Современный взгляд на ведение пациентов с язвенным колитом легкой и средней степени тяжести в амбулаторной практике

В статье рассмотрены современные подходы к лечению язвенного колита. Указывается, что для выбора тактики и алгоритма лечения важное значение имеют протяженность поражения, а также степень тяжести текущего обострения, классифицируемая как легкая, средняя и тяжелая. Критерии полезны для оценки необходимости госпитализации, но не учитывают такие важные признаки, как ночные симптомы, внекишечные проявления, эндоскопическая активность. Степень тяжести обострения заболевания характеризует его тяжесть в данный момент, но может не отражать долгосрочное совокупное бремя болезни. Протяженность поражения, в свою очередь, может влиять на выбор способа введения препарата. Выделяют проктит (распространение воспаления до ректосигмоидного угла), левостороннее (воспаление ограничено селезеночным изгибом) и распространенное поражение (воспаление распространяется проксимальнее селезеночного изгиба, включая панколит). Для достижения целей терапии определен временной период от начала лечения до ожидаемого клинического ответа, ремиссии и эндоскопического заживления. Непосредственными и краткосрочными целями названы клинический ответ и ремиссия, а также нормализация уровня С-реактивного белка. В качестве официальной промежуточной цели лечения рекомендовано снижение фекального кальпротектина до оптимального диапазона. Степень повышения концентрации фекального кальпротектина коррелирует с тяжестью воспаления, и при легкой степени заболевания ее значения могут быть нормальными или пограничными. В этой ситуации повторный контроль фекального кальпротектина с течением времени может прояснить клиническую картину. Это было продемонстрировано в недавнем проспективном когортном исследовании, где последовательное определение фекального кальпротектина с интервалом в 1 месяц являлось наилучшим предиктором обострения до появления клинических симптомов. Наряду с эндоскопическим заживлением слизистой оболочки, долгосрочной целью названо восстановление качества жизни и отсутствие инвалидности. В статье рассмотрено применение для лечения язвенного колита препаратов группы месалазина, топических и системных стероидов, а также рассматриваются подходы к мониторингу заболевания и долгосрочному ведению пациентов.

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