仙白汤灌肠治疗溃疡性结肠炎疗效观察

[目的]观察柳氮磺吡啶(SASP)口服联合仙白汤灌肠治疗溃疡性结肠炎(UC)的临床疗效.[方法]将活动期轻、中度UC患者分为2组:灌肠组50例、对照组30例.灌肠组采用口服SASP联合仙白汤灌肠治疗;对照组单用SASP口服治疗;治疗2周后观察2组患者的大便次数、黏液血便、腹痛症状改善情况,并行结肠镜及组织病理学检查.[结果]灌肠组腹痛、便次、黏液血便症状改善平均时间分别为4.6 d、5.88 d、4.92 d,对照组分别为6.6d、8.4d、7.4d,(P＜0.01);治疗后复查肠镜,对照组总有效率为73.33％,灌肠组为96.00％(P＜0.01);总体评估,灌肠组完全缓解14例,有效32例,无效4例,总有效率为92.00％,对照组依次为6、16、8例、73.33％,2组比较差异有统计学意义(P＜0.01).[结论]SASP联合仙白汤灌肠治疗UC可快速缓解症状、促进溃疡愈合,控制UC的活动期,比单用SASP更能控制炎症急性发作,疗效更显著.     

康复新液保留灌肠治疗溃疡性结肠炎60例

[目的]观察康复新液灌肠治疗溃疡性结肠炎（UC）的疗效。[方法]120例住院治疗的UC患者随机分为2组,各60例,康复新组用康复新液100 ml加0.9%氯化钠50 ml,每晚保留灌肠1次,共30 d;对照组用柳氮磺胺吡啶（SASP）片4 g研粉后加入0.9%氯化钠100 ml中,每晚保留灌肠1次,共30 d。[结果]康复新组,显效21例,有效31例,无效8例,总有效率为86.7%;对照组依次为16、25、19例,68.3%,2组比较,康复新组总有效率明显高于对照组（P〈0.05）。[结论]康复新液灌肠治疗UC疗效稳定可靠,不良反应少,患者依从性、耐受性好,是一种值得临床推广应用的治疗方法。     

溃疡性结肠炎的治疗

溃疡性结肠炎(UC)现代治疗目标是尽早控制发作,不用激素的维持缓解、内镜下黏膜愈合,降低住院率与手术率,以提高生活质量。治疗原则是分级、分期、分段用药,采用综合性、个体化治疗措施。药物以氨基水杨酸类药物(5-ASA)、肾上腺皮质激素(GCS)和免疫抑制剂(IS)为主,新型生物制剂英夫利昔(IFX)用于顽固性UC与重症病例。手术指征为大出血、穿孔、中毒性巨结肠、恶变和内科治疗无效的顽固病例。中药用于80%的UC病例,深入研制和应用可起到更好的补充与替代作用。     

Leukocyte removal therapy for ulcerative colitis does not affect postoperative complications

Background We investigated the incidence of postoperative complications in patients treated with or without preoperative leukocyte removal therapy (LRT). Methods The case notes of 387 patients with ulcerative colitis (UC) who underwent surgical intervention were retrospectively reviewed. One hundred nine patients were treated with LRT within 8 weeks before surgery (LRT group), and 278 had not received LRT since at least 8 weeks before surgery (without LRT group). We reviewed the postoperative complications according to type of initial operation. Results Of the patients who underwent an ileal J-pouch anal anastomosis (IPAA) without an ileostomy, 3 (6.5%) in the LRT group developed pouch-related complications (PRC), while 11 (7.5%) in the without LRT group developed PRC. The overall postoperative complication rates were 28.3% in the LRT group and 21.8% in the without LRT group. For patients who underwent an IPAA with an ileostomy, the overall rates of postoperative complications were 39.1% in the LRT group and 31.8% in the without LRT group. Among those undergoing a total colectomy, 33.3% in the LRT group and 18.2% in the without LRT group had postoperative complications. No statistically significant differences were demonstrated between the two groups with respect to postoperative complications. Conclusions Our results suggest that preoperative LRT does not influence the rate of postoperative complications in UC patients.     

