激素在溃疡性结肠炎的应用ppt课件.ppt

1、The Clinical Application of Corticosteroids in Ulcerative Colitis,rui nan Wang,Two parts,The introduction of Ulcerative colitis The clinical application of Corticosteroids in Ulcerative colitis,Ulcerative colitis,Definition: Chronic non-specific colitis Inflammation of the mucosa and submucosa of th

2、e large intestine,Features:,diarrhea with feces containing mucus, pus and blood, abdominal pain and tenesmus; and recurrence is common Mostly seen in 20-50 years of age, and in Europe Less common in China,Infection,Environmental factors,Genetic susceptible,Immune ,UC,UC,Cryptic abscess in UC,Clinica

3、l Manifestations,Symptoms: diarrhea abdominal pain, others : tenesmus, anorexia, nausea and vomiting Signs: tenderness in the left hypogastrium and rebound tenderness,Manifestations of digestive system,Systemic manifestations,fever,tachycardia,Anemia, malnutrition, volume depletion, disturbance in a

4、cid-basebalance and hypoalbuminemia in advanced patients,Extra-intestinal manifestations,erythema nodosum, arthritis, ankylosing spondylitis, iritis，episcleritis, conjunctivitis, ulcers of oral mucosa, chronic active hepatitis and so on.,erythema nodosum,A.course classification initial type chronic

5、relapse type chronic permanent type acute and fulminant type,Clinical classification,UC,B.Extent classification (1) mild type (2) moderate type (3)severe type,Classification,UC,C.range classification Proctitis or proctosigmoiditis:40-50% Left-sided or intermediate colitis :30-40% Pancolitis:20% D.pe

6、riod classification Active phase Alleviative phase,Classification,UC,UC,endoscopic examination,Diseased mucosa: hyperemic and edematous, blood vessels not clear-cut, mucosa erosions and multiple shallow ulcers; rough, fragile, bleeding easily granular, pus; pseudopolyps seen,Mucosa irregularity, saw

7、-tooth like, loss of haustrations, shortening of colon and pseudopolyps formation Contraindicated in fulminant type,UC,Barium enema,typical symptoms+one of endoscopic appearances and biopsy (or one of x-ray barium enema signs)+elimination of other alike disease Notice:1.symptoms are not typical,whil

8、e endoscopic appearances are typical-diagnosis 2.symptoms are typical, while endoscopic appearances are not typical-suspect,Diagnosis,Treatment,General treatment,Drug treatment,Sulfasalazine,Corticosteroids,Immune inhibitor,First choice,Severe patients,Surgical therapy,Indications: abscess formation

9、, canceration, perforation, fistula, mega-colon and refractory colitis, failure of medical therapy etc,Second part,The clinical application of Corticosteroids in Ulcerative colitis,Finding,CORTISONE IN ULCERATIVE COLITIS FINAL REPORT ON A THERAPEUTIC TRIAL,BRITISH MEDICAL JOURNAL On OCTOBER 29 1955,

10、S. C. TRUELOVE, M.D., M.R.C.P. AND L. J. WITTS, M.D., F.R.C.P.,Conclusion,the patients receiving cortisone enjoyed a clear-cut advantage over the patients on a dummy preparation. About two out of every five patients on cortisone therapy were in clinical remission at the end of six weeks treatment, c

11、ompared with less than one out of every six patients receiving the inert therapy.,Among the patients treated with cortisone those in their first attack have fared somewhat better than those in relapse.,How to decide the dose of Corticosteroids,The American Journal of GASTROENTEROLOGY,Ulcerative Coli

12、tis Practice Guidelines in Adults,by American College of Gastroenterology Practic Parameters Committee,Ulcerative Colitis Practice Guidelines in Adults,Oral prednisone shows a dose response effect between 20 and 60 mg per day , with 60 mg per day modestly more effective than 40 mg per day but at the

13、 expense of greater side-effects .,Ulcerative Colitis Practice Guidelines in Adults,No randomized trials have studied Corticosteroids taper schedules; most recommendations have advised 40 60 mg per day until significant clinical improvement occurs and then a dose taper of 5 10 mg weekly until a dail

14、y dose of 20 mg is reached. At this point tapering generally proceeds at 2.5 mg per week.,The therapeutic plan is determined by the Patients condition and preferences,severe and fulminant type,For patients who suffer from severe and fulminant type of UC ：intravenous injection Corticosteroids is Firs

15、t choice , recommend dosage hydrocortisone 300mg or meprednisone 60mg。,mild and moderate type with largely lesion,For mild and moderate patient, First choice oral Sulfasalazine ，while it is not effective，recommend oral prednisone 2060 mg/d,mild and moderate type with Distal lesion,Corticosteroids to

16、pical therapies,Effect of topical administration of budesonide and tranditional corticosteroids on active distal ulcerative colitis or proctitis,Shang hai Jiao tong University School of Medicine,Research from,Conclusion,The effects of budesonide and traditional corticosteroids on active distal Ulcer

17、ative colitis or Proctitis are similar. However, budesonide maybe Preferable to traditional corticosteroids ,since its inhibitory effect on Plasma cortisol level is lower than traditional corticosteroids.,adverse effects,Such as cushingoid features, emotional and psychiatric disturbances, infections

18、, glaucoma. Complications include gastroduodenal mucosal injury, impaired wound healing, and metabolic bone disease.,steroid-dependency,Although short term control of symptoms can be achieved with steroid treatment, followed by recurrence during alleviating dose or stopping administration this pattern of drug response，known as steroid-dependency,The therapeutic plan for steroid-dependency,Azathioprine 2-2.5mg/kg*d Cyclosporin therapy for severe ulcerative colitis