溃疡性结肠炎是最常见的结肠炎类型，其发病率和患病率较高，在英国，每年发病率约为10/100 000，患病率约为24/100000。国际的胃肠组织，如WGO（World Gastroenterology Organisation），AGC（American College of Gastroenterology），ECCO（European Cron's and Colitis Organisation）、BSG （British Society of Gastroenterology）及NICE均发布过IBD和溃疡性结肠炎的指南或共识，并根据最新的循证医学证据不断更新。BSG 于2011年发布了IBD管理指南，次年即2012年ECCO也更新了溃疡性结肠炎（UC）共识，今年2013年NICE就紧跟着在其官方网站上在线发表了成人、儿童和青年人UC管理指南，足见其欧洲国家对UC治疗的重视。隶属于英国国家卫生服务系统（NHS）的NICE（National institute for Health and Care Excellence）作为一个制定临床指南的“标杆”角色，已经获得了很高的国际声誉。它制定的指南与其他组织相比，更重视对卫生技术（例如新的和现有的药物、治疗方法以及流程的使用）的成本效益的评估，这与英国实行医保制度有关，因为严格限制了患者每年医保的花费，所以NICE指南推荐的药物都是基于经济性与疗效的最适选择。

 
 
一、年龄 (age)
This guideline covers people of all ages with a diagnosis of ulcerative colitis. These terms are defined as follows:
-    adults: 18 years or older     
-    children: 11 years or younger 
-    young people: 12 to 17 years 
 
该指南适用于各年龄段的UC患者。年龄划分如下：
-    成人：满18岁或以上
-    儿童：11岁或更小
-    青少年：12岁到17岁
 

二、疾病程度Severity of ulcerative colitis
Mild, moderate and severe
-    In adults these categories are based on the Truelove and Witts' severity index.
-    In children and young people these categories are based on the Paediatric Ulcerative Coli-tis Activity Index (PUCAI).
Subacute
The following definition (based on that in NICE technology appraisal guidance 140) is used: subacute ulcerative colitis is defined as moderately to severely active ulcerative colitis that would normally be managed in an outpatient setting and does not require hospitalisation or the consideration of urgent surgical intervention
轻、中、重度UC

-    成人中这些分类根据Truelove 和 Witts'程度指数
-    儿童和青少年中，这些分类基于儿科UC活动指数（PUCAI）。详情见指南
亚急性UC
亚急性UC定义为一般在门诊处理而不需要住院或进行紧急外科手术的中到重度急性期UC。
详见指南。

三、诱导缓解
1.For mild to moderate ulcerative colitis
1.轻中度溃疡性结肠炎
 
step 1 therapy 初始治疗
Proctitis and proctosigmoiditis
1.1 To induce remission in people with a mild to moderate first presentation or inflammatory exacerbation of proctitis or proctosigmoiditis:
-    consider adding an oral aminosalicylate to a topical aminosalicylate

直肠炎或直肠乙状结肠炎
1.1 直肠炎或直肠乙状结肠炎的轻中度首次发作和炎症加重的诱导缓解：
-    考虑口服联用局部氨基水杨酸类制剂。

1.2    To induce remission in people with a mild to moderate first presentation or inflammatory exacerbation of proctitis or proctosigmoiditis who cannot tolerate or who decline aminosalicylates, or in whom aminosalicylates  are contraindicated:
-    offer a topical corticosteroid or
-    consider oral prednisolone,  taking into account the person's preferences.

1.2不耐受或拒绝应用氨基水杨酸制剂的、有氨基水杨酸禁忌的轻中度首次发作或炎症加重的直肠炎和直肠乙状结肠炎患者，对其进行诱导缓解：
考虑患者个人意愿
-    给予局部应用糖皮质激素
-    或考虑口服泼尼松龙

1.3    To induce remission in people with  subacute proctitis or proctosigmoiditis, consider oral predni-solone,  taking into account the person's preferences.

1.3 诱导缓解亚急性直肠炎和直肠乙状结肠炎患者，考虑口服泼尼松龙，考虑患者个人意愿。

Left-sided and extensive ulcerative colitis
1.4    To induce remission in adults with a mild to moderate first presentation or inflammatory exacerbation of left-sided or extensive ulcerative colitis:
-    offer a high induction dose of an oral aminosalicylate
-    consider adding a topical aminosalicylate or oral beclometasone dipropionate taking into ac-count the person's preferences.

左半结肠型和全结肠型溃疡性结肠炎
1.4    左半结肠型或全结肠型溃疡性结肠炎轻中度首次发作或炎症加重的诱导缓解：
考虑患者个人意愿
-   给予高诱导剂量的口服氨基水杨酸制剂。
-   考虑添加局部氨基水杨酸制剂或口服丙酸地塞米松

1.5    To induce remission in children and young people with a mild to moderate first presentation or inflammatory exacerbation of left-sided or extensive ulcerative colitis:
offer an oral aminosalicylate
-    consider adding a topical aminosalicylate[9] or oral beclometasone dipropionate[14], taking into account the person's preferences (and those of their parents or carers as appropriate).

