摘要
目的 分析短期联合方案对末端回肠型CD(L1型)和结肠型CD(L2型)患者诱导临床缓解与黏膜愈合的疗效差异.方法 研究收集2014年1月至2016年6月于上海交通大学医学院附属瑞金医院确诊为L1型及L2型CD患者,予以英夫利昔单抗(5 mg/kg)联合硫唑嘌呤(1 mg/kg)治疗30周,并于第38周行疾病再评估检查与内镜复查.以CDAI评分<150分作为临床缓解判断指标,采用简化CD内镜下评分(SES-CD,simple endoscopic score for CD)评价内镜下严重程度,黏膜愈合以内镜下溃疡消失为标准.分析后对比两组患者临床缓解率与黏膜愈合率的差异.结果 本研究入组43例患者,其中L1型19例,L2型24例,男∶女=31∶12,发病年龄为15~53岁.治疗前CDAI均≥150分,且两组间CDAI评分无统计学差异(P>0.05).经30周联合方案治疗后总体临床缓解率为86%(37/43)、黏膜愈合率为48.8%(21/43).两组患者经治疗后临床缓解率分别为89.5%(17/19)和83.3%(20/24)(P>0.05).L1型CD患者黏膜愈合率显著高于L2型患者(68.4% vs.33.3%,P=0.031).结论 短期联合治疗方案诱导CD患者临床缓解率较高,并能使约半数患者达到黏膜愈合.而不同亚型CD患者黏膜愈合率存在一定的差异性,结肠型CD患者黏膜愈合率低于末端回肠型CD患者.提示CD累及结肠往往需要更为长期的联合方案治疗.
Objective Bioagents in combination with immunosuppressors have synergistic effect in the treatment of Crohn's disease,including clinical remission and mucosal healing.Short-term combination therapy(30 weeks)in the treatment of different CD sublypes was rarely reported.This study aimed to analyze the effect on clinical remission and mucosal healing in ileal CD(LI)and colonic CD(L2).Methods LI and L2 CD patients diagnosed in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine between Jan 2014 and Jun 2016 were enrolled.They were given Infliximab(5 mg/kg)in combination with azathioprine(1 mg/kg)for 30 weeks.Evaluation and endoscopy were performed in week 38.Clinical remission was judged by CDAI<150 and endoscopic severity was performed by SES-CD(simple endoscopic score for CD).Mucosal healing was judged by disappearance of ulcers under endoscopy.The difference between the two groups was compared.Results Fourty-three patients were enrolled in the study with 19 LI and 24 L2 cases,the male female ratio was 31:12 and the onset age is range 15-53 years.The CDAI score were both M 150 in the two groups before diagnosis and no statistical difference was found in CDAI in the two groups.The clinical remission and mucosal healing rate after 30 weeks was 86%(37/43)and 48.8%(21/43)(P>0.05).Clinical remission rates were 89.5%(17/19)and 83.3%(20/24)in LI and L2 sublypes respectively.The mucosal healing rate was significantly higher in LI than in L2 CD patients(68.4%vs.33.3%,P=0.031).Conclusion Short-tenn combination therapy induced high remission rate in CD patients and half of the patients achieved mucosal healing.There is difference in mucosal healing rate between subtypes CD patients,which is low in L2 CD compared with L1 CD,indicating longer combinational treatment for CD patients with involvement of colon.
作者
顾于蓓
孙菁
范嵘
陈憩
蒋咏梅
钟捷
Gu Yubei;Sun Jing;Fan Rong;Chen Xi;Jiang Yongmei;Zhong Jie(Department of Gastroenterology,Ruijin Hospital,Affiliate to Shanghai Jiaotong University,School of Medicine,Shanghai 200025,China)
出处
《中华炎性肠病杂志（中英文）》
2017年第1期29-33,共5页
Chinese Journal of Inflammatory Bowel Diseases
基金
上海市科学技术委员会生物医学重点课题(子课题)16411950408.