Predictors of a response to cyclosporine or leukocyte removal therapy in patients with refractory ulcerative colitis

Introduction: Despite decades of clinical experience in optimizing the induction and maintenance of remission in patients with ulcerative colitis (UC), some patients remain refractory to conventional medical treatment while, in others, the effectiveness of drugs is limited by side‐effects. We investigated factors predictive of the efficacy of cyclosporine and leukocyte removal therapy in patients with intractable UC. Methods: Forty‐five patients with moderate to severe UC who were refractory to corticosteroid therapy were enrolled. Twenty‐six patients were treated with cyclosporine and 19 by leukocyte removal therapy. Disease activity index (DAI) score assessment, and colonoscopic and histological examinations were done before and at 10, 20 and 40 days after the initiation of treatment. A clinical response to treatment was defined as a decrease in DAI score of 3 points or more at 40 days. Results: Responder ratio did not significantly differ between the cyclosporine (65.6%) and leukocyte removal therapy (63.2%) groups. Factors predictive of a response to cyclosporine therapy were fever (≥ 38.0°C), anemia and large mucosal ulceration. In contrast, mucosal bleeding and poor extensibility of the intestinal lumen were predictive of a poor response to cyclosporine. No significant differences in any clinical or endoscopic parameter predictive of a response to leukocyte removal therapy were identified. Conclusions: Intravenous cyclosporine may be effective in patients who have severe steroid‐refractory UC, and leukocyte removal therapy may be useful in patients with moderate active UC predicted to be refractive to cyclosporine.     

肠愈宁治疗活动期溃疡性结肠炎疗效观察

[目的]观察肠愈宁颗粒治疗活动期溃疡性结肠炎(UC)的临床疗效.[方法]60例患者随机分为2组各30例,治疗组予以中药肠愈宁颗粒口服,10g,早晚分服;对照组予口服美沙拉嗪1.0 g/次,4次/d.8周为1个疗程.观察2组患者治疗后主要临床症状、结肠镜下黏膜改善情况及临床疗效.[结果]治疗组总有效率为93.3％,对照组90.0％,2组比较差异无统计学意义(P＞0.05).临床症状改善情况2组比较差异亦无统计学意义(P＞0.05).[结论]肠愈宁颗粒治疗活动期UC疗效显著,与西药美沙拉嗪相当,值得临床推广应用.     

Outpatient treatment of moderately severe active ulcerative colitis with pulsed steroid therapy and conventional steroid therapy

Pulsed steroid therapy may induce rapid remission in patients with moderately severe ulcerative colitis in outpatient clinics. A total of 19 patients with moderately severe active ulcerative colitis who refused hospitalization were treated between October 1999 and September 2001 in the outpatient clinic. Patients were treated with either conventional oral steroid therapy or intravenous pulsed steroid therapy followed by conventional oral steroid therapy. Eight patients received conventional steroid therapy and 11 patients received pulsed steroid therapy followed by conventional steroid therapy. The efficacies of the two types of steroid therapy were equal, but patients with active colitis responded more quickly to pulsed steroid therapy than to conventional steroid therapy. No serious adverse effects were observed. Moderately severe colitis can be safely treated with either conventional or pulsed steroid therapy in the outpatient clinic, but pulsed steroid therapy may induce clinical remission more quickly than conventional steroid therapy.     

Effects of oral tacrolimus as a rapid induction therapy in ulcerative colitis

AIM:To determine the efficacy and safety of rapid induction therapy with oral tacrolimus without a meal in steroid-refractory ulcerative colitis(UC)patients.METHODS:This was a prospective,multicenter,observational study.Between May 2010 and August 2012,49 steroid-refractory UC patients(55 flare-ups)were consecutively enrolled.All patients were treated with oral tacrolimus without a meal at an initial dose of 0.1mg/kg per day.The dose was adjusted to maintain trough whole-blood levels of 10-15 ng/m L for the first 2 wk.Induction of remission at 2 and 4 wk after tacrolimus treatment initiation was evaluated using Lichtiger’s clinical activity index(CAI).RESULTS:The mean CAI was 12.6±3.6 at onset.Within the first 7 d,93.5%of patients maintained high trough levels(10-15 ng/m L).The CAI significantly decreased beginning 2 d after treatment initiation.At 2wk,73.1%of patients experienced clinical responses.After tacrolimus initiation,31.4%and 75.6%of patients achieved clinical remission at 2 and 4 wk,respectively.Treatment was well tolerated.CONCLUSION:Rapid induction therapy with oral tacrolimus shortened the time to achievement of appropriate trough levels and demonstrated a high remission rate 28 d after treatment initiation.Rapid induction therapy with oral tacrolimus appears to be a useful therapy for the treatment of refractory UC.     