1.5 儿童和青少年左半结肠型或全结肠型溃疡性结肠炎轻中度首次发作或炎症加重的诱导缓解：
给予口服氨基水杨酸制剂。考虑患者个人意愿（酌情考虑其双亲或监护人的意见）


1.6    To induce remission in people with a mild to moderate first presentation or inflammatory exacer-bation of left-sided or extensive ulcerative colitis who cannot tolerate or who decline aminosalicylates, in whom aminosalicylates are contraindicated or who have  subacute ulcerative colitis, offer oral prednisolone.

1.6    不耐受或拒绝应用氨基水杨酸类制剂的、有氨基水杨酸禁忌的、或有亚急性溃疡性结肠炎的轻中度首次发作或炎症加重的左半结肠型或全结肠型溃疡性结肠炎患者，对其进行诱导缓解，给予口服泼尼松龙。

Step2 Therapy: All extents of disease 进一步治疗

1.7  Consider adding oral prednisolone[11] to aminosalicylate therapy to induce remission in people with mild to moderate ulcerative colitis if there is noimprovement within 4 weeks of starting step 1 aminosalicylate therapy or if symptoms worsen despite treatment. Stop beclometasone dipropionate if adding oral prednisolone.

1.7如果初始氨基水杨酸治疗4周内无改善或者症状加重的轻中度UC患者，考虑氨基水杨酸联合口服泼尼松龙诱导缓解，联合口服泼尼松龙时停用丙酸地塞米松。

1.8 Consider adding oral tacrolimusto oral prednisolone to induce remission in people with mild to moderate ulcerative colitis if there is an inadequate response to oral prednisolone after 2–4 weeks

1.8，如果口服泼尼松龙2-4周应答不明显的轻中度UC患者，考虑口服泼尼松龙联合口服他克莫司诱导缓解。

1.9 For guidance on infliximab for treating subacute ulcerative colitis (all extents of disease), refer to Infliximab for subacute manifestations of ulcerative colitis (NICE technology appraisal guidance 140).Ulcerative colitis NICE clinical guideline 166?

1.9 英夫利昔治疗亚急性UC（包括各种类型）患者，参考NICE technology appraisal guidance 166

2．Treating acute severe ulcerative colitis: all extents of disease
2．治疗急性重度UC
The multidisciplinary team多学科综合治疗
For people admitted to hospital with acute severe ulcerative colitis:
-    ensure that a gastroenterologist and a colorectal surgeon collaborate to provide treatment and management
-    ensure that the composition of the multidisciplinary team is appropriate for the age of the person
-    seek advice from a paediatrician with expertise in gastroenterology when treating a child or young person
-    ensure that the obstetric and gynaecology team is included when treating a pregnant woman.

2.1急性重度UC的住院患者：
-    确保一位胃肠病学家和一位结直肠外科医生协作进行治疗和管理
-    根据患者年龄、确保多学科小组的组成
-    治疗儿童青少年时从具有胃肠病学专业知识的儿科专家那里咨询建议
-    治疗孕妇患者时要有包括妇科和产科小组在内参与。

 Step 1 therapy初始治疗
2.2 For people admitted to hospital with acute severe ulcerative colitis (either a first presentation or an inflammatory exacerbation):
-    offer intravenous corticosteroids to induce remission and
-    assess the likelihood that the person will need surgery (see  recommendation 1.2.16).
2.3    Consider intravenous ciclosporin or surgery for people:
-    who cannot tolerate or who decline intravenous corticosteroids or
-    for whom treatment with intravenous corticosteroids is contraindicated.
-    Take into account the person's preferences when choosing treatment.

2.2对急性重度UC的住院患者（无论首次发作还是炎症加重）：静脉注射糖皮质激素诱导缓解并评估外科手术的可能性。
2.3对不耐受或拒绝静脉注射糖皮质激素、有静脉注射糖皮质激素禁忌的患者：静脉注射环孢素或者外科手术，选择治疗方案时考虑患者个人意愿


 Step 2 therapy 进一步治疗
2.4    Consider adding intravenous ciclosporin[16] to intravenous corticosteroids or consider surgery for people:
-    who have little or no improvement within 72 hours of starting intravenous corticosteroids or
-    whose symptoms worsen at any time despite corticosteroid treatment.
-    Take into account the person's preferences when choosing treatment.
2.5    For guidance on infliximab for treating acute severe ulcerative colitis (all extents of disease) in people for whom ciclosporin is contraindicated or clinically inappropriate, refer to  Infliximab for acute exacerbations of ulcerative colitis (NICE technology appraisal guidance 163).

