CAJ | 학술논문

目的观察英夫利西联合硫唑嘌呤治疗克罗恩病(CD)的疗效及黏膜愈合情况与预后的关系.方法研究对象为广州中山大学附属第一医院接受英夫利西联合硫唑嘌呤治疗的20例活动性CD患者.根据CD活动指数分别评价治疗10周、30周、54周及2年时的临床疗效.根据内镜下黏膜应答情况分别评价治疗10周、30周、54周时的内镜下疗效.两组间比较采用方差分析或Fisher精确概率法.黏膜愈合影响因素采用Logistic回归分析.结果治疗10周、30周、54周和2年时的无糖皮质激素临床缓解率分别为12/20、16/20、15/20和15/20,10周、30周和54周时的黏膜愈合率分别为8/20、12/20和10/20.Logistic多因素回归分析显示,年轻是影响治疗30周时黏膜愈合的惟一因素((OR=0.774,95％CI:0.630～0.950).30周时黏膜应答者与内镜下无效者在30周及2年时的无糖皮质激素临床缓解率(30周时为14/14比2/6,2年时为14/14比1/6)均差异有统计学意义(Fisher精确概率法,P均＜0.01).30周时获无糖皮质激素临床缓解的16例患者在54周时有4例停用英夫利西,其余12例继续英夫利西治疗,停用和续用英夫利西者的无糖皮质激素临床缓解率(4/4比11/12)和黏膜愈合率(2/4比7/12)均差异无统计学意义(P均＞0.05).结论英夫利西联合硫唑嘌呤治疗可有效促进和维持CD黏膜愈合,黏膜应答者能维持较长期的无糖皮质激素临床缓解.
목적 관찰영부리서연합류서표령치료극라은병(CD)적료효급점막유합정황여예후적관계.방법 연구대상위엄주중산대학부속제일의원접수영부리서연합류서표령치료적20례활동성CD환자.근거CD활동지수분별평개치료10주、30주、54주급2년시적림상료효.근거내경하점막응답정황분별평개치료10주、30주、54주시적내경하료효.량조간비교채용방차분석혹Fisher정학개솔법.점막유합영향인소채용Logistic회귀분석.결과 치료10주、30주、54주화2년시적무당피질격소림상완해솔분별위12/20、16/20、15/20화15/20,10주、30주화54주시적점막유합솔분별위8/20、12/20화10/20.Logistic다인소회귀분석현시,년경시영향치료30주시점막유합적유일인소((OR=0.774,95％CI:0.630～0.950).30주시점막응답자여내경하무효자재30주급2년시적무당피질격소림상완해솔(30주시위14/14비2/6,2년시위14/14비1/6)균차이유통계학의의(Fisher정학개솔법,P균＜0.01).30주시획무당피질격소림상완해적16례환자재54주시유4례정용영부리서,기여12례계속영부리서치료,정용화속용영부리서자적무당피질격소림상완해솔(4/4비11/12)화점막유합솔(2/4비7/12)균차이무통계학의의(P균＞0.05).결론 영부리서연합류서표령치료가유효촉진화유지CD점막유합,점막응답자능유지교장기적무당피질격소림상완해.
Objective To inspect the efficacy and mucosa healing condition of infliximab with azathioprine combination therapy in Crohn's disease (CD) and its correlation with prognosis.Methods A total of 20 active CD patients who received infliximab and azathioprine combination therapy at The First Affiliated Hospital of Sun Yat-sen University were objects of this study.The clinical efficacy was evaluated at 10 weeks,30 weeks,54 weeks and 2 years respectively according to CD activity index.The efficacy was evaluated under endoscopy at 10 weeks,30 weeks,54 weeks and 2 years respectively according to mucosal response situation under endoscopy.The data were analyzed by analysis of variance or Fisher's exact test between two groups.The factor affecred mucosal healing was analyzed by Logistic regression analysis.Results The clinical remission rate of patients without steroid at week 10,30,54 and 2 year were 12/20,16/20,15/20 and 15/20 respectively.Mucosal healing rate at week 10,30 and 54 weeks were 8/20,12/20 and 10/20 respectively.Logistic regression analysis indicated that age was the only factor affected mucosal healing at 30 weeks (OR =0.774,95％ CI:0.630 to 0.950).There was significant differences in clinical remission between mucosa response patients and invalid under endoscopy at 30 weeks and 2 years without steroid (at 30 weeks:14/14 vs 2/6; at 2 years:14/14 vs 1/6; all P＜0.01).Infliximab were withdrawn in 4 of 16 patients who was in non-steroid clinical remission at 30 weeks,and the other 12 patients were continued with infliximab therapy.There was no significant difference in non-steroid clinical remission rate (4/4 vs 11/12) and mucosa healing rate (2/4 vs 7/12) between withdrawal and continue of infliximab therapy (all P＞0.05).Conclusions Infliximab with azathioprine combination therapy can effectively promote and maintain mucosa healing in CD.The mucosa response patients can maintain long time non-steroid clinical remission.