发炎性肠疾病治疗之新进展谢铭钧.PDF

發炎性腸疾病(IBD)治療之新進展 臺大醫院 謝銘鈞 2013/05/11 IBD疾病特徵 克 隆氏症 潰瘍性結腸炎 •慢性 •慢性 • GI道任何部份 •僅大腸 (結腸 ) •原發性 •原發性 • 緩解－復發型 • 緩解－復發型 • 不連續的散發性病理 •連續性病理 •影響整個腸壁 (透壁性) •僅影響黏膜 (腸壁較深層 的部份則否 ) 3 IBD的治療目標 •降低疾病活性 • 達到並維持緩解 • 預防併發症 •減少手術需求 •改善營養狀態 •改善病患的生活品質 (QoL) 4 臨床實務上之考量 局部治療?全身性給藥?  INFLAMMATORY BOWEL DISEASE (IBD)  ULCERATIVE COLITIS (潰瘍性結腸炎)  CROHN’S DISEASE (克隆氏症)  CHEMOPREVENTION OF COLORECTAL CANCER (大腸直腸癌化學性預防)  IRRITABLE BOWEL SYNDROME (腸躁症) DELIVERY STRATEGIES(傳輸策略) PRODRUGS(前驅藥物) pH-DEPENDENT SYSTEM(酸鹼敏感性載體) TIME-DEPENDENT SYSTEM(遲滯性載體) MICROFLORA-ACTIVATED SYSTEM ULCERATIVE COLITIS Two months later after treatment 5-Aminosalicylic acid  MW :153  FORMULAR: C7H7NO3 PRODRUGS (前驅藥物) (A+B) 11 12  Colon bacteria (400 species, 10 –10 CFU/ml) Azoreductase, glycosidase, glucuronidase, urease  Reduction and hydrolysis  Cleavage of the linkage bond Adequate site-specific As a new chemical entity SULFASALAZINE (前驅藥物) Azoreductase sulfapyridine 5-ASA Disadvantage of Sulfasalazine Dose-related and non-dose related Different chemical entity Unpredictable site-specific release from small bowel to colon Vast majority of side eff