• 四川大學(xué)華西醫(yī)院消化內(nèi)科,成都,610041;

目的 　針對近期收治的1例常規(guī)治療療效不理想的潰瘍性結(jié)腸炎患者,我們進(jìn)行了證據(jù)檢索和評價(jià),以期找到更有效的治療方法.
方法 　計(jì)算機(jī)檢索MEDLINE(1978～2004)、CBMdisc(1978～2004)及Cochrane圖書館(2004年第3期),查找 5-氨基水楊酸(5-ASA)灌腸液治療潰瘍性結(jié)腸炎及與病情緩解有關(guān)的系統(tǒng)評價(jià)、臨床隨機(jī)對照試驗(yàn)等,并對所獲證據(jù)進(jìn)行評價(jià).
結(jié)果 　高質(zhì)量的臨床證據(jù)表明,5-ASA灌腸液治療潰瘍性結(jié)腸炎及幫助病情緩解均優(yōu)于口服5-ASA及柳氮磺胺嘧啶局部灌腸治療.據(jù)此臨床證據(jù),結(jié)合醫(yī)生經(jīng)驗(yàn)及病人意愿,對該例患者實(shí)施5-ASA 1g+生理鹽水100 ml qd,睡前保留灌腸治療.1周后,患者臨床癥狀明顯緩解,腹瀉基本停止,每天解黃色黏液便1～2次.腸鏡復(fù)查,炎癥較前明顯減輕.出院后繼續(xù)用上述方案維持治療,每周2次.門診隨訪1年,患者未再復(fù)發(fā),也無明顯副作用發(fā)生.
結(jié)論 　5-ASA灌腸液是控制潰瘍性結(jié)腸炎活動期間病情及幫助緩解、減少復(fù)發(fā)的有效藥物.

引用本文： 吳宗英,王一平. 1例潰瘍性結(jié)腸炎的循證治療. 中國循證醫(yī)學(xué)雜志, 2005, 05(7): 571-573. doi: 復(fù)制

1. Lloyd RS, Francois M, Scott G, Malcolm R, Norton G, Fred S, Thomas M, Joseph S, Ed Prokipchuk, Lowell B. 5-aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis and proctitis[J]. Gastroenterology, 1987; 92(35): 1894-1898.
2. Cobden I, al-Mardini H, Zaitoun A, Record CO. Is topical therapy necessary in acute distal colitis? Double-bind comparison of high-dose oral mesalazine versus steroid enemas in the treatment of active distal ulcerative colitis[J]. Aliment Pharmacol Ther, 1991; 5(5): 513-522.
3. Lori K, Hartley C, Cornelius D, Peter R, John Orchard. A comparison of mesalamine suspention enema and oral sulfasalazine for treatment of active distal ulcerative colitis in adults[J]. The American Journal of Gastroenterology, 1995; 90(5): 736-739.
4. Bianchi PG, Ardizzone S, Petrillo M, Fasoli A, Molteni P, Imbesi V. Low pentasa dosage versus hydrocortisone in the topical treatment of active ulcerative colitis: a randomized, double-blind study[J]. The American Journal of Gastroenterology, 1995; 90(5): 736-739.
5. Campieri M, Lanfranchi GA, Bazzocchi G, Brignola C, Sarti F, Franzin G, Battocchia A, Labo G, Dal MontePR. Treatment of ulcerative colitis with high-dose 5-aminosalicyclic acid enemas[J]. Lancet, 1981; 45(8): 270-271.
6. Mulder CJ, Tytgat GN, Wiltink EH, Houthoff HJ. Comparison of 5-aminosalicyclic acids and prednisolone phosphate sodium enema in the treatment of distal ulcerative colitis. A prosective, randomized, double-blind trial[J]. Scandinavian Journal of Gastroenterology, 1988; 23(8): 1005-1008.