2.4对静脉注射糖皮质激素72小时效果不明显或无改善，或任何时候尽管使用了糖皮质激素治疗但症状加重的患者：考虑静脉注射糖皮质激素联用静脉注射环孢素或者考虑外科手术。选择治疗方案需考虑患者个人意愿。
2.5 英夫利昔治疗环孢素禁忌或临床不适用的急性重度UC（各种类型全包括）患者，指南意见参考NICE technology appraisal guidance 163。

 Assessing likelihood of needing surgery评估外科手术的可能性
2.7    Be aware that there may be an increased likelihood of needing surgery for people with any of the following:
-    stool frequency more than 8 per day
-    pyrexia
-    tachycardia
-    an abdominal X-ray showing colonic dilatation
-    low albumin, low haemoglobin, high platelet count or C-reactive protein (CRP) above 45 mg/litre (bear in mind that normal values may be different in pregnant women).

以下任何现象提示可能增加手术必要性
?    大便频率每天多于8次
?    发热
?    心跳过速
?    腹部X光检测到结肠扩张
?    低白蛋白、低血红蛋白、血小板计数升高、或C反应蛋白高于45 毫克/升都是外科手术可能性增加的参考因素（记住孕妇的正常值与一般情况不同）。


四、Maintaining remission维持缓解
a. proctitis and proctosigmoiditis
3.1 To maintain remission after a mild to moderate inflammatory exacerbation of proctitis or proctosigmoiditis, consider the following options, taking into account the person's preferences:
?    a topical aminosalicylate alone （daily or intermittent） or
?    an oral aminosalicylate[10] plus a topical aminosalicylate（daily or intermittent） or
an oral aminosalicylate alone, explaining that this may not be as effective as combined treatment or an intermittent topical aminosalicylate alone.

a. 直肠炎和直肠乙状结肠炎
3.1 轻中度直肠炎和直肠乙状结肠炎炎症加重后的维持缓解，考虑选择：单独局部氨基水杨酸制或口服的氨基水杨酸制剂联合局部应用的氨基水杨酸制剂或单独口服的氨基水杨酸制剂。需考虑患者个人意愿。

b. Left-sided and extensive ulcerative colitis
3.2 To maintain remission in adults after a mild to moderate inflammatory exacerbation of left-sided or extensive ulcerative colitis:
?    offer a low maintenance dose of an oral aminosalicylate
?    when deciding which oral aminosalicylate to use, take into account the person's preferences, side effects and cost.

b. 左半结肠型和全结肠型溃疡性结肠炎
3.2 轻中度成人/儿童和青少年左半结肠型或全结肠型溃疡性结肠炎炎症加重的维持缓解
?    给予低的维持剂量的口服氨基水杨酸制剂。
?    当决定用哪个口服氨基水杨酸制剂时，考虑患者的个人喜好、副作用和花费。


c. All extents of disease
3.4 Consider oral azathioprine or oral mercaptopurine to maintain remission:
?    after two or more inflammatory exacerbations in 12 months that require treatment with systemic corticosteroids or
?    if remission is not maintained by aminosalicylates.
To maintain remission after a single episode of acute severe ulcerative colitis:
?    consider oral azathioprine or oral mercaptopurine
?    consider oral aminosalicylates in people who cannot tolerate or who decline azathioprine and/or mercaptopurine, or in whom azathioprine and/or mercaptopurine are contraindicated.


3.4在如下情况下，口服硫唑嘌呤或巯嘌呤以维持缓解
?    需要静脉应用糖皮质激素治疗，在12个月内出现两次或两次以上的炎症加重或者氨基水杨酸制剂不能维持缓解


3.5急性重度UC单次发作后的维持缓解 
?    考虑口服硫唑嘌呤或巯嘌呤
?    患者不耐受或拒绝应用硫唑嘌呤和/或巯嘌呤，或禁忌硫唑嘌呤和/或巯嘌呤的，考虑口服氨基水杨酸制剂

d. Dosing regimen for oral aminosalicylates
3.6 Consider a once-daily dosing regimen for oral aminosalicylates when used for maintaining remission. Take into account the person's preferences, and explain that once-daily dosing can be more effective, but may result in more side effects.

d．口服氨基水杨酸的给药方案
3.6维持缓解可考虑每日一次口服氨基水杨酸制剂，但需解释可能发生更多不良反应。考虑患者个人意愿。

f Monitoring for Children and young people with ulcerative colitis in the following circumstances:
-    during chronic active disease
-    after treatment with systemic corticosteroids
-    after recurrent active disease.
   
f. 在以下时期对儿童和青少年监测（骨健康、生长和青春期发育）
-    慢性复发型、活跃动期中
-    静脉注射糖皮质激素治疗后
-    复发的活动期后