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目的了解硫唑嘌呤维持克罗恩病患者临床缓解的疗效及安全性。方法收集1998 2005年13例经口服泼尼松或病变肠段切除术后获得临床缓解的克罗恩病患者,分析经硫唑嘌呤治疗前及平均治疗(每天2 mg/kg)达18个月后的克罗恩病活动指数(CDAI)、Harvey-Bradshaw指数、泼尼松剂量减少情况、生物学指标变化及有无不良反应,并进行统计学分析。结果硫唑嘌呤治疗后,患者的CDAI评分下降,平均为96.1分,10例患者保持完全缓解(76.9%)。Harvey-Bradshaw指数平均下降1.8分,11例缓解(84.6%)。两种评估方法结果密切相关(r=0.8)。9例患者在开始服用硫唑嘌呤同时,缓慢递减泼尼松剂量(每天或隔天5～10 mg)或停服。绝大多数患者血小板计数、红细胞沉降率及C-反应蛋白能保持在诱导缓解后的正常值范围内。血清总蛋白及白蛋白值在诱导缓解后进一步升高达正常(或接近正常)值水平。除个别患者肝酶发生轻度(<正常2倍)升高外,大多数患者在应用硫唑嘌呤前后无明显变化。少数患者发生短暂的白细胞减少或轻度肝转氨酶升高,在密切观察及保肝治疗后继续治疗。1例患者在同时服用5-氨基水杨酸制剂(6个月)时,发生白细胞减少与肝转氨酶轻度升高而停药。结论除少数患者发生不良反应外,硫唑嘌呤在泼尼松或手术治疗诱导缓解后,能使大多数克罗恩病患者继续保持临床缓解。
Objective To understand the efficacy and safety of azathioprine in maintaining clinical response to Crohn’s disease. METHODS: Thirteen patients with Crohn’s disease who received clinical remission after oral prednisone or bowel resection of diseased intestine from 1998 to 2005 were analyzed before treatment with azathioprine and mean treatment (2 mg / kg daily) for 18 months Post-Crohn’s disease activity index (CDAI), Harvey-Bradshaw index, prednisone dose reduction, changes in biological indicators and whether there are adverse reactions, and statistical analysis. Results After azathioprine treatment, patients’ CDAI score decreased with an average of 96.1 points and 10 patients achieved complete remission (76.9%). The Harvey-Bradshaw index dropped an average of 1.8 points and 11 cases were relieved (84.6%). The results of the two assessment methods are closely related (r = 0.8). Nine patients started their dose of prednisone (5 to 10 mg every day or next day) or stopped taking it, while taking azathioprine. The vast majority of patients with platelet count, erythrocyte sedimentation rate and C-reactive protein can maintain the range of normal after induction of remission. Serum total protein and albumin values increased further to normal (or near normal) values after induction of remission. In addition to mild (<2-fold normal) elevation of liver enzymes in individual patients, most patients had no significant change before and after azathioprine administration. A small number of patients with transient leukopenia or mild elevated liver transaminase in the close observation and treatment of liver continued treatment. One patient discontinued leukopenia and mild hepatic transaminase elevation when taking 5-aminosalicylic acid (6 months) at the same time. Conclusion In addition to a few patients with adverse reactions, azathioprine in prednisone or surgical treatment induced remission, the majority of patients with Crohn’s disease can continue to maintain clinical remission.