浙江大学学报（医学版）2026，Vol.55Issue(4)：373-380,8.DOI:10.3724/zdxbyxb-2025-0382
急性重度溃疡性结肠炎临床治疗进展
Advances in the clinical management of acute severe ulcerative colitis
摘要
Abstract
Acute severe ulcerative colitis(ASUC)is a critical emergency life-threatening complication of inflammatory bowel disease.A subset of patients fails to respond to first-line intravenous corticosteroid therapy and requires timely salvage treatment.Previously,guidelines recommended infliximab and cyclosporine as the main salvage therapies;however,recent years have witnessed clinical advances.Accelerated and intensified dosing regimens of infliximab,compared with standard dosing,may help patients with high inflammatory burden and hypoalbuminemia achieve earlier clinical and biochemical remission.Among small molecule Janus kinase inhibitors,tofacitinib as an adjunct to intravenous corticosteroids has been shown to improve short-term clinical response rates,while upadacitinib has shown promising efficacy as a salvage therapy when intravenous corticosteroids,standard or intensified infliximab are ineffective.For patients unresponsive to monotherapy or those with extraintestinal manifestations,dual-targeted therapy,through multi-pathway synergistic blockade,achieves superior clinical,endoscopic,and biochemical outcomes compared to monotherapy,providing new evidence-based support for treatment optimization.In addition,exclusive enteral nutrition and hyperbaric oxygen therapy play important roles in the comprehensive management of ASUC by modulating the gut microbiota and promoting mucosal healing,respectively.This review summarizes the therapeutic outcomes and limitations of these emerging pharmacological agents or regimens in the clinical treatment of ASUC,aiming to provide a reference for optimizing clinical management strategies for ASUC.关键词
急性重度溃疡性结肠炎/溃疡性结肠炎激素抵抗型/英夫利西单抗/Janus激酶抑制剂/双重靶向治疗/全肠内营养/高压氧治疗/综述Key words
Acute severe ulcerative colitis/Steroid-resistant ulcerative colitis/Infliximab/Janus kinase inhibitor/Dual-targeted therapy/Exclusive enteral nutrition/Hyperbaric oxygen therapy/Review分类
医药卫生引用本文复制引用
邵文怡,周颖,许丰..急性重度溃疡性结肠炎临床治疗进展[J].浙江大学学报（医学版）,2026,55(4):373-380,8.基金项目
浙江省医药卫生科技计划(2025KY206) （2025KY206）
宁波市公益性研究计划(2024S029) （2024S029）
宁波市临床重点专科建设项目(2024BZZ-1)This study was supported by Medical and Health Science and Technology Project of Zhejiang Province(2025KY206),Ningbo Municipal Public Welfare Research Plan(2024S029),and Ningbo Key Clinical Specialty Construction Project(2024BZZ-1) （2024BZZ-1）
