初发型中重度克罗恩病患者英夫利息单克隆抗体治疗后非深度缓解的危险因素分析

Analysis of Risk Factors for Non-Deep Remission After IFX Treatment in Patients with Early-Onset Moderate-Severe Crohn’s Disease

目的:分析初发型中重度克罗恩病患者英夫利息单克隆抗体(IFX)治疗后非深度缓解的危险因素。方法:对116例初发型中重度克罗恩病患者临床资料进行回顾性分析,所有患者均经IFX治疗,依据患者治疗后是否出现深度缓解分为深度缓解组(n=53)和非深度缓解组(n=63)。比较2组患者一般情况和临床资料,Logistic多因素分析非深度缓解的影响因素,并分析维生素D补充剂对炎症指标的影响。结果:非深度缓解组患者的饮酒史占比、症状出现至IFX治疗时间、合并肠外表现(关节痛)占比、合并活动性肛周病变占比高于深度缓解组,差异有统计学意义(P<0.05);非深度缓解组患者的25羟维生素D[T-25(OH)D]、白蛋白(ALB)、维生素D补充剂占比均低于深度缓解组,超敏C反应蛋白(hs-CRP)高于深度缓解组,差异有统计学意义(P<0.05);肠外表现(关节痛)(OR=2.034)、T-25(OH)D≤15μg·L^(-1)(OR=1.812)、无维生素D补充剂(OR=1.412)以及症状出现至IFX治疗时间长(OR=1.652),为初发型中重度克罗恩病患者IFX治疗后非深度缓解的危险因素;有维生素D补充剂的患者血清白介素-6(IL-6)、红细胞沉降率(ESR)、hs-CRP水平均低于无维生素D补充剂的患者,血清白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平均高于无维生素D补充剂的患者(P<0.05)。结论:肠外表现(关节痛)、T-25(OH)D≤15μg·L^(-1)、无维生素D补充剂为初发型中重度克罗恩病患者IFX治疗后非深度缓解的危险因素,给予患者维生素D补充剂可缓解炎症反应,对克罗恩病深度缓解有一定促进作用。

Objective:To analyze the risk factors for non-deep remission in patients with early-onset moderate-severe Crohn’s disease after IFX treatment.Methods:The clinical data of 116 patients with early-onset moderate-severe Crohn’s disease were retro-spectively analyzed.All patients were treated with IFX.They were divided into the deep remission group(n=53)and the non-deep remission group(n=63)according to whether they had deep remission after treatment.The general and clinical data of the two groups were compared.Logistic multivariate analysis was conducted to analyze the risk factors of non-deep remission in patients with early-onset moderate-severe Crohn’s disease after IFX treatment and to analyze the effect of vitamin D supplementation on inflammatory in-dicators.Results:The percentage of patients in the non-deep remission group with a drinking history,the time from symptom appear-ance to IFX treatment,the percentage of patients with extra-intestinal manifestations,and the percentage of patients with active peri-anal lesions were significantly higher than those in the deep remission group(P<0.05).The T-25(OH)D,ALB levels,and the per-centage of vitamin D supplementation in patients in the non-deep remission group was lower than that in the deep remission group,The hs-CRP levels was higher than that in the deep lemission group,and the difference was statistically significant(P<0.05);Extra-intestinal manifestations(joint pain),T-25(OH)D≤15μg·L^(-1),absence of vitamin D supplementation,and duration of symptoms until IFX treatment are all risk factors for non-deep remission in patients with early-onset moderate-severe Crohn’s disease after IFX treatment.Serum IL-6,ESR,and hs-CRP levels in patients with vitamin D supplements were lower than those in patients without vi-tamin D supplements,and serum IL-8 and TNF levels in patients with vitamin D supplements were higher than those of patients with-out vitamin D supplements(P<0.05).Conclusion:Extra-intestinal manifestations(joint pain),T-25(OH)D≤15μg·L^(-1),no vita-min D supplements,and symptoms until IFX treatment are risk factors for non-deep remission of patients with early-onset moderate-severe Crohn’s disease after IFX treatment.The administration of vitamin D supplements to patients can alleviate inflammatory reac-tions and promote the deep remission of Crohn’s disease.