炎症性肠病患者缓解期药物降级策略

摘要/Abstract

摘要： 炎症性肠病（inflammatory bowel disease,IBD）包括溃疡性结肠炎（ulcerative colitis,UC）和克罗恩病（Crohn disease,CD）,需长期药物维持缓解。制定缓解期药物降级策略对减少不良反应、减轻经济负担具有重要意义,但停药风险和获益尚存争议。部分缓解期UC患者可减量使用5-氨基水杨酸盐,但停药后复发风险升高。免疫调节剂如硫唑嘌呤长期使用存在安全性问题,但通过药物监测体系可实现安全停药。生物制剂在缓解期停药后复发率较高,特别是未达到深度缓解者。此外,联合治疗患者的药物降级策略需综合评估。停药后的复发监测尤为关键,内镜、血清C反应蛋白和粪便钙卫蛋白等生物标志物可作为有效的预测工具。本文通过回顾缓解期IBD患者药物降级研究,为临床实践提供参考,促进医患共同决策。

关键词: 炎症性肠病, 药物降级, 缓解期, 复发监测

Abstract: Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), requires long-term pharmacological maintenance of remission. Developing de-escalation strategies during remission is crucial for reducing side effects and alleviating economic burdens, though the risks and benefits of discontinuation remain controversial. 5-aminosalicylic acid (5-ASA) can be reduced in some UC patients during remission, but carries a high risk of relapse upon discontinuation. Immunomodulators such as azathioprine present safety concerns with prolonged use, yet safe discontinuation can be achieved through monitoring systems. Biologics show high relapse rates after discontinuation in remission, especially in patients without deep remission. De-escalation in combination therapy requires comprehensive assessment. Post-discontinuation relapse monitoring is critical, with endoscopy and biomarkers such as C-reactive protein (CRP) and fecal calprotectin (FCP) serving as effective predictive tools. This review summarizes recent studies on drug de-escalation in IBD remission, providing guidance for clinical practice and fostering shared decision-making between patients and physicians.

Key words: Inflammatory bowel disease, Exit strategy, Remission, Relapse monitoring

中图分类号:

R574

顾于蓓, 洪聿. 炎症性肠病患者缓解期药物降级策略[J]. 内科理论与实践.

Gu Yubei, Hong Yu. Treatment Withdrawal in Inflammatory Bowel Disease For Remission Maintenance[J]. Journal of Internal Medicine Concepts & Practice.

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