[1]郭晓鹤,蒯　君,朱艳丽,等.沙利度胺联合美沙拉嗪和强的松治疗难治性溃疡性结肠炎疗效观察[J].新乡医学院学报,2021,38(6):585-588.[doi:10.7683/xxyxyxb.2021.06.019]
　GUO Xiaohe,KUAI Jun,ZHU Yanli,et al.Effect of thalidomide combined with mesalazine and prednisone in the treatment of refractory ulcera-tive colitis[J].Journal of Xinxiang Medical University,2021,38(6):585-588.[doi:10.7683/xxyxyxb.2021.06.019]
点击复制

沙利度胺联合美沙拉嗪和强的松治疗难治性溃疡性结肠炎疗效观察
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年6
页码:
585-588
栏目:
临床研究
出版日期:
2021-06-05

文章信息/Info

Title:
Effect of thalidomide combined with mesalazine and prednisone in the treatment of refractory ulcera-tive colitis
作者:
郭晓鹤; 蒯　君; 朱艳丽; 杨　芳; 秦　蕾; 杨　艳; 徐泽静; 秦咏梅
(新乡医学院第一附属医院消化内科，河南　卫辉　453100)
Author(s):
GUO Xiaohe; KUAI Jun; ZHU Yanli; YANG Fang; QIN Lei; YANG Yan; XU Zejing; QIN Yongmei
(Department of Gastroenterology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
关键词:
难治性溃疡性结肠炎沙利度胺安全性评价; 临床观察
Keywords:
refractory ulcerative colitisthalidomidesafety evaluationclinical observation
分类号:
R574.1
DOI:
10.7683/xxyxyxb.2021.06.019
文献标志码:
A
摘要:
目的　探讨沙利度胺联合美沙拉嗪和强的松治疗难治性溃疡性结肠炎(RUC)的临床效果。方法　选择2013年9月至2018年12月新乡医学院第一附属医院收治的68例RUC患者为研究对象， 根据治疗方案的不同将患者分为对照组(n=48)和观察组(n=20)。2组患者均给予口服美沙拉嗪肠溶片（每次1 g，每日3次）联合强的松片（第1周按照0.75 mg·kg-1·d-1给予，随后每周减量5 mg）；在此基础上，观察组患者给予口服沙利度胺片，每日100 mg，睡前一次口服；2组患者均治疗12周。治疗12周后对2组患者的临床疗效进行判定，并计算总有效率。采用改良Mayo评分系统中的内镜评分标准评估2组患者治疗前及治疗12周的结肠内镜下表现。采用酶联免疫吸附试验检测患者血清血管内皮生长因子（VEGF）、肿瘤坏死因子-α（TNF-α）水平。观察2组患者治疗期间血常规、尿常规、肝功能、肾功能、神经系统等不良反应发生情况，并计算不良反应发生率。结果　对照组和观察组患者的总有效率分别为35.42%(17/48)、60.00%(12/20)，观察组患者的总有效率显著高于对照组(χ2=19.854,P<0.05)。治疗前2组患者的Mayo评分及血清VEGF、TNF-α水平比较差异无统计学意义(P>0.05) 2组患者治疗后的Mayo评分及血清VEGF、TNF-α水平均显著低于治疗前(P<0.05)；治疗后观察组患者的Mayo评分及血清VEGF、TNF-α水平均显著低于对照组(P<0.05)。对照组和观察组患者治疗期间不良反应发生率分别为33.33%(16/48)和30.00%(6/20)，2组患者不良反发生率比较差异无统计学意义(χ2=2.335，P>0.05)。结论　沙利度胺联合美沙拉嗪和强的松治疗RUC效果显著，沙利度胺可能通过降低血清TNF-α和VEGF水平在RUC治疗中发挥作用。
Abstract:
Objective　To explore the clinical effect of thalidomide combined with mesalazine and prednisone in the treatment of refractory ulcerative colitis (RUC).Methods　A total of 68 patients with RUC admitted to the First Affiliated Hospital of Xinxiang Medical University from September 2013 to December 2018 were selected as the research objects.According to the different treatment plans,the patients were divided into the control group (n=48) and observation group (n=20).The patients in the two groups were given oral mesalazine enteric-coated tablets（1 g each time,3 times once a day）combined with prednisone tablets（0.75 mg·kg-1·d-1 was given in the first week,followed by a weekly reduction of 5 mg）; on this basis,Patients in the observation group were given thalidomide treatment 100 mg daily,once before going to bed；the patients in the two groups were treated for 12 weeks.After 12 weeks of treatment,the clinical efficacy of patients in the two groups was judged,and the total effective rate was calculated.The colonoscopy performance of patients in the two groups was evaluated by endoscopic scoring standard of the modified Mayo scoring system before treatment and 12 weeks after treatment.The serum vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNF-α) levels of patients in the two groups was detected by enzyme-linked immunosorbent assay.The occurrence of adverse reactions such as blood routine,urine routine,liver function,renal function and nervous system during the treatment of patients in the two groups was observed,and the incidence of adverse reactions was calculated.Results　The total effective rate of patients in the control group and observation group was 35.42% (17/48) and 60.00% (12/20),respectively; the total effective rate of the patients in the observation group was significantly higher than that in the control group (χ2=19.854,P<0.05).There was no statistical difference in the Mayo score and the levels of serum VEGF and TNF-α of patients between the two groups before treatment (P>0.05); the Mayo score and levels of serum VEGF and TNF-α of patients in the two groups after treatment were significantly lower than those before treatment (P<0.05); after treatment,the Mayo score and the levels of serum VEGF and TNF-α of patients in the observation group were significantly lower than those in the control group (P<0.05).The incidence of adverse reactions during treatment in the control group and observation group were 33.33% (16/48) and 30.00% (6/20),respectively.There was no significant difference in the incidence of adverse reactions of patients between the two groups (χ2=2.335,P>0.05).Conclusion　The thalidomide combined with mesalazine and prednisone has a significant effect in the treatment of RUC.Thalidomide may play a role in RUC treatment by reducing serum TNF-α and VEGF levels.

