双气囊小肠镜对小肠克罗恩病患者小剂量硫唑嘌呤治疗后黏膜修复的评估作用  

Evaluate the effect of mucosal healing after low-dose azathioprine in patients with small bowel Croim＇s disease by double-balloon enteroscopy

作　　者：俞丽芬[1] 程时丹[1] 张天宇[1] 唐永华 缪飞 钟捷[1] 

机构地区：[1]交通大学医学院附属瑞金医院消化科,上海200025 [2]放射科

出　　处：《中华消化内镜杂志》2014年第9期489-493,共5页Chinese Journal of Digestive Endoscopy

摘　　要：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（co）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150em的末端回肠为DBE主要的观察区域，以CD简化内镜评分（SES—CO）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。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.

关 键 词：小肠 克罗恩病 硫唑嘌呤 黏膜修复 双气囊小肠镜 

分 类 号：R574[医药卫生—消化系统]