中国普外基础与临床杂志

中国普外基础与临床杂志

英夫利昔单抗联合挂线治疗克罗恩病肛瘘的长期疗效

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目的 探讨英夫利昔单抗(inlfiximab,IFX)联合挂线治疗克罗恩病(Crohns disease,CD)肛瘘的长期疗效并分析影响临床愈合和复发的因素。 方法 从南京中医药大学附属医院临床医疗 HIS 数据库中收集 2010 年 7 月至 2017 年 1 月期间接受 IFX 联合挂线治疗、随访时间超过 1 年的 CD 肛瘘患者,统计瘘管愈合及复发情况并分析其影响因素。 结果 本研究中共纳入符合标准的 103 例 CD 肛瘘患者,中位随访时间 36 个月,64 例瘘管完全愈合,其中 47 例无复发愈合;34 例复发,1、3、5 年累积瘘管复发率分别为 21.8%、32.6% 和 37.4%。多因素分析显示:蒙特利尔分型 B1[HR=3.987,95% CI(1.640,9.694),P=0.023]和无脓肿[HR=2.724,95% CI (1.101,6.740),P=0.030]是瘘管长期愈合的有利因素;IFX 维持治疗>3 次[HR=5.497,95% CI (1.197–25.251),P=0.028]是瘘管复发的危险因素。 结论 IFX 联合挂线治疗 CD 肛瘘后患者长期愈合较高,蒙特利尔分型 B1 型、不伴脓肿,IFX 维持治疗≤3 次患者的长期疗效更好。

Objective To investigate long-term efficacy of infliximab (IFX) combined with seton placement in treatment of anal fistula with Crohn disease (CD) and to analyze factors affecting its clinical healing and recurrence. Methods The CD patients with anal fistula underwent the IFX combined with seton placement therapy from July 2010 to January 2017 were collected from the HIS database of the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine. The healing and recurrence of anal fistula with CD were counted and their influencing factors were analyzed. Results A total of 103 CD patients with anal fistula were included in the study. After a median follow-up of 36 months, 64 patients (62.1%) had a complete fistula healing, 34 patients (33.0%) relapsed. The cumulative recurrence rates of fistula in the 1, 3, and 5 years was 21.8%, 32.6%, and 37.4%, respectively. The multivariate analysis showed that the Montreal classification B1 [HR=3.987, 95% CI (1.640, 9.694), P=0.023] and no abscess [HR=2.724, 95% CI (1.101–6.740), P=0.030] were positively associated with the long-term healing of fistula, and the IFX maintenance treatment >3 times [ HR=5.497, 95% CI (1.197, 25.251), P=0.028] was a risk factor for the recurrence. Conclusions Long-term healing of fistula by IFX combined with seton placement therapy is higher. Montreal classification B1, without abscess, and IFX maintenance treatment less than 3 times are expected to have a better long-term efficacy.

