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目的探讨小剂量巯唑嘌呤(Azathioprine,AZA)治疗顽固性溃疡性结肠炎(UC)的临床疗效。方法选择2008年4月—2012年1月于武汉市东西湖区人民医院诊治的采用小剂量AZA治疗的47例顽固性UC患者为研究对象,收集其临床资料,分析总结AZA治疗顽固性UC的临床疗效及安全性。结果 47例顽固性UC患者中,28例为中度活动UC,19例为重度活动UC。采用AZA治疗时间为8周~44个月,平均剂量为(1.21±0.41)mg/(kg·d)。参考MAYO活动指数评分评定疗效,在治疗后3个月、半年、1年的有效率分别是72.3%(34/47)、80.4%(37/46)、93.0%(40/43),缓解率分别是19.1%(9/47)、56.5%(26/46)、76.7%(33/43)。经AZA治疗6个月和1年后血沉和C反应蛋白较治疗前显著下降(P均<0.05)。经AZA治疗6个月及1年后,经内镜检查评定有效率分别为84.8%(39/46)、86.0%(37/43),缓解率分别为63.0%(29/46)、74.4%(32/43),黏膜愈合率分别为63.0%(29/46)、74.4%(32/43)。不良反应发生率为23.9%(11/46),主要为白细胞减少。结论小剂量AZA在顽固性UC的治疗中疗效满意,有效率及黏膜愈合率较高,安全有效。
Objective To investigate the clinical efficacy of low-dose Azathioprine (AZA) in the treatment of refractory ulcerative colitis (UC). Methods Forty-seven patients with refractory UC who were diagnosed and treated with low-dose AZA in Dongxihu District People’s Hospital of Wuhan City from April 2008 to January 2012 were enrolled in this study. The clinical data were collected and the clinical data of AZA in the treatment of refractory UC Efficacy and safety. Results Of the 47 refractory UC patients, 28 were moderately active UC and 19 were heavily active UC. AZA treatment time was 8 weeks to 44 months, the average dose was (1.21 ± 0.41) mg / (kg · d). The MAYO activity index score was used to evaluate the curative effect. The effective rates at three months, half year and one year after treatment were 72.3% (34/47), 80.4% (37/46) and 93.0% (40/43), respectively 19.1% (9/47), 56.5% (26/46) and 76.7% (33/43), respectively. After 6 months and 1 year after AZA treatment, the ESR and C-reactive protein decreased significantly (P <0.05). After 6 months and 1 year after AZA treatment, the effective rate of endoscopic examination was 84.8% (39/46) and 86.0% (37/43) respectively, and the response rates were 63.0% (29/46) and 74.4% (32/43). Mucosal healing rates were 63.0% (29/46) and 74.4% (32/43), respectively. The incidence of adverse reactions was 23.9% (11/46), mainly leukopenia. Conclusions Small dose of AZA is effective and effective in the treatment of intractable UC. The effective rate and high mucosal healing rate are safe and effective.