7. Gionhetti P, Ardizzine S, Benvenuti ME. A new mesalazine gel enema in the treatment of left-sided ulcerative colitis: a randomized controlled multicenter trial[J]. Aliment Phamacol Ther, 1999; 13(3): 381-388.
8. Danish 5-ASA Group. Topical 5-aminoalicyclic acid versus prednisolone in ulcerative proctosigmoiditis. A randomized double blind multicenter trial[J]. Dig Dis Sci, 1987; 32(6): 598-602.
9. Campieri M, Gionchetti P, Benizzi A, Brigola C, Tampieri M, Lannone P, Miglioli M, Barbara L. Optimun dosage of 5-aminoalicyclic acid as rectal enemas in patient with active ulcerative colitis[J]. Gut,1991;32(8):929-931.
10. Sutherland L, Macdonald JK. Oral 5-aminoalicyclic acid for induction of remission in ulcerative colitis(Cochrane Review)[M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
11. Russell DC, Douglas MW, Ronald AT, Thisted, Stephen B, Hanauer. A meta analysis and overview of the literature on treatment options for left-sided ulcerative colitis and ulcerative proctitis[J]. The American Journal of Gastroenterology, 2000; 95(5): 1263-1276.
12. Gerassimos JM, Athanassions H, Kalliopi P, Charis S, Georgios T. Intermittent therapy with high-dose 5-aminosalicyclic acid enemas maintains remission in ulcerative proctitis and proctosigmoiditis[J]. Dis Colon Rectum, 1994; 37(23): 58-62.
13. Andreoli A, Spinena S, Levenstein S, Prantera C. 5-aminoalicyclic acid enema versus oral sulphasazine in maintaining remission in ulcerative colitis[J]. Italian Journal of Gastroenterology, 1994; 26(3): 121-125.
14. Biddle WL, Greenberger NJ, Swan JT, Mcphee MS, Miner PB. 5-aminoalicyclic acid enemas: effective agent in maintaining remission in left-sided ulcerative colitis[J]. Gastroenterology, 1988; 94(4): 1075-1079.
15. Albasio G, Pacini F, Camarri E, Messori A, Trauori G, Bonanomi AG, Bardazzi G, Milla M, Ferrero S, Biaginim, Quaranta S, Amorosi A. Combined therapy with 5-aminoalicyclic acid tablets and enemas for maintaining remission in ulcerative colitis: a randomized double-blind study[J]. American Journal of Gastroenterology, 1997; 92(7): 11143-11147.
16. Sutherland L, Roth D, Beck P, Makiyama K. Role of 5-aminoalicyclic acid for maintenance of remission in ulcerative colitis(Cochrane Review)[M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
17. Gisbert JP, Gomollon F, Pajares JM. Role of 5-aminoalicyclic acid(5-ASA) in the treatment of inflammatory bowel disease: a systematic review[J]. Digestive Disease and Science, 2002; 47(3): 471-488.
  1. 1. Lloyd RS, Francois M, Scott G, Malcolm R, Norton G, Fred S, Thomas M, Joseph S, Ed Prokipchuk, Lowell B. 5-aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis and proctitis[J]. Gastroenterology, 1987; 92(35): 1894-1898.
  2. 2. Cobden I, al-Mardini H, Zaitoun A, Record CO. Is topical therapy necessary in acute distal colitis? Double-bind comparison of high-dose oral mesalazine versus steroid enemas in the treatment of active distal ulcerative colitis[J]. Aliment Pharmacol Ther, 1991; 5(5): 513-522.
  3. 3. Lori K, Hartley C, Cornelius D, Peter R, John Orchard. A comparison of mesalamine suspention enema and oral sulfasalazine for treatment of active distal ulcerative colitis in adults[J]. The American Journal of Gastroenterology, 1995; 90(5): 736-739.
  4. 4. Bianchi PG, Ardizzone S, Petrillo M, Fasoli A, Molteni P, Imbesi V. Low pentasa dosage versus hydrocortisone in the topical treatment of active ulcerative colitis: a randomized, double-blind study[J]. The American Journal of Gastroenterology, 1995; 90(5): 736-739.
