中国普外基础与临床杂志

中国普外基础与临床杂志

拆除引流挂线后局部注射高浓度葡萄糖对克罗恩病肛瘘的疗效初探

查看全文

目的 探索引流挂线+英夫利昔单抗(IFX)+高糖局部注射治疗克罗恩病(CD)肛瘘的效果。 方法 前瞻性收集江苏省中医院肛肠科于 2015 年 8 月至 2017 年 7 月期间收住入院的 30 例 CD 肛瘘患者,分为试验组 12 例和对照组 18 例,试验组患者接受拆除引流挂线+IFX+高糖局部注射治疗,对照组患者仅接受拆除引流挂线+IFX 治疗。于治疗前,以及 IFX 治疗第 6、14、22 和 30 周为观察时间点,检测 2 组患者的实验室指标,并评估 BMI、克罗恩病活动指数评分(CDAI)、肛周克罗恩病活动指数评分(PDAI)及临床疗效。 结果 重复测量资料的方差分析结果表明,各实验室指标 [包括白细胞(WBC)计数、C 反应蛋白(CRP)水平、红细胞沉降率(ESR)、血小板(PLT)计数及血红蛋白(Hb)水平]、BMI、CDAI 及 PDAI 的组间效应和组别及时点的交互效应均无统计学意义(P>0.05),但时点效应均有统计学意义(P<0.05)。不管是在试验组还是在对照组,相比于治疗前,第 6 周的 WBC 计数、CRP 水平、ESR、PLT 计数、CDAI 及 PDAI 均降低,之后几个时点变化不大;而 Hb 水平和 BMI 的变化趋势则相反,在第 6 周时增高,之后维持在一定水平。IFX 治疗第 14、22 及 30 周时,2 组患者的临床疗效比较差异均无统计学意义(P>0.05)。 结论 拆除引流挂线的同时局部注射高糖治疗 CD 肛瘘的效果不明显,有待进一步验证。

Objective To explore the effect of local injection of high concentration of glucose when removing setons of perianal fistulizing in Crohn’s disease (CD). Methods Thirty cases of CD combined with anal fistula admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from August 2015 to July 2017 were collected prospectively, 12 cases were divided into experimental group and 18 cases were divided into control group. Cases of the experimental group received demolition of drainage seton+IFX+local injection of high concentration of glucose treatment, cases of the control group received the drainage setons removing+IFX only. Before treatment, and at 6, 14, 22, and 30 weeks after IFX treatment, the laboratory indicators of the 2 groups were detected, and BMI, Crohn’s diseaseactivity index (CDAI), perianal disease activity index (PDAI), and clinical efficacy were evaluated. Results Therewas no significant difference on the group effect and interaction of group and time (P>0.05), but time (P<0.05). Both in the experimental group and the control group, compared with before treatment group, the counts of WBC and platelet, levels of C reaction protein (CRP) and erythrocyte sedimentation rate (ESR), CDAI, and PDAI at 6 months after IFX therapy decreased and maintained at the latter period, but the level of hemoglobin (Hb) and BMI increased at 6 weeks after IFX therapy and maintained at the latter period. On the clinical effect, there was no significant difference at the time points of 14, 22, and 30 weeks of IFX therapy (P>0.05). Conclusion The treatment of local injection of high concentration of glucose when removing setons has not shown any positive effect to CD combined with anal fistula, this conclusion needs to be further studied.

关键词: 克罗恩病; 肛瘘; 高糖局部注射; 英夫利西单抗; 挂线; 效果

Key words: Crohn’s disease; anal fistula; local injection of high concentration of glucose; infliximab; seton; effect

