6-巯基嘌呤治疗炎症性肠病的单中心10年治疗经验

作     者：Glazier K.D. Palance A.L. Griffel L.H. Das K.M. 樊菁 

作者机构：UMDNJ- Robert Wood Johnson Med. Sch. 1 Robert Wood Johnson Place New Brunswick NJ 08903 United States Dr. 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2005年第1卷第7期

页      面：40-41页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：炎症性肠病 单中心 克罗恩病 溃疡性结肠炎 结肠淋巴瘤 临床反应 复发率 黑色素瘤 白细胞减少 正常分娩 

摘      要：Goals: To report the 10- year experience of a single center in treating pati ents with refractory inflammatory bowel disease (IBD) with relatively lower dose of 6- mercaptopurine (6- MP). Study: The charts of 285 patients with IBD (Cro hn’ s disease 160 and ulcerative colitis 125) receiving 6- MP were reviewed. C linical response, subsequent breakthrough while taking 6- MP, and relapse rates when 6- MP was discontinued and side effects were assessed. Results: Ninety- three percent of the patients were taking 50 to 75 mg/day of 6- MP. Complete re mission was achieved in 62% , partial remission in 14.5% , and failure to achi eve remission in 23.5% of the patients. Of complete responders, 27.5% had br eakthrough while continuing 6- MP. Nine percent of those that achieved a comple te remission experienced a relapse after 6- MP was discontinued. Side effects i ncluded leukopenia (11.2% ), abnormal liver function tests (3.8% ), various in fections, including pneumonia (3.1% ), pancreatitis (2.5% ), nausea (2.1% ), headache (2.8% ), fever (1.4% ), hair loss (1% ), and rash (0.7% ). Two canc ers occurred while taking 6- MP: melanoma on the finger and a fatal colonic lym phoma. Four patients continued 6- MP throughout pregnancies and had normal outc omes. Conclusions: In our experience 6- MP is relatively safe and appears to be as effective at a lower dosage (0.84 mg/kg per day) compared with the recommend ed higher dosage (1- 1.5 mg/kg per day), when leukopenia was more frequent. Ser ious side effects, although rare, need to be monitored.