英夫利西单抗治疗克罗恩病肛瘘停药后复发的影响因素分析  

Risk Factors for Relapse of Perianal Fistulizing Crohn’s Disease After Discontinuation of Infliximab Therapy

作　　者：徐锡涛[1] 陆君涛 朱明明[1] 王天蓉[1] 戴张晗[1] 童锦禄[1] 冉志华[1] XU Xitao;LU Juntao;ZHU Mingming;WANG Tianrong;DAI Zhanghan;TONG Jinlu;RAN Zhihua(Division of Gastroenterology and Hepatology,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai Inflammatory Bowel Disease Research Center,Shanghai Institute of Digestive Disease,Shanghai,200127)

机构地区：[1]上海交通大学医学院附属仁济医院消化内科上海市消化疾病研究所上海市炎症性肠病研究中心,200127

出　　处：《胃肠病学》2021年第9期513-518,共6页Chinese Journal of Gastroenterology

摘　　要：背景:英夫利西单抗(IFX)治疗克罗恩病(CD)合并活动性肛瘘获得缓解后,部分停药患者会在数周至数年内复发。目的:探讨IFX治疗CD肛瘘停药后复发情况和可能的影响因素。方法:回顾性收集2013年6月-2019年5月在上海仁济医院应用IFX治疗CD肛瘘、获得影像学部分或完全缓解后停药病例的临床资料,提取人口学、临床和影像学特征以及治疗和复发信息,采用Kaplan-Meier曲线分析肛瘘复发和肠道复发情况,采用Cox比例风险模型筛选复发影响因素。结果:共56例IFX治疗CD肛瘘后停药的患者纳入研究,停药时肛瘘影像学完全缓解26例,部分缓解30例。中位随访时间为20.5个月,21例(37.5%)患者肛瘘复发。停药后12、24、60个月肛瘘累积复发率分别为29.0%、33.7%和42.8%,肠道累积复发率分别为21.7%、31.2%和56.4%。多因素分析显示,非狭窄非穿透型病变(HR=9.711,95%CI:1.210~77.939,P=0.032)、直肠累及(HR=3.034,95%CI:1.119~8.231,P=0.029)是IFX停药后CD肛瘘复发的独立危险因素,IFX使用次数多则为保护因素(HR=0.885,95%CI:0.792~0.990,P=0.032)。结论:CD肛瘘经IFX治疗获得缓解停药后复发率高,非狭窄非穿透型病变和直肠累及是肛瘘复发的危险因素,增加IFX使用次数可减少肛瘘复发。Background: Some of the active perianal fistulizing Crohn’s disease(CD) patients achieving remission with infliximab(IFX) therapy would develop relapse of perianal fistula within weeks to years after discontinuation of IFX therapy. Aims: To assess the outcomes of patients with perianal fistulizing CD after discontinuation of IFX therapy and the risk factors for relapse of perianal fistula. Methods: The clinical data of patients with perianal fistulizing CD who received IFX therapy at Shanghai Renji Hospital between June 2013 and May 2019 and stopped IFX therapy after achieving complete or partial radiological remission were collected retrospectively and analyzed. Demographic data, clinical and imaging characteristics, as well as data of IFX treatment and relapse of perianal fistula were extracted. Kaplan-Meier analysis was performed to calculate the cumulative probabilities of perianal and luminal relapse, while Cox proportional hazards model was applied to identify the risk factors for relapse. Results: A total of 56 perianal fistulizing CD patients who had been treated with IFX and stopped IFX therapy were included. Of them 26 achieved complete radiological remission and 30 achieved partial radiological remission. The median follow-up time was 20.5 months. Twenty-one patients(37.5%) had relapse of perianal fistula. The cumulative probabilities of perianal relapse were 29.0%, 33.7% and 42.8% at 12, 24 and 60 months after IFX discontinuation, respectively;and the cumulative probabilities of luminal relapse were 21.7%, 31.2% and 56.4% at 12, 24 and 60 months after IFX discontinuation, respectively. Multivariate analysis showed that non-stricturing and non-penetrating type(HR=9.711, 95% CI: 1.210-77.939, P=0.032) and involvement of rectum(HR=3.034, 95% CI: 1.119-8.231, P=0.029) were independent risk factors for relapse of perianal fistula, while the frequency of using of IFX therapy was a protective factor(HR=0.885, 95% CI: 0.792-0.990, P=0.032). Conclusions: There is a high risk of relapse of perianal fistulizin

关 键 词：CROHN病 肛瘘 英夫利西单抗 停药 复发 危险因素 

分 类 号：R574.62[医药卫生—消化系统]