兰索拉唑所致显微镜结肠炎62例分析

Analysis on lansoprazole-induced microscopic colitis in 62 patients

目的 分析兰索拉唑所致显微镜结肠炎的临床特点及危险因素. 方法 检索PubMed、大医医学搜索、中国学术期刊全文数据库和万方医学数据库,收集兰索拉唑致显微镜结肠炎（MC）相关文献,记录患者原发疾病、合并疾病、用药剂量、用药途径、合并用药、发生MC潜伏期、临床表现、肠镜检查特征、治疗措施及转归等,分析兰索拉唑致MC的特点与危险因素. 结果 共检索到兰索拉唑致MC相关文献30篇,全部为病例报告.患者共62例,男性22例（35.5％）,女性40例（64.5％）;年龄36～ 92岁,平均（69＆#±12）岁,＞50岁患者57例（91.9％）;胶原性结肠炎（CC）43例（69.4％）,淋巴细胞性结肠炎（LC）18例（29.0％）,LC转化成CC 1例（1.6％）.62例患者均口服用药.用药至发生MC的潜伏期为5d～6年,其中用药后1～6个月内发生者31例（60.8％）.临床均表现为非血性水样腹泻（3 ～ 10次/d者59例,＞10次/d者3例）.62例患者均进行了肠镜检查,37例显示轻度异常或水肿,11例有线性黏膜缺损和黏膜撕裂.18例患者组织病理学检查可见上皮下胶原层增厚、固有层炎性细胞浸润、上皮淋巴细胞增多.20例患者存在合并使用MC高危药物的情况,其中13例合用了非甾体抗炎药.轻、中度药源性MC患者58例,停用兰索拉唑或换用奥美拉唑、雷贝拉唑钠治疗即恢复;严重药源性MC患者4例,停用兰索拉唑并使用糖皮质激素治疗后恢复正常. 结论 兰索拉唑所致MC临床表现以水样腹泻、结肠黏膜轻度异常或水肿及组织病理学可见结肠黏膜上皮下胶原增厚为特征.年龄、性别及合并用药可能与MC的发生有关.

Objective To analyze the clinical characteristics and risk factors of lansoprazoleinduced microscopic colitis （MC）.Methods PubMed,Da-Yi medical search,CHKD and Wanfang databases were searched and articles related to MC induced by lansoprazole were collected.The patients＆#’ primary diseases,coexisting diseases,the dosage,the way of administration,combination drugs,latent period,clinical manifestations,colonoscopic findings,the treatment measures,and the outcomes were recorded and the clinical characteristics,the risk factors of MC induced by lansoprazole were analyzed.Results A total of 30 articles and 62 patients with MC induced by lansoprazole were retrieved.All articles were case reports and no randomized controlled trials were found.Of all the 62 patients,22 were male （35.5%） and 40 were female （64.5%） with age from 36 to 92 years and the average age was （69 ＆#± 12） years ; 57 patients （91.9%） were 〉 50 years ; 43 patients were with collagenous colitis （CC） （69.4%）,18 patients （29%） were with lymphocytic colitis （LC）,and one patient with LC changed into CC （1.6%）.All patients were treated with oral lansoprazole.The latent period of MC induced by lansoprazole were 5d-6 years and within 1-6 months in 31 patients （60.8%）.The most common clinical manifestations were non-bloody watery diarrhea （3-10 times daily in 59 patients,〉 10 times daily in 3 patients）.Intestinal mucosal screening was performed for all the patients and mild abnormalities or edema were observed in 37 patients,mucosal defect and mucosal laceration in 11 patients,epithelial collagen layer thickening,inflammatory cells infiltration in lamina propria,increased lymphocytes in intraepithelial spaces in 18 patients.High-risk drugs for drug-induced MC were combined use in 20 patients and the combination drugs in 13 patients were non steroidal anti-inflammatory drugs.Fifty-eight patients with mild or moderate druginduced MC returned to normal after withdrawl of lansoprazole and treatment with omeprazole or rabeprazole sodium and 4 patients with severe drug-induced MC recovered after withdrawl of lansoprazole and treatment with glucocorticoids.Conclusions The clinical characteristics in patients with MC induced by lansoprazole are watery diarrhea,mild abnormality or edema of colon mucosa,and thickening in the epithelium of colonic mucosa in histopathology.Age,gender,and combined use of drugs may be related to occurrence of MC induced by lansoprazole.