沙利度胺联合英夫利西治疗难治性炎症性肠病效果及对胰岛素样生长因子-1、转化生长因子-β1的影响

Effect of thalidomide combined with infliximab in treatment of refractory inflammatory bowel disease and its effects on insulin-like growth factor-1 and transforming growth factor-β1

目的探讨沙利度胺联合英夫利西(IFX)治疗难治性炎症性肠病(IBD)的效果及对胰岛素样生长因子-1(IGF-1)、转化生长因子-β1(TGF-β1)含量的影响。方法选取120例难治性IBD患者,随机分为实验组和对照组,每组60例。2组均给予常规治疗(美沙拉嗪),对照组给予IFX,实验组给予IFX联合沙利度胺,连续治疗2个月。比较2组疗效、肠道菌群紊乱率、不良反应及治疗前和治疗1、2个月后克罗恩病活动指数(CDAI)、胶囊内镜评分指数(Lewis评分)、血清IGF-1、TGF-β1水平及营养状态指标[白蛋白(ALB)、转铁蛋白(Tf)]。结果实验组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗1、2个月后,实验组CDAI、Lewis评分低于对照组,差异有统计学意义(P<0.05);实验组血清IGF-1、TGF-β1和ALB、Tf水平高于对照组,差异有统计学意义(P<0.05)。实验组肠道菌群紊乱率改善情况优于对照组,差异有统计学意义(P<0.05);2组口鼻黏膜干燥、咽喉部不适、恶心呕吐等不良反应发生率比较,差异无统计学意义(P>0.05)。结论沙利度胺联合IFX治疗难治性IBD患者,可调节其血清IGF-1、TGF-β1水平,有效缓解临床表现,抑制炎症活动,改善患者营养状态与肠道菌群紊乱,且安全性高。

Objective To investigate the effect of thalidomide combined with infliximab(IFX)in treatment of refractory inflammatory bowel disease(IBD)and its effects on insulin-like growth factor-1(IGF-1)and transforming growth factor-β1(TGF-β1).Methods A total of 120 patients with refractory IBD were randomly divided into experimental group and control group,with 60 cases in each group.The two groups were given conventional treatment(mesalazine),the control group was given IFX,and the experimental group was given IFX combined with thalidomide,continuous treatment for two months.The efficacy,intestinal flora disturbance rate,adverse reactions,Crohn's disease activity index(CDAI),Lewis score,serum IGF-1,TGF-β1 levels and nutritional status indexes[albumin(ALB),transferrin(Tf)]before and after treatment for 1 month and 2 months of the two groups were compared.Results The total effective rate of the experimental group was significantly higher than that of the control group(P<0.05).After one month and two months of treatment,CDAI and Lewis scores of the experimental group were significantly lower than those of the control group(P<0.05);the serum levels of IGF-1,TGF-β1 as well as ALB and Tf in the experimental group were significantly higher than those in the control group(P<0.05).The improvement of intestinal flora disturbance rate in the experimental group was significantly better than that in the control group(P<0.05).There was no significant difference in the incidence of oral and nasal mucosa dryness,throat discomfort,nausea and vomiting between two groups(P>0.05).Conclusion In the treatment of refractory IBD patients,thalidomide combined with IFX can regulate serum IGF-1 and TGF-β1 levels,effectively relieve clinical manifestations,inhibit inflammatory activities,and improve nutritional status and intestinal flora disorders of patients,and it has high safety.