英夫利昔单用和联合硫唑嘌呤治疗克罗恩病的疗效分析

Infliximab or infliximab combined azathioprine therapy for Crohn′s disease

目的比较英夫利昔(Infliximab,IFX)单药治疗和英夫利昔联合硫唑嘌呤(Azathioprine,AZA)治疗中重度克罗恩病(Crohn′s disease,CD)患者的疗效。方法选取2010年6月至2014年5月在南方医科大学南方医院消化科进行治疗的47例中重度CD患者为研究对象,按照治疗方式的不同,将患者分为IFX组29例和IFX+AZA组18例。观察两组患者治疗前、治疗后第14周和第30周的实验室指标(WBC、ESR、CRP、ALB)、克罗恩病活动度指数(CDAI)、临床缓解率、克罗恩病简化内镜评分(SESCD)、黏膜愈合率以及不良反应的情况。结果第14周时,IFX组和IFX+AZA组的临床缓解率分别为:58.6%(17/29)vs 72.2%(13/18),(P>0.05);黏膜愈合率分别为:51.7%(15/29)vs 55.6%(10/18),(P>0.05)。两组患者的WBC水平均较治疗前显著下降,BMI和ALB水平显著升高。第30周时,IFX组和IFX+AZA组的临床缓解率分别为:75.9%(22/29)vs 88.9%(15/18),(P>0.05);部分患者在第30周复查内镜,两组的黏膜愈合率分别为:47.1%(8/17)vs 83.3%(5/6),(P>0.05)。两组患者的WBC水平均较治疗前显著下降,BMI和ALB水平升高。结论 IFX和IFX+AZA两种方法均可有效诱导和维持中度CD患者临床缓解和黏膜愈合,但后者疗效有更优趋势。

Aim To compare the efficacy of infliximab alone or infliximab combined azathioprine thera-py for patients with moderate to severe Crohn′s disease（CD）. Methods Forty seven CD patients from Febru-ary 2012 to April 2014 were reviewed . According to different therapy, 29 CD patients were assigned into IFX group,18 CD patients were assigned into IFX＋AZA group. Laboratory index（WBC, ESR, CRP, ALB）,Crohn′s disease activity index（CDAI）, rate of clinical remission, SES-CD, rate of mucosal healing and side effects at the beginning of therapy, week 14 and week 30 were recorded and analyzed. Results At week 14, rates of clin-ical remission of IFX group and IFX＋AZA group were 58.6%（17/29） vs 72.2%（13/18）（P〉0.05）;rates of mu-cosal healing of IFX group and IFX＋AZA group were 51.7%（15/29） vs 55.6%（10/18） （P〉0.05）. For both group, WBC level was significantly decreased;BMI and ALB levels were significantly increased. At week 30, rates of clinical remission of IFX group and IFX＋AZA group were 75.9%（22/29） vs 88.9%（15/18）（P〉0.05）;rates of mucosal healing of IFX group and IFX＋AZA group were 47.1%（8/17） vs 83.3%（5/6）（P〉0.05）. For both group, WBC levels were significantly decreased;BMI and ALB levels were increased. Conclusions Both IFX monotherapy and IFX＋AZA two drugs combined therapy could effectively induce and maintain clinical remission and mucosal healing in patients with moderate CD, and the efficacy of IFX＋AZA group would be better.