对于维持缓解治疗的疗程目前意见不一。一般认为,所有UC 患者均需推荐终生维持治疗[19,20],尤其是左侧结肠以上,广泛结肠或全结肠病变,及每年复发1 次以上的远端结肠病变。远端结肠炎患者已获缓解2 年及不愿接受该类药物治疗者,可停止治疗。目前有证据表明,维持疗法可以降低结、直肠癌的危险。因此UC 患者应规范接受氨基水杨酸和免疫抑制剂的维持疗法,以减少复发,预防结直肠癌[21,22]。
虽然近年在氨基水杨酸和激素类有众多新药问世,治疗方法也不断增多,但资料显示,UC 治疗的有效率近20 年无明显差异[23 ~ 26]。究其原因,这些药物主要在减少副作用,改变输送方式,选择作用部位上有所改变,但药物作用的成分5-ASA 和激素没有改变。因此寻找先进,合理,科学,优化的治疗方案,规范UC 的治疗是当前的主要任务。现阶段要充分发挥协作组的作用,进一步研究氨基水杨酸和激素在诱导缓解治疗时单独和联合治疗的作用;进一步研究氨基水杨酸和免疫抑制剂维持缓解治疗时单独和联合治疗的疗效和疗程;进一步研究益生菌以及生物治疗在诱导缓解和维持缓解治疗中的作用,只有这样才能发挥药物治疗UC 的最大作用及最小副作用,才能提高UC 治疗的效果。
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来源:Domestic Course . 国内讲堂 作者:宋卫生 刘思德