挂线序贯不同药物治疗活动期克罗恩病肛瘘的临床疗效比较  

Efficacy comparison of seton sequential treatment with different drugs for perianal fistula of active Crohn′s disease

作　　者：韩娟 孙薛亮[2] 何宗琦[2] 甄曙光[2] 杜骏 童经陆 谷云飞[3] 文科[2] Han Juan;Sun Xueliang;He Zongqi;Zhen Shuguang;Du Jun;Tong Jinglu;Gu Yunfei;Wen Ke(Department of Anorectum,Suzhou Hospital of Integrated Traditional Chinese and Western Medicine,Suzhou 215101,China;Department of Anorectum,Affiliated Suzhou Hospital of Traditional Chinese Medicine,Nanjing University of Chinese Medicine,Suzhou 215009,China;Department of Anorectum,Affiliated Hospital,Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]苏州市中西医结合医院肛肠科,215101 [2]南京中医药大学附属苏州市中医医院肛肠科,215009 [3]南京中医药大学附属医院肛肠科,210029

出　　处：《中华炎性肠病杂志（中英文）》2020年第4期316-321,共6页Chinese Journal of Inflammatory Bowel Diseases

摘　　要：目的:比较挂线序贯不同药物治疗活动期克罗恩病(CD)肛瘘的临床疗效。方法:回顾性分析2017年1月至2018年12月南京中医药大学附属苏州市中医医院和苏州市中西医结合医院收治的42例活动期CD肛瘘患者的临床资料,行挂线疗法后序贯药物治疗,根据药物不同分为IFX组(n=11)、硫唑嘌呤组(n=14)和美沙拉嗪组(n=17)。比较3组患者治疗前后疗效、实验室检查、疾病活动指数(CDAI、PDAI)、肛门自制(Wexner)评分等指标的差异。结果:随访42例,中位随访时间24个月(12~34个月)。术后肛瘘痊愈和有效的患者占比在IFX组、硫唑嘌呤组和美沙拉嗪组分别为90.9%、71.4%和35.3%,3组肛瘘愈合情况总体差异存在统计学意义(P=0.020)。IFX组、硫唑嘌呤组、美沙拉嗪组治疗后CDAI评分均明显小于治疗前评分[(96.66±51.23)分比(170.12±52.67)分、(142.11±79.68)分比(196.82±81.10)分、(179.91±42.06)分比(208.02±42.60)分,均P<0.05];3组治疗后CDAI评分总体差异具有统计学意义(P=0.005),其中美沙拉嗪组CDAI评分明显高于IFX组(P<0.05)。IFX组、硫唑嘌呤组治疗后PDAI评分均明显小于治疗前评分[(1.71±0.91)分比(9.91±3.53)分、(3.81±2.40)分比(10.07±2.67)分,均P<0.05];IFX组、硫唑嘌呤组、美沙拉嗪组治疗后PDAI评分总体差异具有统计学意义[(1.71±0.91)分比(3.81±2.40)分比(10.45±2.84)分,P<0.001],且3组评分依次升高(均P<0.05)。结论:挂线序贯不同药物是治疗活动期CD肛瘘的有效手段,IFX和硫唑嘌呤是合适的药物选择。Objective To compare the clinical efficacies of seton sequential treatment with different drugs for perianal fistula of active Crohn′s disease(CD).Methods Clinical data of 42 active CD patients with anal fistula undergoing seton sequential treatment in Suzhou Hospital of Traditional Chinese Medicine and Suzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2017 to December 2018 were retrospectively analyzed.According to seton sequential drugs,patients were divided into IFX group(n=11),azathioprine group(n=14)and mesalazine group(n=17).The pre-and post-operative symptoms,laboratory tests,disease activity indexes(CDAI and PDAI),anal self-control(Wexner)score were compared among 3 groups.Results Forty-two patients were followed up with a median time of 24 months(12-34 months).The proportions of healing and effectiveness of anal fistula patients were 90.9%,71.4%and 35.3%in the IFX group,azathioprine group and mesalazine group respectively.There was a significant difference in anal fistula healing among 3 groups(P=0.020).The CDAI scores after treatment in IFX group,azathioprine group and mesalazine group were lower than those scores before treatment[(96.66±51.23)points vs(170.12±52.67)points,(142.11±79.68)points vs(196.82±81.10)points,(179.91±42.06)points vs(208.02±42.60)points,all P<0.05].There was a significant general difference in CDAI score among the 3 groups(P=0.005).And the CDAI score after treatment in mesalazine group was obviously higher than that in IFX group(P<0.05).The PDAI scores after treatment in IFX group and azathioprine group were lower than those scores before treatment[(1.71±0.91)points vs(9.91±3.53)points,(3.81±2.40)points vs(10.07±2.67)points,both P<0.05].There was a significant general difference in PDAI score among IFX group,azathioprine group and mesalazine group[(1.71±0.91)points vs(3.81±2.40)points vs(10.45±2.84)points,P<0.001]and the PDAI scores after treatment gradually increased(all P<0.05).Conclusions Seton sequential treatment with drug is a

关 键 词：克罗恩病 肛瘘 挂线 序贯治疗 抗肿瘤坏死因子单克隆抗体 免疫抑制剂 英夫利西单克隆抗体 硫唑嘌呤 美沙拉嗪 

分 类 号：R574[医药卫生—消化系统] R657.16[医药卫生—内科学]