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

Mucosal healing in different intestinal segments in patients receiving infliximab treatment for small bowel Crohn's disease

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。

Objective To evaluate the mucosal healing in the terminal ileum, colon and small bowel in patients receiving infliximab treatment for small bowel Crohn＇s disease （SBCD）. Methods The clinical data of 18 patients with SBCD treated with infliximab were analyzed for laboratory findings （routine blood tests, C-reative protein, and albumin）, Crohn’s disease activity index （CDAI）, Lewis score （LS）, Crohn＇s disease simplified endoscopic score （SES-CD） and adverse effects before and after 30 weeks of infliximab treatment. Results SES-CD, LS, CDAI and CRP were all decreased significantly, but the body mass index and albumin were significantly increased in the 18 patients after 30 weeks of IFX treatment. Sixteen （88.9%） of the patients were in clinical remission, 10 （58.8%） showed terminal ileum and colonic mucosal healing, 4 （22.2%） showed small bowel mucosal healing, and 3 （17.6%） were in deep remission. The 4 patients with small bowel mucosal healing all showed terminal ileum and colon mucosal healing, and 6 patients with terminal ileum and colon mucosal healing did not show small bowel mucosal healing. Conclusion Infliximab treatment can effectively reduce inflammatory activity, induce and maintain clinical remission of SBCD and achieve mucosal healing; small bowel mucosal healing occurs later than terminal ileum and colonic mucosal healing, indicating the importance of small bowel mucosal healing in efficacy analysis of the treatment.