环孢素和英夫利昔在治疗重度溃疡性结肠炎中的临床应用

The clinical application of Cyclosporine and Infliximab in the treatment of severe ulcerative colitis

15%~19%的溃疡性结肠炎患者在疾病进展过程中要经历至少一次疾病严重发作的活动期,而发展为急性重度溃疡性结肠炎,此时应尽早采取有效的治疗措施以诱导疾病缓解。首选治疗方案是静脉使用糖皮质激素类药物,然而该措施只能使约60%的患者获得疾病的完全或部分缓解,40%的患者为激素抵抗型重度溃疡性结肠炎患者,他们可能需要进行补救治疗。环孢素和英夫利昔是主要补救治疗方案,但是目前尚缺乏对两种药物的疗效及安全性的有利证据,同时现有的临床试验采用不同的临床疗效评估标准,这些因素导致了无法在现有临床试验的基础上得到可靠的循证医学证据,从而无法提出较好的治疗方案。此篇综述将总结近年来的相关文献,评价两种药物的疗效及安全性,以指导临床实践。

15% -19% of the patients with ulcerative colitis would experience at least once severe flare-up in the course of the disease progression, and thus develop acute severe ulcerative colitis. Early and effective therapies should be taken to induce disease remission. The preferred treatment in this case is intravenous corticosteroids. However, only 60% of the patients can achieve complete or partial remission after this treatment. The rest 40% of the patients belong to severe steroid-refractory ulcerative colitis, and they have the possibility to commence the rescue therapy. Cyclosporine and Infliximab are the major rescue therapies, but at present, there is few conclusive evidence for the efficacy and safety of both drugs. Meanwhile, the existing clinical trials assess the clinical efficacy of the both drugs in different criterias. These factors result in unavailable conclusive evidence on the basis of existing clinical trials, and thus the better treat- ment can not be proposed. This review will summarize recent literatures to evaluate the efficacy and safety of the two drugs, so as to guide clinical practice.