参考文献/References:

［1］　PLAMONDON S,NG S C,KAMM M A.Thalidomide in luminal and fistulizing Crohn′s disease resistant to standard therapies［J］.Aliment Pharmacol Ther,2007,25(5):557-567.
［2］　LAZZERINI M,MARTELOSSI S,MARCHETTI F,et al.Efficacy and safety of thalidomide in children and young adults with intractable inflammatory bowel disease:long-term results［J］.Aliment Pharmacol Ther,2007,25(4):419-427.
［3］　DIAMANTI A,KNAFELZ D,PANETTA F,et al.Thalidomide as rescue therapy for acute severe ulcerative colitis［J］.Eur Rev Med Pharmacol Sci,2014,18(12):1690-1693.
［4］　LAZZERINI M,MARTELOSSI S,MAGAZZ G,et al.Effect of Thalidomide on clinical remission in children and adolescents with ulcerative colitis refractory to other immunosuppressives:pilot randomized clinical trial［J］.Inflamm Bowel Dis,2015,21(8):1739-1749.
［5］　中华医学会消化病学分会炎症性肠病学组.中华医学会炎症性肠病诊断与治疗的共识意见(2018年·北京)［J］.中华消化杂志,2018,38(5):292-311.
［6］　欧阳钦,胡品津,钱家呜,等.对我国炎症性肠病诊断治疗规范的共识意见［J］.现代消化及介入诊疗,2008(2):139-145.
［7］　沈骏,冉志华,童锦禄,等.炎症性肠病内镜分级和评分标准的一致性研究［J］．中华消化内镜杂志,2008,25(5):239-244.
［8］　郑秀霞,王承党.沙利度胺的药理特点及其在溃疡性结肠炎中的作用［J］.国际消化病杂志,2011,31(3):153-156,169.
［9］　SPEIRS A L.Thalidomide and congential abnormalities［J］.Lancet,1962,1(7224):303-305.
［10］　WETTSTEIN A R,MEAGHER A P.Thalidomide in Crohn′s disease［J］.Lancet,1997,350(9089):1445-1446.
［11］　卜玉杰．沙利度胺治疗溃疡性结肠炎疗效观察［J］．中国实用医药,2015,10(11):162-163．
［12］　RAFIEE P,STEIN D J,NELSON V M,et al.Thalidomide inhibits inflammatory and angiogenic activation of human intestinal microvascular endothelial cells (HIMEC)［J］.Am J Physiol Gastroin-test Liver Physiol,2010,298(2):G167-G176.
［13］　陈邓林,谢贤和,高允锁.沙利度胺联合化疗治疗中国晚期非小细胞肺癌患者的随机对照试验Meta分析［J］.中国肿瘤临床,2012,39(22):1818-1823.
［14］　俞珊,季晖.沙利度胺联合用药抗肿瘤研究进展［J］.中国临床药理学与治疗学,2009,14(2):230-236.
［15］　马芳,黄学惠.沙利度胺的抗肿瘤作用及临床用途研究进展［J］.现代肿瘤医学,2009,17(9):1799-1802.
［16］　陈琼．沙利度胺治疗儿童克罗恩病的临床观察［D］．衡阳：南华大学，2017．
［17］　梁国庆．沙利度胺治疗难治性克罗恩病的临床疗效观察［J］．现代诊断与治疗，2015,26(23):5344-5345.
［18］　MURCH S H，BRAEGGER C P，WALKER-SMITH J A，et al．Location of tumour necrosis factor alpha by immunohistochemistry in chronic inflammatory bowel disease［J］．Gut,1993,34：1705-1709．
［19］　宗娟娟，林璐，苏莎．沙利度胺治疗顽固性复发性阿弗他溃疡的疗效［J］．南昌大学学报(医学版),2014,54(10):71-72.
［20］　PENG X,ZHI M,WEI M,et al.Thalidomide results in diminished ovarian reserve in reproductive age female IBD patients［J］.Medicine (Baltimore),2017,96(21):e6540.
［21］　SHI H Y,CHAN F K,LEUNG W K,et al.Low-dose azathioprine is effective in maintaining remission in steroid-dependent ulcerative colitis:results from a territory-wide Chinese population-based IBD registry［J］.Therap Adv Gastroenterol,2016,9(4):449-456.

更新日期/Last Update: 2021-06-05