英夫利西单抗联合肠内营养在中重度溃疡性结肠炎治疗中的临床价值

Infliximab combined with enteral nutrition for the clinical value of moderate to severe ulcerative colitis

目的:观察英夫利西单抗联合肠内营养(EN)为主的治疗方法对中重度溃疡性结肠炎(UC)患者的临床疗效。方法:收集20例传统治疗无效的中重度UC患者,予英夫利西单抗5 mg/kg的剂量静脉微泵输注一个疗程(共6次)联合EN治疗3个月,并口服硫唑嘌呤进行维持治疗。结果:经治疗后UC患者的BMI、Hb、ALB均较治疗前明显升高(P<0.05);UC改良的Mayo评分、CRP、ESR、WBC均较治疗前明显降低(P<0.05);16例UC患者治疗有效,其中15例患者达到临床缓解,12患者达到黏膜愈合。随访6~24个月,其中1例患者发生恶性淋巴瘤,1例患者自行停服硫唑嘌呤后病情复发,其余患者病情控制良好未复发。结论:英夫利西单抗联合EN为主诱导UC患者临床缓解、并予硫唑嘌呤维持UC患者临床缓解的方法对于中重度UC患者具有良好的临床疗效,可以改善患者的预后。

Objective： To observe the clinical value of infliximab combined with enteral nutrition （EN） in the treatment of moderate to severe ulcerative colitis （UC）. Methods： A total of 20 patients with moderate to severe UC who showed no response to traditional therapies were selected in this study. These UC patients were treated with intravenous micropump of infliximab at a dose of 5 mg/kg for 6 times, combined EN treatment for 3 months and oral azathioprine for maintenance treatment. Results： After treatment, the body mass index （BMI）, hemoglobin （Hb） and serum albumin （ALB） in UC patients were all significantly increased than those before treatment （all P〈0.05）, while the modified Mayo score, C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR） and white blood cell count （WBC） in UC patients were all lower than those before treatment （all P〈0.05）. A total of 16 UC patients showed effective response to the treatment, of whom 15 UC patients achieved clinical remission and 12 UC patients achieved mucosal healing. Followed up for 6 to 24 months, 1 UC patient developed malignant lymphoma, 1 UC patient had a relapse after withdrawal of azathioprine, and the remaining patients had good disease control without recurrence. Conclusion： Infliximab combined with EN-induced clinical remission and maintenance therapy with azathioprine could have good clinical efficacy in the treatment of moderate to severe UC, and it also could improve the prognosis of UC patients.