ABSTRACT
Objective To evaluate the efficacy and safety of azathioprine (AZA) in the treatment of refractory ulcerative colitis (UC).Methods Retrospective analysis of the clinical improvement,endoscopic improvement and mucosal healing rate,inflammation marker improvement after AZA administration and its safety in 24 refractory UC patients were performed,who were recruited between January 2007 and December 2011 in West China Hospital,Sichuan University,China.Results Twenty-four patients were enrolled,with a median age of 36 years old and a median course of 4 years.Among them,14 cases were moderate UC and 10 cases were severe UC.The patients were treated with AZA in a dose of (1.23 ±0.34) mg· kg-1 · d-1 from 7 weeks to 42 months.Efficacy was judged by Mayo disease activity index.At 3 months,6 months and 1 year after treatment,the effective rates were 73.9％ ( 17/23),81.8％(18/22) and 14/16 respectively,and the remission rates were 17.4％ (4/23),54.5％ (12/22) and 12/16respectively.Both ESR and C reactive protein level after treatment for 6 months and 1 year were significantly lower than those before treatment [ (9.3 ±8.9) mrn/1h,(10.9 ±7.3) mm/1h vs (22.3 ± 10.7) mm/1h;2.5(1.0-22.3) mg/L,2.3(1.0-28.0) mg/L vs 18.4(3.6-137.0) mg/L; all P ＜0.05].Corticosteroid withdrawal rates at 3 months and 1 year after AZA treatment were 16/18 and 15/16,respectively.At 6 months and 1 year after AZA treatment,the endoscopic improvement rates were 85.7％ ( 18/21 ) and 13/15 respectively; the cndoscopic remission rates were 61.9％ ( 13/21 ) and 11/15 respectively; and the mucosal healing rates were 61.9％ ( 13/21 ) and 11/15 respectively.Adverse effects were occurred in 8 patients.Leukopenia was the most common adverse effect,followed by liver function injury,alopecia and epigastric discomfort.Conclusions AZA is effective in the treatment of refractory UC patients with a low dose of ( 1.23 ± 0.34) mg· kg - 1 · d - 1,especially in the steroid withdrawing,maintaining remission and mucosal healing without severe adverse effects.
ABSTRACT
Primary intestinal NK/T cell lymphoma is extremely rare and early diagnosis is frequently difficult. The aim of this study is to investigate the clinicopathological findings, immunophenotype, and T cell receptor [TCR] gamma gene rearrangement of primary intestinal NK/T cell lymphomas in 25 Chinese cases. Clinical data of the 25 cases were analyzed. Immunohistochemistry for immunophenotype, in situ hybridization for EBER, and polymerase chain reaction for TCR y gene rearrangement were investigated. Survival curves according to clinical characteristics were analyzed. The median age was 33 years and the median survival was 7 months. The common symptoms consisted of abdominal pain, fever, marasmus, diarrhea, and hematochezia. Endoscopically, the tumors were mainly featured by focal, multifocal or diffuse irregular ulcers, which most frequently emerged in the ascending colon. Histologically, the tumors were characterized by the proliferation of pleomorphic atypical lymphoid cells [ALCs], necrosis, lympho-epithelial lesions, and mixed inflammatory infiltration. The positive frequency of CDepsilon was 88.2%, of CD56 was 84%, granzyme B was 90%, and EBER was 84.2%. A total of 12 out of 14 cases [85.7%] highly expressed Ki67. The negative prognostic factors for survival were Ann Arbor stage HIE or IVE [P = 0.039] and more than one extranodal site of disease [P = 0.019]. Primary intestinal NK/T cell lymphomas most frequently favor young people and have a poor prognosis. Due to the nonspecific clinical and endoscopic findings, it is difficult to distinguish intestinal NK/T cell lymphomas from inflammatory and infectious disorders. Histopathology, immunophenotype, and DNA study play key roles in differential diagnosis