溃疡性结肠炎认识新视角

吴开春; 阴玥; 万健; 鱼静敏

doi:10.3969/j.issn.1671-038X.2023.03.02

溃疡性结肠炎认识新视角

- 空军军医大学西京消化病医院消化科国家消化系统疾病临床医学研究中心(西安, 710032)

详细信息

作者简介:
吴开春，空军军医大学西京消化病医院副院长、主任医师、教授、博士生导师。国家教育部“长江学者奖励计划”特聘教授，“国家杰出青年基金”获得者。兼任世界胃肠病组织(WGO)执行理事、亚太消化学会(APAGE)秘书长、中华消化学会副主任委员、全军消化专业委员会主任委员、陕西省消化学会主任委员。国家自然科学基金委优秀创新群体带头人。获得国家重点研发计划等课题20余项。发表SCI论文300余篇。获国家科技进步一等奖和创新群体奖各1项

通讯作者: 吴开春，E-mail：kaicwu@fimmu.edu.cn

中图分类号: R574.62

收稿日期: 2023-02-23

刊出日期: 2023-03-15

New perspectives on ulcerative colitis

- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University, National Clinical Research Center For Digestive Diseases, Xi'an, 710032, China

More Information

Corresponding author: WU Kaichun, E-mail: kaicwu@fimmu.edu.cn

Received Date: 23 February 2023

Publish Date: 15 March 2023

摘要

摘要: 近年来随着对溃疡性结肠炎(UC)认识的深入、诊断技术的发展以及生物制剂等新药的研发与应用，各类共识指南对于UC的疾病评估、治疗方案和治疗目标等建议进行了调整与完善。本文从我国UC诊断现状、治疗目标的变化、生物制剂及传统药物的应用和急重症UC处理等方面对UC的诊治作一论述，以期对未来临床实践提供启发。
- 溃疡性结肠炎 /
- 治疗目标 /
- 生物制剂 /
- 急重症溃疡性结肠炎
Abstract: In recent years, with the in-depth understanding of ulcerative colitis(UC), the improvement of diagnostic technology, as well as the development and application of new drugs such as biologics, various consensus or guidelines have been adjusted and improved for disease evaluation, treatment plan, and therapeutic goals of UC. This article discusses the diagnosis and treatment of UC in China from the aspects of the current status of diagnosis, the changes of therapeutic goals, the application of biologics and traditional drugs, as well as the treatment of acute severe ulcerative colitis, so as to provide inspiration for future clinical practice.
- ulcerative colitis /
- therapeutic goals /
- biological agents /
- acute severe ulcerative colitis

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表 1 不同药物治疗UC至达标时间^[5] 周

治疗药物	短期目标	中期目标			长期目标
治疗药物	临床应答	临床缓解	CRP/ESR正常化	FC下降	内镜黏膜愈合
口服5-氨基水杨酸	4	8	8	10	13
口服激素	2	2	5	8	11
局部用激素	3	8	8	9	13
巯嘌呤	11	15	15	15	20
托法替布	6	11	9	11	14
阿达木单抗	6	11	10	12	14
英夫利西单抗^a)	5	10	9	11	13
维得利珠单抗^a)	9	14	14	15	18
注：^a)在我国获批UC适应证的生物制剂；ESR：红细胞沉降率。

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表 2 考虑采用降阶梯治疗的高危因素及原因^[12]

高危因素	原因
诊断年龄 < 40岁	UC患者预后不良的高危因素
广泛结肠病变	更易发生结直肠癌，行结肠切除术的风险更高
内镜下黏膜病变严重	治疗1年但未达黏膜愈合的患者，其结肠切除风险高于达标患者
低血清白蛋白、高CRP水平	结肠切除术和急诊手术的预测因素，也提示患者炎症负荷大
合并肠外表现	UC患者预后不良的风险因素；抗TNF-α药物治疗多种肠外表现有效

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