  5. 5. Campieri M, Lanfranchi GA, Bazzocchi G, Brignola C, Sarti F, Franzin G, Battocchia A, Labo G, Dal MontePR. Treatment of ulcerative colitis with high-dose 5-aminosalicyclic acid enemas[J]. Lancet, 1981; 45(8): 270-271.
  6. 6. Mulder CJ, Tytgat GN, Wiltink EH, Houthoff HJ. Comparison of 5-aminosalicyclic acids and prednisolone phosphate sodium enema in the treatment of distal ulcerative colitis. A prosective, randomized, double-blind trial[J]. Scandinavian Journal of Gastroenterology, 1988; 23(8): 1005-1008.
  7. 7. Gionhetti P, Ardizzine S, Benvenuti ME. A new mesalazine gel enema in the treatment of left-sided ulcerative colitis: a randomized controlled multicenter trial[J]. Aliment Phamacol Ther, 1999; 13(3): 381-388.
  8. 8. Danish 5-ASA Group. Topical 5-aminoalicyclic acid versus prednisolone in ulcerative proctosigmoiditis. A randomized double blind multicenter trial[J]. Dig Dis Sci, 1987; 32(6): 598-602.
  9. 9. Campieri M, Gionchetti P, Benizzi A, Brigola C, Tampieri M, Lannone P, Miglioli M, Barbara L. Optimun dosage of 5-aminoalicyclic acid as rectal enemas in patient with active ulcerative colitis[J]. Gut,1991;32(8):929-931.
  10. 10. Sutherland L, Macdonald JK. Oral 5-aminoalicyclic acid for induction of remission in ulcerative colitis(Cochrane Review)[M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
  11. 11. Russell DC, Douglas MW, Ronald AT, Thisted, Stephen B, Hanauer. A meta analysis and overview of the literature on treatment options for left-sided ulcerative colitis and ulcerative proctitis[J]. The American Journal of Gastroenterology, 2000; 95(5): 1263-1276.
  12. 12. Gerassimos JM, Athanassions H, Kalliopi P, Charis S, Georgios T. Intermittent therapy with high-dose 5-aminosalicyclic acid enemas maintains remission in ulcerative proctitis and proctosigmoiditis[J]. Dis Colon Rectum, 1994; 37(23): 58-62.
  13. 13. Andreoli A, Spinena S, Levenstein S, Prantera C. 5-aminoalicyclic acid enema versus oral sulphasazine in maintaining remission in ulcerative colitis[J]. Italian Journal of Gastroenterology, 1994; 26(3): 121-125.
  14. 14. Biddle WL, Greenberger NJ, Swan JT, Mcphee MS, Miner PB. 5-aminoalicyclic acid enemas: effective agent in maintaining remission in left-sided ulcerative colitis[J]. Gastroenterology, 1988; 94(4): 1075-1079.
  15. 15. Albasio G, Pacini F, Camarri E, Messori A, Trauori G, Bonanomi AG, Bardazzi G, Milla M, Ferrero S, Biaginim, Quaranta S, Amorosi A. Combined therapy with 5-aminoalicyclic acid tablets and enemas for maintaining remission in ulcerative colitis: a randomized double-blind study[J]. American Journal of Gastroenterology, 1997; 92(7): 11143-11147.
  16. 16. Sutherland L, Roth D, Beck P, Makiyama K. Role of 5-aminoalicyclic acid for maintenance of remission in ulcerative colitis(Cochrane Review)[M/CD]. In: The Cochrane Library, Issue 3, 2004. Oxford: Update Software.
  17. 17. Gisbert JP, Gomollon F, Pajares JM. Role of 5-aminoalicyclic acid(5-ASA) in the treatment of inflammatory bowel disease: a systematic review[J]. Digestive Disease and Science, 2002; 47(3): 471-488.