【摘要】：目的探討小腸受累的克羅恩病(CD)患者使用英夫利西單抗(IFX)治療第30周回末及結(jié)腸和小腸黏膜愈合情況。方法回顧性分析了18例接受IFX治療的小腸受累CD患者的臨床資料。觀察治療前和治療后第30周時患者實驗室指標(血常規(guī)、CRP、白蛋白)、克羅恩病活動度指數(shù)、膠囊內(nèi)鏡Lewis評分、克羅恩病簡化內(nèi)鏡評分及不良反應的情況。結(jié)果與治療前相比,治療后第30周18例小腸CD患者的內(nèi)鏡下克羅恩病簡化內(nèi)鏡評分、Lewis評分、克羅恩病活動度指數(shù)評分、C反應蛋白均顯著下降,體質(zhì)量指數(shù)和白蛋白明顯升高。臨床緩解率為88.9%(16/18),回末及結(jié)腸黏膜愈合率58.8%(10/17,1例患者治療后未復查結(jié)腸鏡),小腸黏膜愈合率22.2%(4/18),深度緩解率17.6%(3/17)。在IFX治療第30周,4例小腸黏膜愈合者回末及結(jié)腸黏膜均達到愈合,而回末及大腸黏膜愈合而小腸黏膜未愈合者6例。結(jié)論 IFX可有效誘導和維持小腸CD患者的臨床緩解及黏膜愈合,減輕炎性活動。小腸黏膜愈合滯后于回末及結(jié)腸的黏膜愈合。小腸CD治療療效評價除關(guān)注回末及結(jié)腸的黏膜愈合外,還應結(jié)合小腸黏膜愈合情況。
[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.
【作者單位】： 南方醫(yī)科大學南方醫(yī)院消化內(nèi)科;
【基金】：國家自然科學基金(H1609)~~
【分類號】：R574.5

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本文編號：2357540