溃疡性结肠炎的内科保守治疗.pptxVIP

溃疡性结肠炎的内科保守治疗第1页/共20页 溃疡性结肠炎的药物治疗和预后第2页/共20页 诊断与治疗诊断：排除性、综合性和完整性诊断治疗：强调分型、分期、分度、分段的原则疗效评定：缓解、有效、无效提倡多中心协作研究第3页/共20页 Treatment goalsPotential future treatment goals for ulcerative colitis include sustained clinical remission, sustained mucosal healing with a reduction in colorectal dysplasia and cancer, and maintaining normal GI physiology.Mesalamine therapy is sufficient in approximately 50% of patients.There are limited data that azathioprine might induce and maintain clinical remission and endoscopic healing.Infliximab is effective for induction and maintenance of clinical remission and endoscopic healing.Data on adalimumab and certolizumab are lacking.Current Directions in IBD Therapy: What Goals Are Feasible With Biological Modifiers? 2008 by the AGA Institute第4页/共20页 SASP早在20世纪初期，斯堪的纳维亚的风湿病专家Suartg发现，水杨酸偶氮磺胺（SASP）的抗炎和抗菌特性可用于治疗类风湿性关节炎。1942年由Dana Svartz 医师首先将柳氮磺胺吡啶应用于溃疡性结肠炎（UC）的治疗，取得了良好效果，成为UC治疗的一个里程碑。自从SASP用作UC的维持治疗后，复发率为原来的1/4，并大大改善了许多患者的生活质量。经过半个多世纪的实践，SASP一直是UC患者广泛应用的药物之一。但由于该药口服耐药性差，不良反应多，通过开发研制了新剂型、改变给药途径等方法显著提高了疗效、减少了不良反应。第5页/共20页 氨基水杨酸制剂第6页/共20页 GCsIntravenous corticosteroids have been established as the most eff ective fi rst-line treatment for acute severe UC since the first trial of this treatment regimen was published in 1974 by Truelove and Jewell . In this study, 36 of 49 patients (73.5 % ) with severe UC were found to be in remission 5 days aft er commencing intensive intravenous treatment with prednisolone 60 mg / day (in divided doses). The introduction of intravenous corticosteroid treatment has led to a substantial decrease in the morbidity and mortality associated with acute severe UC .A number of parenteral corticosteroids have been tested in the treatment of severe UC . There was no obvious differences in treatment response between the various steroidsHowever, there was no evidence to support increasing the corticosteroid dose beyond 60 mg / day of methylprednisolone or equivalentTruelove SC , Jewell DP . Intensive intravenous regimen for