溃疡性结肠炎患者首次糖皮质激素治疗后1年内复发预测因子分析

[目的]探讨溃疡性结肠炎(UC)患者首次糖皮质激素治疗后1年内复发情况及其预测因子。[方法]对37例首次接受糖皮质激素治疗、随访1年或者1年内因复发再次入院的UC患者的资料进行回顾性分析。[结果]37例UC患者中,1年内复发者(A组)19例(51%),平均复发时间为开始使用糖皮质激素后5.0个月;1年复发者(B组)18例,占49%。与B组相比,A组全结肠型UC患者比例明显较高(50%∶90%),差异有统计学意义(P=0.009)。单变量分析提示全结肠型UC与开始糖皮质激素治疗后1年内的复发显著相关(P=0.009),多变量分析也提示全结肠型UC与1年内复发显著相关(P=0.037,OR:12.006,95%CI:1.163~123.959)。[结论]UC患者首次接受糖皮质激素治疗诱导缓解后,1年内复发率仍较高;全结肠型UC与开始糖皮质激素治疗后1年内复发相关。     

中国溃疡性结肠炎10218例的特点

目的分析中国溃疡性结肠炎患者的特点.方法对从1981年到2000年20年间中国医学文献报告及我院确诊的1021 8例患者进行分析结果①病例数目20年间,中国医学文献报告及我院确诊的患者共10218例,其中最近10年报告的病例数目是前10年3.8倍.②病变范围直肠乙状结肠炎和直肠炎占70.20%,左半结肠炎占22.50%,广泛性或全结肠炎占7.30%.③病变类型初发型34.8%,慢性反复发作型52.6%,慢性持续性10.7%,急性暴发性1.9%.④病程75.5%患者小于5年,15.5%患者在5年和10年之间,只有9.1%患者大于10年.⑤肠外表现6.1%患者有肠外表现.⑥年龄发病的平均年龄是40.7岁(范围从6岁～80岁,高峰年龄段是30岁～49岁).⑦性别男女比是1.09.⑧吸烟病情严重程度和吸烟之间无负相关(P＞0.05),⑨家族遗传性270例患者中有4例有家族史.⑩治疗单纯采用西药(氨基水杨酸类或/和皮质激素)治疗的占18.6%,单纯采用中医治疗的占20.1%,采用中西医结合治疗的占59.1%,手术1.3%,其他治疗占0.9%.结论中国溃疡性结肠炎的病例数目在过去10年中显著增加,病变主要以左半结肠为主,病程短,肠外表现少见,发病年龄相对较大,男女比例数目大致相等,家族遗传少见,吸烟与病情轻重之间无显著相关,中医药治疗在中国广泛应用.     

The beneficial effect of azathioprine on maintenance of remission in severe ulcerative colitis

Background. The search is on to find more effective drug regimens for patients with severe ulcerative colitis, as conventional drugs such as sulfasalazine and its congeners fail to prevent relapse in a significant number of patients. Azathioprine has also been reported to be useful as a steroid-sparing drug in patients who suffer from frequent relapses. As these drugs when used individually fail to sustain remission in a significant number of patients, we evaluated the combination of these two drugs. Methods. Thirty-five newly diagnosed patients with severe ulcerative colitis were randomized into two groups; group A (combination therapy) received sulfasalazine and azathioprine, while group B (sulfasalazine monotherapy) received sulfasalazine and placebo. In addition, all the patients received steroids initially to achieve clinical remission. The patients were followed-up for a period of 1 year. The therapeutic outcome was measured by the number of patients who suffered relapse in each group. Results. All the patients completed the 1-year study period. While 4 patients (23.5%) in group A suffered relapse of disease, 10 (55.6%) in group B suffered relapse, the difference being statistically significant. The relapse-free period was also significantly longer in group A. Conclusions. Combination therapy (sulfasalazine and azathioprine) is more effective than sulfasalazine and placebo in the maintenance of remission in patients with severe ulcerative colitis. Received: November 20, 2000 / Accepted: September 14, 2001     

Granulocytapheresis in the treatment of patients with active ulcerative colitis

In recent years, considering the role of inflammatory processes and the involvement of the immune system in ulcerative colitis, granulocytapheresis, a technique for removing circulating leukocytes and preventing their migration into the intestinal mucosa, has been proposed for the treatment of acute ulcerative colitis. Initially introduced for the treatment of patients who did not respond to conventional therapy only, this new therapy may become a useful and safe method to induce clinical remission in patients with acute disease. This article will review the clinical applications and issues concerning the use of granulocytapheresis in ulcerative colitis.