摘要
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.
作者
徐民民
王浩
竺平
谷云飞
陈邑岐
陈红锦
李悠然
曾莉
XU Minmin;WANG Hao;ZHU Ping;GU Yunfei;CHEN Yiqi;CHEN Hongjin;LI Youran;ZENG Li(Department of Colorectal Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210000, P. R. China;The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210000, P. R. China)
出处
《中国普外基础与临床杂志》
CAS
2018年第6期714-720,共7页
Chinese Journal of Bases and Clinics In General Surgery
基金
江苏省中医药局科技项目(项目编号:JD201509)
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
Crohn＇s disease
anal fistula
local injection of high concentration of glucose
infliximab
seton
effect
