胶囊内镜在小肠克罗恩病英夫利西单抗治疗第14周疗效评估中的应用价值
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2014年广东省省级科技计划项目(2014A020212172)


Evaluation of capsule endoscopy for small bowel Crohn disease at 14th week of Infliximab therapy
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    摘要:

    目的 评价小肠受累的克罗恩病(CD)患者使用英夫利西(IFX)单抗治疗第14周临床缓解情况,以及采用胶囊内镜联合回结肠镜评估肠道黏膜愈合情况的临床价值。方法回顾性分析23例接受IFX治疗的小肠受累的CD患者的临床资料。观察治疗前和治疗后第14周时患者实验室指标(血常规、C反应蛋白、白蛋白)、克罗恩病活动度指数(CDAI)、胶囊内镜Lewis评分、克罗恩病简化内镜评分(SES-CD)、不良反应及并发症的情况。结果与治疗前相比,治疗后第14周23例CD患者的CDAI评分和炎症指标、C反应蛋白均显著下降(P<0.01),体重指数(BMI)和白蛋白均明显升高(P<0.05),临床缓解率为91.3%(21/23)。在IFX治疗第14周,8/23(34.8%)的患者达到小肠黏膜愈合,12/21(57.1%)达到回末及结肠黏膜愈合,而仅7/21(33.3%)达到小肠和结肠均黏膜愈合。治疗第14周时,达到临床缓解期、炎症指标正常且回末及结肠达到黏膜愈合(SES-CD评分≤2)的12例患者中,仍有5例(41.7%)患者处于小肠炎症活动期(LS评分>135)。结论IFX可以有效诱导小肠受累的CD患者实现临床缓解和黏膜愈合。CD患者中回末同小肠其他部位愈合情况并不同步,因而对于小肠和结肠均受累的CD患者评估疗效和黏膜愈合情况时,在排除肠梗阻和严重肠腔狭窄后,仍有必要联合胶囊内镜和回结肠镜进行全消化道评估。

    Abstract:

    ObjectiveTo evaluate clinical remission in patients with small bowel Crohn′s disease(SBCD) who have received infliximab(IFX) therapy and to evaluate capsule endoscopy combined with ileocolonoscopy for mucosal healing at 14th week of IFX therapy. MethodsClinical data of 23 SBCD patients who received IFX were retrospectively analyzed. Laboratory indices [routine blood tests, C-reactive protein (CRP)and albumin], Crohn′s disease activity index (CDAI), Lewis score (LS), Crohn′s disease simplified endoscopic score (SES-CD), side effects and complications were compared before IFX treatment and at 14th week of IFX therapy. ResultsIn 23 SBCD patients, both CDAI and CRP levels significantly decreased (P<0.01) while body mass index (BMI) and albumin levels increased at 14th week (P<0.05),compared with those before treatment. The clinical remission rate at 14th week was 91.3%(21/23). There were 8/23(34.8%)SBCD patients achieving mucosal healing in small bowel, 12/21(57.1%) in terminal ileum and colon, and 7/21(33.3%) in both small bowel and colon.Twelve patients achieved both clinical remission and biochemical remission at 14th week and all of them achieved mucosal healing in both terminal ileum and colon(SES-CD≤2). However, there were 5(41.7%) of them still with small bowel inflammation (LS>135). ConclusionIFX plays a role in promoting clinical remission and mucosal healing in SBCD patients. Mucosal healing of CD patients in terminal ileum and other parts of small intestine are not synchronized. For CD patients with small bowel and colon involved, the evaluation of the whole gastrointestinal tract by capsule endoscopy combined with ileocolonoscopy is recommended on condition that they have no intestinal obstruction or severe stricture.

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邱琛,朱振浩,龚伟,等.胶囊内镜在小肠克罗恩病英夫利西单抗治疗第14周疗效评估中的应用价值[J].中华消化内镜杂志,2017,34(3):181-185.

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  • 在线发布日期: 2017-04-27
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