早期应用英夫利昔联合免疫抑制剂治疗中重度克罗恩病的疗效观察

摘要

Objective To evaluate the efficacy and safety of early combination therapy of infliximab and immunosuppressor for moderate to severe Crohn's disease (CD).Methods The clinical data of 16 moderate to severe CD patients were analyzed retrospectively.All patients were intravenously infused with 5 mg/kg infliximab as a basic dose at week 1,2,6,and then infliximab 5 mg/kg every 8 week.The therapeutic effect and prognosis of the patients were analyzed,and the changes of the clinical indexes were compared after two weeks.Results The clinical efficiencies of moderate to severe CD patients were 93.75 ％ (15/16) at week 2,86.67 ％ (13/15) at week 6,71.43 ％ (10/14) at week 14,46.15 ％ (6/13) at final time.The remission rates were 31.25％ (5/16) at week 2,73.33％ (11/15) at week 4,57.14％(8/14) at week 14 and 46.15％ (6/13)at final time.The relapse rate was 1 at week 2,6.67％ (1/15) at week 6,14.29％ (2/14) at week 14 and 38.46％ (5/13) at final time.After the combination treatment,the score of Crohn disease activity index (CDAI),PLT,erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) decreased obviously at week 2 compared with those at week 1,and the difference was statistically significant (P ＜ 0.05).Eventually,4 patients achieved mucosal healing and 2 patients' symptoms of oral ulcer or arthralgia were improved.During the follow-up period,there were five patients with adverse events including one case of evanescent eruption and 4 cases of infection.Conclusion For moderate to severe CD patients,early combined therapy has been shown to have a rapid clinical remission and maybe a higher rate of mucosal healing,but better long term outcomes are not observed.%目的 评价早期应用英夫利昔单抗联合免疫抑制剂治疗中重度克罗恩病患者(CD)的疗效.方法 回顾性分析16例中重度CD患者临床资料,所有患者在第1、2、6周英夫利昔单抗静脉滴注(剂量为5 mg/kg),同时联合免疫抑制剂(硫唑嘌呤)治疗,其后每8周行1次维持治疗,分析患者治疗效果和预后,并比较第2周后各项检查指标的变化.结果 在第2、6、14周及末次随访时,达到临床治疗有效率分别为93.75％ (15/16)、86.67％(13/15)、71.43％ (10/14)及46.15％(6/13);达到临床缓解率分别为31.25％ (5/16)、73.33％ (11/15)、57.14％ (8/14)及46.15％(6/13);复发率分别为0、6.67％ (1/15)、14.29％ (2/14)及38.46％ (5/13).与治疗前相比,患者第2周克罗恩活动指数(CDAI)、血小板(PLT)计数、红细胞沉降率(ESR)及C反应蛋白(CRP)均明显降低(P＜0.05).最终有4例患者达到黏膜愈合,2例患者口腔黏膜溃疡、关节痛的症状改善.随访观察期间5例出现不良反应,其中1例为全身一过性皮疹,4例为感染.结论 对于中重度CD患者,早期采取英夫利昔联合免疫抑制剂治疗,可能具有快速的诱导缓解作用,同时可达到临床反应或黏膜愈合,但对改善患者长期预后并不明显.