不同治疗方法对克罗恩病肠切除术后复发预防效果分析
摘要
目的探讨克罗恩病(CD)患者肠切除术后,不同预防治疗对患者的影响。方法选取自2007年1月至2015年12月于郧西县人民医院行肠切除术的48例CD患者为研究对象。根据患者的术后用药情况,将所有患者分为A组(n=33)、B组(n=6)、C组(n=9)三组。A组给予巯基嘌呤单药治疗;B组给予抗肿瘤坏死因子(TNF-α)单药治疗;C组在B组基础上联合使用免疫抑制剂药物治疗。比较各组患者治疗成功率。结果 A组患者治疗成功率为42.4%(14/33),B组患者治疗成功率为50.0%(3/6),C组患者治疗成功率为88.9%(8/9)。A、B两组患者治疗成功率比较,差异无统计学意义(P>0.05);A、C两组患者治疗成功率比较,差异有统计学意义(P<0.05);B、C两组患者治疗成功率比较,差异无统计学意义(P>0.05)。结论抗TNF-α和免疫抑制剂联合疗法具有良好的耐受性,疗效确切且优于硫嘌呤类药物单一疗法。
引文
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[17] 李玥,钱家鸣.免疫抑制剂在炎症性肠病中的治疗新进展[J].中国医院用药评价与分析,2014,14(1):3-4.
[18] 刘佰运,王忠诚,吴建中.免疫抑制剂硫唑嘌呤对慢性脑血管痉挛的防治作用[J].中华神经外科杂志,1999,15(2):111.
[19] 刘芳,李靖涛,宋振梅,等.英夫利昔单抗联合硫唑嘌呤对克罗恩病患者免疫功能和细胞因子的影响[J].中华全科医学,2017,15(4):586-588,592.
[20] 林海,姚国和,李强,等.硫唑嘌呤治疗激素依赖溃疡性结肠炎的IL-8、TNF-α水平的临床研究[J].齐齐哈尔医学院学报,2017,38(2):178-179.
[2] 刘占举.克罗恩病的药物治疗策略[J].检验医学与临床,2015,52(2):13-14.
[3] Onali S,Petruzziello C,Calabrese E,et al.Frequency,pattern,and risk factors of postoperative recurrence of Crohn′s disease after resection different from ileo-colonic[J].J Gastrointest Surg,2009,13(2):246-252.
[4] Sachar DB,Lemmer E,Ibrahim C,et al.Recurrence patterns after first resection for stricturing or penetrating Crohn′s disease[J].Inflamm Bowel Dis,2009,15(7):1071-1075.
[5] Regueiro M,Kip KE,Baidoo L,et al.Postoperative therapy with infliximab prevents long-term Crohn′s disease recurrence[J].Clin Gastroenterol Hepatol,2014,12(9):1494-1502.
[6] Regueiro M,Feagan BG,Zou B,et al.Infliximab reduces endoscopic,but not clinical,recurrence of Crohn′s disease after ileocolonic resection[J].Gastroenterology,2016,150(7):1568-1578.
[7] De Cruz P,Kamm MA,Hamilton AL,et al.Efficacy of thiopurines and adalimumab in preventing Crohn′s disease recurrence in high-risk patients - a POCER study analysis[J].Aliment Pharmacol Ther,2015,42(7):867-879.
[8] De Cruz P,Kamm MA,Hamilton AL,et al.Crohn′s disease management after intestinal resection:a randomised trial[J].Lancet,2015,385(9976):1406-1417.
[9] Doherty G,Bennett G,Patil S,et al.Interventions for prevention of post-operative recurrence of Crohn′s disease[J].Cochrane Database Syst Rev,2009,4(4):CD006873.
[10] Araki T,Uchida K,Okita Y,et al.Impact of postoperative infliximab maintenance therapy on preventing the surgical recurrence of Crohn′s disease:a single-center paired case-control study[J].Surg Today,2014,44(2):291-296.
[11] Sorrentino D,Terrosu G,Paviotti A,et al.Early diagnosis and treatment of postoperative endoscopic recurrence of Crohn′s disease:partial benefit by infliximab-a pilot study[J].Dig Dis Sci,2012,57(5):1341-1348.
[12] Gisbert JP,Panes J.Loss of response and requirement of infliximab dose intensification in Crohn′s disease:a review[J].Am J Gastroenterol,2009,104(3):760-767.
[13] Sorrentino D,Terrosu G,Avellini C,et al.Infliximab with low-dose methotrexate for prevention of postsurgical recurrence of ileocolonic Crohn disease[J].Arch Intern Med,2007,167(16):1804-1807.
[14] Hendler SA,Cohen BL,Colombel JF,et al.High-dose infliximab therapy in Crohn′s disease:clinical experience,safety,and efficacy[J].J Crohns Colitis,2015,9(3):266-275.
[15] Khanna R,Bressler B,Levesque BG,et al.Early combined immunosuppression for the management of Crohn′s disease(REACT):a cluster randomised controlled trial[J].Lancet,2015,386(10006):1825-1834.
[16] 赵峻,张莉蓉,乔海灵.免疫抑制剂硫唑嘌呤的药物不良反应[J].中国误诊学杂志,2006,6(5):839-841.
[17] 李玥,钱家鸣.免疫抑制剂在炎症性肠病中的治疗新进展[J].中国医院用药评价与分析,2014,14(1):3-4.
[18] 刘佰运,王忠诚,吴建中.免疫抑制剂硫唑嘌呤对慢性脑血管痉挛的防治作用[J].中华神经外科杂志,1999,15(2):111.
[19] 刘芳,李靖涛,宋振梅,等.英夫利昔单抗联合硫唑嘌呤对克罗恩病患者免疫功能和细胞因子的影响[J].中华全科医学,2017,15(4):586-588,592.
[20] 林海,姚国和,李强,等.硫唑嘌呤治疗激素依赖溃疡性结肠炎的IL-8、TNF-α水平的临床研究[J].齐齐哈尔医学院学报,2017,38(2):178-179.