引用本文: 徐民民, 王浩, 竺平, 谷云飞, 陈邑岐, 陈红锦, 李悠然, 曾莉. 拆除引流挂线后局部注射高浓度葡萄糖对克罗恩病肛瘘的疗效初探. 中国普外基础与临床杂志, 2018, 25(6): 714-720. doi: 10.7507/1007-9424.201711050 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Rozpondek P, Zwolińska-Wcisło M, Przybylska M, et al. Effectiveness of anti-TNF alpha antibodies in treatment of fistulizing Crohn’s disease. Przegl Lek, 2011, 68(9): 602-605.
2. Caprilli R, Gassull MA, Escher JC, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut, 2006, 55 Suppl 1: i36-i58.
3. Gionchetti P, Dignass A, Danese S, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: surgical management and special situations. J Crohns Colitis, 2017, 11(2): 135-149.
4. Gecse KB, Bemelman W, Kamm MA, et al. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut, 2014, 63(9): 1381-1392.
5. Molan PC. The evidence supporting the use of honey as a wound dressing. Int J Low Extrem Wounds, 2006, 5(1): 40-54.
6. Paine E, Shen B. Endoscopic therapy in inflammatory bowel diseases (with videos). Gastrointest Endosc, 2013, 78(6): 819-835.
7. 中华医学会消化病学分会炎症性肠病学组. 炎症性肠病诊断与治疗的共识意见 (2012 年·广州). 胃肠病学, 2012, 17(12): 763-781.
8. 王浩, 徐民民, 竺平, 等. 保留括约肌挂线引流术联合英夫利昔单抗治疗肛周瘘管型克罗恩病的短期临床疗效. 中国普外基础与临床杂志, 2017, 24(11): 1380-1383.
9. 欧强, 谷云飞, 陈邑歧, 等. 保留括约肌挂线法治疗克罗恩病肛瘘的临床疗效评价 (附 22 例报道). 中国普外基础与临床杂志, 2014, 21(4): 479-481.
10. 杨柏霖, 林秋, 陈红锦, 等. 英夫利昔单抗联合手术治疗克罗恩病肛瘘的临床疗效. 中华胃肠外科杂志, 2013, 16(4): 323-327.
11. 中华医学会消化病学分会炎症性肠病学组. 炎症性肠病营养支持治疗专家共识 (2013·深圳). 中华内科杂志, 2013, 52(12): 1082-1087.
12. Best WR, Becktel JM, Singleton JW, et al. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology, 1976, 70(3): 439-444.
13. Irvine EJ. Usual therapy improves perianal Crohn’s disease as measured by a new disease activity index. McMaster IBD Study Group. J Clin Gastroenterol, 1995, 20(1): 27-32.
14. 李悠然, 谷云飞, 练磊.世界胃肠病组织克罗恩病肛瘘专家共识. 中华胃肠外科杂志, 2015, 18(7): 726-729.
15. 王俊珊, 刘占举. 克罗恩病所致肛瘘的诊治进展. 医学与哲学, 2016, 37(16): 54-56.
16. Hyder SA, Travis SP, Jewell DP, et al. Fistulating anal Crohn’s disease: results of combined surgical and infliximab treatment. Dis Colon Rectum, 2006, 49(12): 1837-1841.
17. Tanaka S, Matsuo K, Sasaki T, et al. Clinical advantages of combined seton placement and infliximab maintenance therapy for perianal fistulizing Crohn’s disease: when and how were the seton drains removed? Hepatogastroenterology, 2010, 57(97): 3-7.
18. Al-Maawali AK, Nguyen P, Phang PT. Modern treatments and stem cell therapies for perianal Crohn’s fistulas. Can J Gastroenterol Hepatol, 2016, 2016: 1651570.
19. 张喆, 秦芳芳, 杨俊, 等. 干细胞移植治疗克罗恩病肛瘘的研究进展. 国际消化病杂志, 2017, 37(1): 8-11.
20. Ciccocioppo R, Gallia A, Sgarella A, et al. Long-term follow-up of Crohn disease fistulas after local injections of bone marrow-derived mesenchymal stem cells. Mayo Clin Proc, 2015, 90(6): 747-755.
21. Alessandroni L, Kohn A, Cosintino R, et al. Local injection of infliximab in severe fistulating perianal Crohn’s disease: an open uncontrolled study. Tech Coloproctol, 2011, 15(4): 407-412.
22. Tonelli F, Giudici F, Asteria CR. Effectiveness and safety of local adalimumab injection in patients with fistulizing perianal Crohn’s disease: a pilot study. Dis Colon Rectum, 2012, 55(8): 870-875.
23. Vlcekova P, Krutakova B, Takac P, et al. Alternative treatment of gluteofemoral fistulas using honey: a case report. Int Wound J, 2012, 9(1): 100-103.
24. 杨柏霖, 竺平, 孙桂东. 克罗恩病肛瘘的诊断与治疗. 世界华人消化杂志, 2009, 17(20): 2058-2063.
25. 朱威, 胡福良, 李英华, 等. 蜂蜜的抗菌机理及其抗菌效果的影响因素. 天然产物研究与开发, 2004, 16(4): 372-375.