CAJ | 학술논문

目的：探讨双气囊小肠镜（ DBE）在评估小剂量硫唑嘌呤对中度小肠克罗恩病（ CD）黏膜修复效应中的临床价值。方法分别采用多层螺旋小肠CT和经肛DBE筛选病变主要累及回肠，且既往无免疫抑制剂和生物制剂使用史的CD患者。设定回盲瓣以上150 cm的末端回肠为DBE主要的观察区域，以CD简化内镜评分（ SES-CD）为标准，分别在小剂量硫唑嘌呤治疗12个月和24个月后对黏膜修复情况进行评估。结果36例患者对硫唑嘌呤的平均耐受剂量为（61.8±17.2）mg/d。36例在治疗12个月后的总体黏膜完全修复、接近完全修复、部分修复和无修复的比例分别为19.4%（7/36）、5.6%（2/36）、27.8%（10/36）和47.2%（17/36）；治疗24个月后的相应比例为30.6%（11/36）、25.0%（9/36）、33.3%（12/36）和11.1%（4/36）。初始 SES-CD 分值的高低（ OR =2.71，95%CI：1.11~6.63，P=0.029）和病程的长短（ OR=1.27，95%CI：1.10~1.47，P=0.001）是与小肠CD黏膜修复相关的2个因素。结论 DBE在评估小肠CD治疗后黏膜修复方面具有显著的优势，最适宜的复查时间为小剂量硫唑嘌呤治疗后至少12个月以上。
목적：탐토쌍기낭소장경（ DBE）재평고소제량류서표령대중도소장극라은병（ CD）점막수복효응중적림상개치。방법분별채용다층라선소장CT화경항DBE사선병변주요루급회장，차기왕무면역억제제화생물제제사용사적CD환자。설정회맹판이상150 cm적말단회장위DBE주요적관찰구역，이CD간화내경평분（ SES-CD）위표준，분별재소제량류서표령치료12개월화24개월후대점막수복정황진행평고。결과36례환자대류서표령적평균내수제량위（61.8±17.2）mg/d。36례재치료12개월후적총체점막완전수복、접근완전수복、부분수복화무수복적비례분별위19.4%（7/36）、5.6%（2/36）、27.8%（10/36）화47.2%（17/36）；치료24개월후적상응비례위30.6%（11/36）、25.0%（9/36）、33.3%（12/36）화11.1%（4/36）。초시 SES-CD 분치적고저（ OR =2.71，95%CI：1.11~6.63，P=0.029）화병정적장단（ OR=1.27，95%CI：1.10~1.47，P=0.001）시여소장CD점막수복상관적2개인소。결론 DBE재평고소장CD치료후점막수복방면구유현저적우세，최괄의적복사시간위소제량류서표령치료후지소12개월이상。
Objective To evaluate the clinical value of double-balloon enteroscopy( DBE)in as-sessing the effect of mucosal healing in patients with moderate small bowel Crohn's disease( CD)treated with low-dose azathioprine. Methods CD patients who were naive to any immunomodulators or biological a-gents with lesions mainly located in ileu were screened by multislice CT enterography and anal-route DBE at baseline. Lesions at 150 cm proximal to ileocecal valve were assessed by DBE with Simple Endoscopic Score for CD( SES-CD)after 12 and 24 months of low-dose azathioprine treatment,respectively. Results A total of 36 patients were enrolled and the average tolerated dose of azathioprine was(61. 8 ± 17. 2)mg/day. The total rates of complete,near-complete,partial and no mucosal healing in 36 patients were 19. 4%(7/36), 5. 6%(2/36),27. 8%(10/36),and 47. 2%(17/36)at month 12 and 30. 6%(11/36),25. 0%(9/36), 33. 3%(12/36),and 11. 1%(4/36)at month 24,respectively. The baseline SES-CD score(OR=2. 71, 95%CI:1. 11-6. 63,P=0. 029)and duration of disease(OR=1. 27,95%CI:1. 10-1. 47,P =0. 001) were two relevant factors associated with mucosal healing of small bowel CD. Conclusion DBE has a signif-icant advantage in assessing post-therapy mucosal healing for patients with small bowel CD. The optimal time point for the first follow-up by DBE is at least 12 months after low-dose azathioprine treatment.