本文選題：克羅恩病 + 英夫利昔單抗　； 參考：《中國實用內(nèi)科雜志》2017年03期

【摘要】：目的探討英夫利昔單抗(IFX)聯(lián)合硫唑嘌呤(AZA)治療合并2個以上預后不良高危因素克羅恩病(CD)患者的療效及安全性。方法回顧性分析2013年3月至2015年6月中國醫(yī)科大學附屬盛京醫(yī)院接受早期IFX聯(lián)合AZA治療的18例合并≥2個預后不良高危因素CD患者的臨床資料。比較治療前、治療后14、30周患者實驗室指標、克羅恩病活動指數(shù)(Best CDAI)評分、克羅恩病簡化內(nèi)鏡評分(SES-CD)、瘺管愈合率及不良反應的情況。結(jié)果 18例患者均完成14周的治療,其中9例完成30周的治療。與治療前相比,治療后第14周患者Best CDAI、SES-CD評分、紅細胞沉降率(ESR)及C反應蛋白(CRP)明顯下降(P0.05);紅細胞比容(HCT)、白蛋白(ALB)及體重指數(shù)(BMI)明顯升高(P0.05)。與治療后第14周相比,治療后第30周患者Best CDAI、SES-CD評分進一步顯著下降(P0.05);BMI進一步上升(P0.05)。第14、30周臨床緩解率分別為83.3%(15/18)、88.9%(8/9);內(nèi)鏡下黏膜愈合率分別為11.1%(2/18)、55.6%(5/9)。6例合并有肛瘺的CD患者中2例完成第30周的治療。治療后第14周,6例瘺管部分愈合;2例患者完成了30周的治療,瘺管均完全愈合。2例在第2周出現(xiàn)一過性肝功能異常,3例患者在第6周時出現(xiàn)WBC計數(shù)下降,經(jīng)相應治療短期內(nèi)恢復正常,均未影響繼續(xù)治療。所有患者隨訪至2016年10月11日未觀察到藥物相關感染及惡性腫瘤等不良事件發(fā)生。結(jié)論 IFX早期聯(lián)合AZA治療合并≥2個預后不良高危因素的CD患者,可有效改善臨床癥狀,控制全身炎癥狀態(tài);持續(xù)治療能夠有效誘導并維持疾病緩解,促進內(nèi)鏡下腸黏膜愈合,促進瘺管愈合;且并未明顯增加不良反應的發(fā)生。
[Abstract]:Objective to evaluate the efficacy and safety of infliximab IFX combined with azathioprine (AZA) in the treatment of patients with more than 2 risk factors for poor prognosis: Crohn's disease. Methods from March 2013 to June 2015, clinical data of 18 patients with CD complicated with more than 2 risk factors for poor prognosis in Shengjing Hospital affiliated to China Medical University who received early IFX combined with AZA therapy were retrospectively analyzed. The laboratory indexes, activity index of Crohn's disease and best CDAIscore, the simplified endoscopic score of Crohn's disease, the fistula healing rate and the adverse reactions were compared before and 14 weeks after treatment. Results all 18 patients completed 14 weeks of treatment, 9 of them completed 30 weeks of treatment. Compared with before treatment, the scores of Best CDAISES-CD, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were significantly decreased in the patients at the 14th week after treatment, and the RBC specific volume of HCT, Alb) and body mass index (BMI) were significantly increased (P 0.05). Compared with the 14th week after treatment, the scores of Best CDAISES-CD in the patients at the 30th week after treatment were significantly lower than those at the 14th week after treatment. At 1430 weeks, the clinical remission rate was 83.3 / 1888. 9%, respectively, and the rate of mucosal healing under endoscope was 11. 1 / 18 / 55.6 / 9.6 patients with anal fistula. 2 of the patients with anal fistula completed the treatment at 30 weeks. At the 14th week after treatment, 6 patients with partial fistula healing and 2 patients with partial fistula healing completed the treatment for 30 weeks. The fistula was completely healed in 2 patients with transient hepatic dysfunction at week 2. The WBC count decreased in 3 patients at the 6th week. After the corresponding treatment within a short period of time to return to normal, did not affect the continuation of treatment. No adverse events such as drug-related infection and malignant tumor were observed in all patients until Oct 11, 2016. Conclusion early IFX combined with AZA can effectively improve clinical symptoms and control systemic inflammation in CD patients with more than 2 risk factors for poor prognosis, and continuous treatment can effectively induce and maintain remission of the disease and promote endoscopic intestinal mucosal healing. Promote fistula healing, and did not significantly increase the incidence of adverse reactions.
【作者單位】： 中國醫(yī)科大學附屬盛京醫(yī)院消化內(nèi)科;
【基金】：沈陽市科技創(chuàng)新專項資金(F13-220-9-50)
【分類號】：R574.62

【相似文獻】

相關期刊論文 前10條

1 宋柳安;克羅恩病伴發(fā)肺結(jié)核1例[J];新醫(yī)學;2000年05期

2 張宗友,王新,蘭梅,郭學剛,苗繼延;克羅恩病20例臨床診治體會[J];臨床內(nèi)科雜志;2001年01期

3 趙濤,鄭澤霖;克羅恩病治療現(xiàn)狀[J];醫(yī)學新知雜志;2001年02期

4 龍峻標,李愛芳,王，

本文編號：1825503