沙利度胺联合英夫利西治疗克罗恩病的临床研究  

Clinical study of thalidomide combined with infliximab in treatment of Crohn's disease

作　　者：范春梅[1] 陈风慧 FAN Chun-mei;CHEN Feng-hui(Department of Gastroenterology,Yan＇an People＇s Hospital,Yan＇an 716000,China;Department of Emergency,Xidian Group Hospital,Xi＇an 710077,China)

机构地区：[1]延安市人民医院消化内科,陕西延安716000 [2]西电集团医院急诊科,陕西西安710077

出　　处：《现代药物与临床》2018年第11期2919-2923,共5页Drugs & Clinic

摘　　要：目的探讨沙利度胺联合英夫利西治疗克罗恩病的临床效果。方法选取2015年5月—2018年5月延安市人民医院收治的182例克罗恩病患者,随机分成对照组和治疗组,每组各91例。对照组患者首次给予注射用英夫利西单抗3 mg/kg,然后在首次给药后的第2、6周各给予一次相同剂量。治疗组在对照组基础上口服沙利度胺片,50 mg/次,2次/d。两组均连续治疗8周。观察两组的临床疗效,比较两组治疗前后简化克罗恩病活动指数(CDAI)、血清指标的变化情况。结果治疗后,对照组和治疗组的总有效率分别为82.42%、92.31%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组一般情况评分、腹部包块评分、伴随疾病评分、腹痛评分、腹泻评分和总分较治疗前均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);治疗后,治疗组这些评分均显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血清白蛋白(ALB)均显著增加,C反应蛋白(CRP)、红细胞沉降率(ESR)、肿瘤坏死因子α(TNF-α)、辅助性T细胞(Th)17/调节性T细胞(Treg)比值、血管内皮生长因子(VEGF)均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);治疗后,治疗组ALB高于对照组,CRP、ESR、TNF-α、Th17/Treg比值、VEGF均低于对照组,两组比较差异具有统计学意义(P<0.05)。结论沙利度胺联合英夫利西治疗克罗恩病具有较好的临床疗效,可改善患者营养状况,减轻组织炎症损伤,纠正Th17/Treg免疫失衡,具有一定的临床推广应用价值。Objective To investigate the clinical effect of thalidomide combined with infliximab in treatment of Crohn＇s disease. Methods Patients（182 cases） with Crohn＇s disease in Yan＇an People＇s Hospital from May 2015 to May 2018 were randomly divided into control（91 cases） and treatment（91 cases） groups. Patients in the control group were given Infliximab for injection 3 mg/kg for the first time, then given the same dosage at the second and sixth weeks. Patients in the treatment group were po administered with Thalidomide Tablets on the basis of the control group, 50 mg/time, twice daily. Patients in two groups were treated for 8 weeks. After treatment, the clinical efficacy was evaluated, and the changes of CDAI score, serum indexes in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment group were 82.42% and 92.31%, and there were differences between two groups（P〈0.05）. After treatment, general condition score, abdominal mass score, comorbidity score, abdominal pain score, diarrhea score and total score were significantly decreased in two groups, and there were differences in the same group（P〈0.05）. After treatment, those scores in the treatment group were significantly lower than those in the control group, and there were differences between two groups（P〈0.05）. After treatment, ALB were significantly increased in two groups, but CRP, ESR, TNF-α, Th17/Treg, and VEGF were significantly decreased, and there were differences in the same group（P〈0.05）. After treatment, ALB in the treatment group was higher than that in the control group, but CRP, ESR, TNF-α, Th17/Treg, and VEGF were lower than those in the control group, and there were differences between two groups（P〈0.05）. Conclusion Thalidomide combined with infliximab has significant clinical effect in in treatment of Crohn＇s disease, and can improve the nutritional status of patients, and also can reduce tissue inflammatory injury, and corr

关 键 词：沙利度胺片 注射用英夫利西单抗 克罗恩病 简化克罗恩病活动指数 白蛋白 C反应蛋白 红细胞沉降率 肿瘤坏死因子-α 辅助性T细胞(Th)17/调节性T细胞(Treg)比值 血管内皮生长因子 

分 类 号：R975[医药卫生—药品]