抗TNF-α制剂对克罗恩病合并肛瘘患者术后免疫平衡和细胞因子水平及远期复发率的影响

摘要

目的 研究抗TNF-α制剂对克罗恩病合并肛瘘患者术后免疫平衡及细胞因子水平和远期复发率的影响.方法 对42例行手术治疗的克罗恩病合并肛瘘患者资料进行回顾,依据术后应用抗TNF-α制剂与否,分为对照组(n=20,单行挂线引流术治疗)和观察组(n=22,挂线引流术+抗TNF-α制剂治疗),比较2组近远期疗效.结果 观察组肛瘘瘘口完全愈合率68.18％,对照组50％,2组差异无统计学意义(P＜0.05);观察组瘘口愈合时间显著短于对照组(P＜0.05);治疗后,2组CDEIS评分、CDAI评分和PDAI评分均显著降低,且观察组降低幅度大于对照组,差异具有统计学意义(P＜0.05);治疗后,观察组CD4+ CD25+ Treg显著上升(P＜0.05),IL-4/IFN-γ值和TGF-β/IL-17值显著下降(P＜0.05),而对照组变化不显著(P＞0.05),组间比较差异有统计学意义(P＜0.05);观察组肛瘘复发率9.09％,肛瘘再发率4.55％,对照组分别为35％和30％,2组差异有统计学意义(P＜0.05).结论 抗TNF-α制剂可明显改善克罗恩病合并肛瘘患者症状,维持免疫平衡,降低肛瘘复发和再发率,与外科手术联合治疗利于提高预后疗效.%Objective To investigate the effects of anti-TNF-α preparations on immune balance,cytokine levels and long-term relapse rate in patients with Crohn's disease complicated by anal fistula.Methods The data about 42 patients with Crohn's disease complicated by anal fistula who were treated by surgery were retrospectively analyzed.According to postoperative application of anti-TNF-α preparations,these patients were divided into the control group (n =20) and observation group (n =22).The patients in control group were treated by thread-drawing drainage alone,however,the patients in observation group were treated by thread-drawing drainage combined with anti-TNF-α preparations.The short-term and long-term curative effect were observed and compared between the two groups.Results The complete healing rate of anal fistula in observation group was 68.18％,which was 50％ in control group,there was no significant difference between two groups (P ＞ 0.05).The healing time of fistula in observation group was significantly shorter than that in control group (P ＜ 0.05).After treatment,CDEIS scores,CDAI scores and PDAI scores were decreased significantly in both grousp,moreover,the decrease extent in observation group was greater than that in control group (P ＜ 0.05).After treatment,CD4+ CD25+ Treg in observation group were significantly increased,and the levels of IL-4/IFN-γand TGF-β/IL-17 were decreased significantly (P ＜ 0.05),however,there were no significant changes in control group (P ＞ 0.05).There were statistically significant differences between groups (P ＜ 0.05).There was significant difference in relapse rate of anal fistula between two groups (P ＜ 0.05).Conclusion The anti-TNF-α preparations can significantly improve the symptoms of patients with Crohn's disease complicated by anal fistula,keep immune balance and reduce relapse rate of anal fistula,moreover,its combination appliaction with surgery can improve the prognosis of patients.