IBD常用的免疫抑制剂_培训课件.ppt

防治对策 尚需长期观察 对于严重肾功能损害的患者应避免大剂量使用 其可使孕妇的妊娠实验呈阴性反应，故在应用此药时应采取避孕措施 雷公藤多甙 类风湿性关节炎、系统性红斑狼疮、强直性脊柱炎等自身免疫性疾病 对免疫系统呈双向调节作用 在体外：低浓度可促进T细胞和B细胞增殖，高浓度则呈抑制作用 在体内：低浓度时促进B细胞的功能，但对T细胞功能无明显影响，高浓度时则对T、B细胞均有抑制作用 不良反应 常见：肝肾损害、骨髓抑制、对生殖系统的影响，长期应用可导致肾间质纤维化 其中对生殖系统的影响较为突出，影响女性的卵巢功能和男性睾丸的精子发育 骨髓抑制可致白细胞及血小板减少，严重者可发生粒细胞缺乏、贫血、再生障碍性贫血，多在用药后一周出现，常同时伴有腹泻，停药后可恢复正常 另外还可引起皮肤黏膜改变，如：皮肤色素沉着、口腔溃疡、痤疮、皮肤瘙痒等 其它：还可导致胃肠道反应、听力减退等 防治对策 肝肾功能不全及造血功能低下者慎用 青春发育期慎用 掌握好剂量和疗程，可适量联合用药 用药期间严密检测血常规、肝肾功能等，出现不良反应立即停药 谢 谢 * * Key Point: Traditional “bottom-up” therapy as recommended by the American College of Gastroenterology (ACG) in its UC practice guidelines utilizes conventional medications such as 5-aminosalicylates (5-ASAs) as first-line therapies, while reserving more aggressive agents (eg, infliximab, IV steroids, cyclosporine) for more severe and/or refractory patients. Background: Current therapeutic paradigms recommend 5-ASA agents as first-line therapy for patients with mild to moderate UC.1 Oral corticosteroids are typically reserved for patients who do not respond to oral 5-ASA agents with or without topical agents, or for patients who need rapid improvement.1 Infliximab has demonstrated efficacy in patients who have moderate to severe UC despite receiving therapy with conventional agents.2 Aggressive medical therapies (IV corticosteroids, cyclosporine) are generally reserved for patients with severe or fulminant UC not responding to maximal oral doses of 5-ASAs and corticosteroids.1 References1. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2004;99(7):1371-1385. 2. Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353:2462-2476. * * Key Point: Although preliminary data in Crohn’s disease suggest that reversing the traditional “step-up” treatment pyramid in favor of “top-down” therapy