| 特集名 | 潰瘍性大腸炎の治療の最先端 | |
|---|---|---|
| 題名 | ステロイドの使い方 (2) 静注，強力静注療法 | |
| 発刊年月 | 1997年 09月 | |
| 著者 | 黒澤 進 | 帝京大学医学部第三内科（市原病院） |
| 著者 | 中村 孝司 | 帝京大学医学部第三内科（市原病院） |
| 【 要旨 】 | 潰瘍性大腸炎に対するステロイドの静注療法は，重症から劇症の症例に適応されるものである．同法はTrueloveが1955年に考案した治療法であるが，その後改良が加えられ，本邦では，現在は厚生省の潰瘍性大腸炎の治療指針となっている．治療のポイントは初期治療からプレドニゾロンを高用量で強力に開始し，粘血便の状態など臨床的症状から効果判定をすみやかに行うことである．良好な反応が得られない場合は，外科的切除の適応となる．潰瘍性大腸炎はクローン病と異なり，手術で完治しうる疾患であることを熟知して治療を行うべきである．最後に，強力静注療法が奏功した1例と，同療法および動注療法も効果がなく手術に至った1例を呈示する． | |
| Theme | Advanced Therapy Ulcerative Colitis | |
|---|---|---|
| Title | TGMedical Treatment for Ulcerative Colitis : Intravenous Steroid Infusion Therapy | |
| Author | Susumu Kurosawa | Third Department of Internal Medicine, Teikyo University, Ichihara Hospital |
| Author | Takashi Nakamura | Third Department of Internal Medicine, Teikyo University, Ichihara Hospital |
| [ Summary ] | Parenteral glucocorticoid treatment is indicated for severe to fulminant active ulcerative colitis. The diagnosis of severe or fulminant ulcerative colitis is made primarily by clinical symptoms such as fever. Frequency of bloody stool, tachycardia combined with simple laboratory data such as anemia and increased ESR. If not treated properly, disastrous results may ensue. The treatment method was originated by Truelove in 1955 and several improvements were made thereafter. In Japan, the National Ministry of Health described this treatment in "The guidelines for the treatment of ulcerative colitis." Some investigators advocate the efficacy of parenteral glucocorticoid pulse therapy over conventional intravenous therapy because there is no need for corticoid tapering and there are few side effects. However, to date, there has been no definitive evidence of the superiority of pulse therapy over conventional intravenous therapy. Further study is needed. The key point in treatment is to start the intravenous prednisolone at as high a dose as possible and to estimate the result by clinical parameters such as bloody stool, fever or pulse. If the patient does not show a satisfactory response, emergent colectomy should be performed. The discussion for medical versus surgical treatment can finally be made by a trial of parenteral gulcocorticoid treatment. Because ulcerative colitis is curable with colectomy, in contrast to Crohn's disease, parenteral gulcocorticoid treatment should be performed keeping these facts in mind. Two cases of ulcerative colitis are presented, one effectively treated by parenteral glucocorticoid therapy and the other by colectomy because parenteral glucocorticoid therapy failed. |
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