关键词: 克罗恩; 肛瘘; 长期疗效; 影响因素

Key words: Crohn disease; anal fistula; long-term efficacy; influencing factors

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1. Ng WK, Wong SH, Ng SC. Changing epidemiological trends of inflammatory bowel disease in Asia. Intest Res, 2016, 14(2): 111-119.
2. 李冠炜, 任建安. 重视我国克罗恩病流行病学的研究. 肠外与肠内营养, 2017, 24(3): 135-137.
3. Molendijk I, Nuij VJ, van der Meulen-de Jong AE, et al. Disappointing durable remission rates in complex Crohn’s disease fistula. Inflamm Bowel Dis, 2014, 20(11): 2022-2028.
4. Molendijk I, Peeters KC, Baeten CI, et al. Improving the outcome of fistulising Crohn’s disease. Best Pract Res Clin Gastroenterol, 2014, 28(3): 505-518.
5. de Zoeten EF, Pasternak BA, Mattei P, et al. Diagnosis and treatment of perianal Crohn disease: NASPGHAN clinical report and consensus statement. J Pediatr Gastroenterol Nutr, 2013, 57(3): 401-412.
6. 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(04): 323-327.
7. Schwartz DA, Wang A, Ozbay B, et al. Comparison of health care utilization and costs between patients with perianal fistulizing Crohn’s disease treated with biologics with or without previous seton placement. Inflamm Bowel Dis, 2017, 23(10): 1860-1866.
8. Bouguen G, Siproudhis L, Gizard E, et al. Long-term outcome of perianal fistulizing Crohn’s disease treated with infliximab. Clin Gastroenterol Hepatol, 2013, 11(8): 975-981.
9. Yassin NA, Askari A, Warusavitarne J, et al. Systematic review: the combined surgical and medical treatment of fistulising perianal Crohn’s disease. Aliment Pharmacol Ther, 2014, 40(7): 741-749.
10. Topstad DR, Panaccione R, Heine JA, et al. Combined seton placement, infliximab infusion, and maintenance immunosuppressives improve healing rate in fistulizing anorectal Crohn’s disease: a single center experience. Dis Colon Rectum, 2003, 46(5): 577-583.
11. Talbot C, Sagar PM, Johnston MJ, et al. Infliximab in the surgical management of complex fistulating anal Crohn's disease. Colorectal Dis, 2005, 7(2): 164-168.
12. Bell SJ, Williams AB, Wiesel P, et al. The clinical course of fistulating Crohn’s disease. Aliment Pharmacol Ther, 2003, 17(9): 1145-1151.
13. Schwartz DA, Loftus EV Jr, Tremaine WJ, et al. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology, 2002, 122(4): 875-880.
14. Mizrahi N, Wexner SD, Zmora O, et al. Endorectal advancement flap: are there predictors of failure? Dis Colon Rectum, 2002, 45(12): 1616-1621.
15. Sandborn WJ, Fazio VW, Feagan BG, et al. AGA technical review on perianal Crohn’s disease. Gastroenterology, 2003, 125(5): 1508-1530.
16. 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.
17. van Koperen PJ, Safiruddin F, Bemelman WA, et al. Outcome of surgical treatment for fistula in ano in Crohn’s disease. Br J Surg, 2009, 96(6): 675-679.
18. Orlando A, Colombo E, Kohn A, et al. Infliximab in the treatment of Crohn’s disease: predictors of response in an Italian multicentric open study. Dig Liver Dis, 2005, 37(8): 577-583.
19. D’Haens GR, Panaccione R, Higgins PD, et al. The london position statement of the world congress of gastroenterology on biological therapy for IBD with the European Crohn’s and Colitis Organization: when to start, when to stop, which drug to choose, and how to predict response? Am J Gastroenterol, 2011, 106(2): 199-212.
20. Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med, 2004, 350(9): 876-885.
21. de Groof EJ, Sahami S, Lucas C, et al. Treatment of perianal fistula in Crohn’s disease: a systematic review and meta-analysis comparing seton drainage and anti-tumour necrosis factor treatment. Colorectal Dis, 2016, 18(7): 667-675.
22. Hotokezaka M, Ikeda T, Uchiyama S, et al. Results of seton drainage and infliximab infusion for complex anal Crohn’s disease. Hepatogastroenterology, 2011, 58(109): 1189-1192.
23. El-Gazzaz G, Hull T, Church JM. Biological immunomodulators improve the healing rate in surgically treated perianal Crohn’s fistulas. Colorectal Dis, 2012, 14(10): 1217-1223.
24. Antakia R, Shorthouse AJ, Robinson K, et al. Combined modality treatment for complex fistulating perianal Crohn’s disease. Colorectal Dis, 2013, 15(2): 210-216.
25. Brochard C, Landemaine A, L’Heritier AM, et al. Anal fistulas in severe perineal Crohn’s disease: Mri assessment in the determination of long-term healing rates. Inflamm Bowel Dis, 2018, 24(7): 1612-1618.
26. Short SS, Dubinsky MC, Rabizadeh S, et al. Distinct phenotypes of children with perianal perforating Crohn’s disease. J Pediatr Surg, 2013, 48(6): 1301-1305.
27. Geltzeiler CB, Wieghard N, Tsikitis VL. Recent developments in the surgical management of perianal fistula for Crohn’s disease. Ann Gastroenterol, 2014, 27(4): 320-330.
28. Tougeron D, Savoye G, Savoye-Collet C, et al. Predicting factors of fistula healing and clinical remission after infliximab-based combined therapy for perianal fistulizing Crohn’s disease. Dig Dis Sci, 2009, 54(8): 1746-1752.
29. Panés J, Rimola J. Perianal fistulizing Crohn’s disease: pathogenesis, diagnosis and therapy. Nat Rev Gastroenterol Hepatol, 2017, 14(11): 652-664.
30. 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.
31. Fields S, Rosainz L, Korelitz BI, et al. Rectal strictures in Crohn’s disease and coexisting perirectal complications. Inflamm Bowel Dis, 2008, 14(1): 29-31.
32. Jones DW, Finlayson SR. Trends in surgery for Crohn’s disease in the era of infliximab. Ann Surg, 2010, 252(2): 307-312.