英夫利西单抗治疗克罗恩病的临床疗效及影响因素

Effectiveness and influencing factors of infliximab in the treatment of Crohn's disease

目的分析英夫利西单抗(IFX)治疗克罗恩病(CD)的有效性及其影响因素。方法回顾性纳入2018年1月1日至2022年7月1日于同济大学附属上海市第十人民医院的IFX治疗的CD住院患者375例,收集患者IFX治疗前基线资料及用药第54周随访资料,包括年龄、性别、病程、蒙特利尔分型、手术史、既往用药史、身高、体重、克罗恩病疾病活动度评分(CDAI)、简化克罗恩病内镜评分(SES-CD),评估IFX治疗1年CD患者的临床和内镜应答率、缓解率。利用卡方检验、单因素及多因素分析发现影响IFX治疗CD有效性的关键因素。结果375例CD有352例为IFX药物治疗,23例为回肠造口术后启用IFX治疗。352例CD患者中,72.7%患者治疗1年后达临床应答(ΔCDAI≥70),61.4%达临床缓解(第54周CDAI<150),56.3%达内镜应答(ΔSES-CD≥50%),37.6%达内镜缓解(SES-CD≤2)。23例回肠造口术后CD患者中,4.3%达内镜缓解(Rutgeert评分<i2)。病程短的CD临床应答率(P=0.001)、内镜应答率(P=0.036)、内镜缓解率(P=0.032)高,非肛周CD的临床应答率高(P=0.006),基线红细胞沉降率低的CD临床缓解率高(P=0.001),基线C反应蛋白高的CD内镜缓解率高(P=0.02);B1型CD临床缓解率及内镜应答率更高(P=0.003),L2型内镜应答率高于L1型CD(P=0.02)。结论IFX对病程短、非肛周、B1型、L2型CD患者治疗效果更有优势。

Objective To evaluate the effectiveness and influencing factors of infliximab(IFX)in the treatment of Crohn's disease(CD).Methods A total of 375 patients with CD who were treated with IFX at Shanghai Tenth People's Hospital Affiliated to Tongji University during January 1,2018 to July 1,2022 were retrospectively included.Baseline data before IFX treatment and follow-up data at the 54th week of treatment were collected,including age,gender,disease duration,Montreal classification,surgery history,drug history,height,weight,Crohn's disease activity score(CDAI),and simplified Crohn's Disease Endoscopic score(SES-CD).Chi-square test and single factor and multiple factor analysis were applied to analyze the key factors affecting the effectiveness of IFX in the treatment of CD.Results Of 375 patients with CD,352 were treated with IFX and 23 were treated with IFX after ileostomy.Of the 352 patients with CD,72.7%achieved clinical response(ΔCDAI≥70),61.4%achieved clinical remission(CDAI<150)at week 54,56.3%achieved endoscopic response(ΔSES-CD≥50%),and 37.6%achieved endoscopic remission(SES-CD≤2).Of the 23 patients with CD after ileostomy,4.3%achieved endoscopic remission(Rutgeert score<i2).Patients with short disease duration better responded to IFX proved by higher clinical response(P=0.001),endoscopic response(P=0.036),and endoscopic remission(P=0.032).Patients without perianal CD achieved higher clinical response rate(P=0.006).Patients with lower erythrocyte sedimentation rate and elevated C-reactive protein at baseline achieved higher clinical remission(P=0.001)and endoscopic remission(P=0.02),respectively.The clinical remission rate and endoscopic response rate of B1 type CD were higher(P=0.003),and the endoscopic response rate of L2 type was higher than that of L1 type CD(P=0.02).Conclusion CD patients with short disease duration,non-perianal,B1 type and L2 type have better response to IFX treatment.