英夫利西单克隆抗体治疗时机对克罗恩病透壁愈合的影响

Effect of timing of infliximab treatment on transmural healing of Crohn′s disease

目的探讨英夫利西单克隆抗体(IFX)治疗时机对克罗恩病(CD)透壁愈合的影响。方法采用回顾性队列研究方法,连续纳入2019年1至12月在中山大学附属第六医院接受IFX治疗的活动性成人CD患者。所有患者在基线及IFX治疗后第14周行肠道超声检查。根据确诊至IFX治疗的时间,分为早期治疗组(≤12个月)和晚期治疗组(>12个月),比较两组在第14周的透壁愈合率和黏膜愈合率。透壁愈合定义为所有肠段的肠壁厚度(BWT)≤3 mm,且层次清晰、血流正常和无肠系膜脂肪增生。黏膜愈合定义为简化的CD内镜评分≤2分且无肠道溃疡。结果共纳入54例患者,早期治疗组28例,晚期治疗组26例。两组患者的基线BWT[6.0(5.3,7.0)mm比7.0(5.0,8.0)mm,Z=-0.668,P=0.504]和简化CD内镜评分[(12.86±9.26)分比(12.89±7.46)分,t=-0.012,P=0.991]间的差异均无统计学意义。第14周时,早期治疗组的BWT下降程度[3.0(1.3,3.0)mm比1.0(0,2.0)mm,Z=-2.922,P=0.003]、透壁愈合率[39.3%(11/28)比11.5%(3/26),χ^(2)=5.405,P=0.020]和黏膜愈合率[52.2%(12/23)比20.8%(5/24),χ^(2)=4.997,P=0.025]均高于晚期治疗组,差异均有统计学意义。结论与CD确诊后晚期启动IFX治疗相比,早期治疗的患者更易获得透壁愈合。

Objective To explore the effect of timing of infliximab(IFX)treatment on transmural healing(TH)in Crohn′s disease(CD).Methods A retrospective cohort study was conducted.Consecutive adult patients with active CD prescribed IFX in the Sixth Affiliated Hospital of Sun Yat-sen University from Janurary to September 2019 were recruited.Patients underwent intestinal ultrasound evaluation at baseline and 14 weeks after IFX initiation.According to the time from diagnosis to IFX initiation,patients were divided into early therapy group(≤12 months)and late therapy group(>12 months).The differences of transmural healing(TH)and mucosal healing(MH)at 14th week between 2 groups were analyzed.TH was defined as bowel wall thickness(BWT)≤3 mm in any segments,with normal stratification and bowel wall vascularity,and without mesenteric fat proliferation.MH was defined as the simplified endoscopic score for CD≤2 points and without ulceration.Results Fifty-four patients were enrolled,including 28 in early therapy group and 26 in late therapy group,and there were no significant differences in baseline BWT[6.0(5.3,7.0)mm vs.7.0(5.0,8.0)mm,Z=-0.668,P=0.504]and simplified endoscopic score for CD[(12.86±9.26)points vs.(12.89±7.46)points,t=-0.012,P=0.991]between the two group.At 14th week,the decrease of BWT[3.0(1.3,3.0)mm vs.1.0(0,2.0)mm,Z=-2.922,P=0.003],the rate of TH[39.3%(11/28)vs.11.5%(3/26),χ^(2)=5.405,P=0.020]and MH[52.2%(12/23)vs.20.8%(5/24),χ^(2)=4.997,P=0.025]in early therapy group were significantly higher than those in late therapy group,respectively.Conclusion Compared with late initiation of IFX treatment after diagnosis,patients with CD who initiate IFX treatment earlier are more likely to achieve TH.