英夫利西单抗治疗的小肠克罗恩病患者不同肠段黏膜愈合情况分析

发布时间：2018-11-25 22:22

【摘要】：目的探讨小肠受累的克罗恩病(CD)患者使用英夫利西单抗(IFX)治疗第30周回末及结肠和小肠黏膜愈合情况。方法回顾性分析了18例接受IFX治疗的小肠受累CD患者的临床资料。观察治疗前和治疗后第30周时患者实验室指标(血常规、CRP、白蛋白)、克罗恩病活动度指数、胶囊内镜Lewis评分、克罗恩病简化内镜评分及不良反应的情况。结果与治疗前相比,治疗后第30周18例小肠CD患者的内镜下克罗恩病简化内镜评分、Lewis评分、克罗恩病活动度指数评分、C反应蛋白均显著下降,体质量指数和白蛋白明显升高。临床缓解率为88.9%(16/18),回末及结肠黏膜愈合率58.8%(10/17,1例患者治疗后未复查结肠镜),小肠黏膜愈合率22.2%(4/18),深度缓解率17.6%(3/17)。在IFX治疗第30周,4例小肠黏膜愈合者回末及结肠黏膜均达到愈合,而回末及大肠黏膜愈合而小肠黏膜未愈合者6例。结论 IFX可有效诱导和维持小肠CD患者的临床缓解及黏膜愈合,减轻炎性活动。小肠黏膜愈合滞后于回末及结肠的黏膜愈合。小肠CD治疗疗效评价除关注回末及结肠的黏膜愈合外,还应结合小肠黏膜愈合情况。
[Abstract]:Objective to investigate the healing of colon and small intestine mucosa in patients with small bowel involvement with Crohn's disease (CD) treated with infliximab (IFX) at the end of the 30th week. Methods the clinical data of 18 patients with small bowel involvement CD treated with IFX were analyzed retrospectively. Laboratory parameters (blood routine, CRP, albumin), activity index of Crohn's disease, Lewis score of capsule endoscope, simplified endoscopic score of Crohn's disease and adverse reactions were observed before and 30 weeks after treatment. Results at 30 weeks after treatment, the simplified endoscopic score, Lewis score, activity index score of Crohn's disease and C-reactive protein were significantly decreased in 18 patients with small intestinal CD. Body mass index and albumin increased significantly. The clinical remission rate was 88.9% (16 / 18), the healing rate of ileal and colonic mucosa was 58.8% (10 / 17) and the rate of intestinal mucosa healing was 22.2% (4 / 18). The depth remission rate was 17.6% (3 / 17). At the 30th week of IFX treatment, the ileum and colon mucosa healed in 4 cases of intestinal mucosa healing, while the ileum and large intestine mucosa healed but the small intestinal mucosa did not heal in 6 cases. Conclusion IFX can effectively induce and maintain the clinical remission and mucosal healing in patients with small intestinal CD. Intestinal mucosal healing lags behind that of ileum and colon. Small intestinal CD therapy should be combined with intestinal mucosal healing in addition to focusing on mucosal healing of ileum and colon.
【作者单位】：南方医科大学南方医院消化内科;
【基金】：国家自然科学基金(H1609)~~
【分类号】：R574.5

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