摘要
目的回顾分析患者临床表现和治疗方案,为根据病情选择合理治疗方案提供依据。方法根据诊断年份分为2005 ~ 2009 年和2010 ~ 2014 年两组。结果两组临床表现无差异(P >0.05),2010 ~ 2014 年的手术率低于2005 ~ 2009 年(P <0.05),合并肛周疾病手术率低,穿透者手术率高。确诊时首先采用内科药物治疗人数2010 ~ 2014 年比2005 ~ 2009 年增加(P <0.05)。5-氨基水杨酸使用率2010 ~ 2014 年低于2005 ~ 2009年(P <0.05),在结肠累及、非狭窄非穿透行为和狭窄的患者中使用率高。免疫抑制剂的使用率2010 ~ 2014 年高于2005 ~ 2009 年(P <0.05),在17 ~ 40 岁、结肠累及和狭窄者中使用率高。抗TNF-α单克隆抗体(英夫利昔)的使用率2010 ~ 2014 年也高于2005 ~ 2009 年(P <0.05),≤ 16 岁、非狭窄非穿透行为和肛周疾病者使用率高。结论诊断时无并发症的患者多采用经典的“升阶梯”方案,而应用英夫利昔的“降阶梯”方案选择的是≤ 16 岁合并肛周疾病的非狭窄非穿透患者;已发生并发症的患者手术率降低,更多狭窄患者使用免疫抑制剂控制疾病活动性;如果条件不允许,则换用加速的“升阶梯”方案,等待时机。总之,针对不同病情采用不同治疗方案最大可能惠及患者。
Objective Crohn's disease (CD) has a variety of clinical manifestations and treatment options. By reviewing the clinical manifestations and treatment options, this study aims to analyze how to rationally select treatment according to the manifestations of CD patients. Methods Patients diagnosed as CD in RenJi Hospital from 2005 to 2014 were divided into two groups based on year of diagnosis: 2005 to 2009 and 2010 to 2014. Medical information was recorded. Results There was no significant difference in clinical manifestations between the two groups. Operation rate during 2010 to 2014 was significantly lower than that during 2005 to 2009 (P < 0.05). The operation rate was low in the patients with perianal diseases, while that was high in the patients with penetrating complication. The number of patients who received medicines at the time of diagnosis was significantly increased during 2010 to 2014 when compared with that during 2005 to 2009 (P < 0.05). Use of 5-aminosalicylic acid was decreased during 2010 to 2014 when compared with that during 2005 to 2009 (P < 0.05), especially in the patients with colonic involvement, non-stricturing and non-penetrating and stricturing behavior. Use of immunosuppressors was increased significantly during 2010 to 2014 when compared with that during 2005 to 2009 (P < 0.05), especially in patients aging from 17 to 40 years old, with colonic involvement and stricturing behavior. Use of infliximab was increased significantly during 2010 to 2014 when compared with that during 2005 to 2009 (P < 0.05), especially in the patients of ≤ 16 years old, non-stricturing and non-penetrating behavior and had perianal disease. Conclusions Patients without complications most likely adopt the "step-up" strategy, while the "top-down" strategy with infliximab is used in patients of ≤ 16 years old, or with perianal disease. The surgical rate is reduced in patients with complications due to increased application of immunosuppressive therapy. The accelerated "step-up" strategy is rational if conditi
作者
邬思远
杨川华
孙伟力
孙筱
张尧
戈之铮
Si-Yuan Wu;Chuan-hua Yang;Wei-li Sun;Xiao Sun;Yao Zhang;Zhi-zheng Ge(Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University,Shanghai 200001, China;Division of Experimental Medicine, Department of Medicine,McGill University, Montreal, Quebec H3A 0G4, Canada)
出处
《中国现代医学杂志》
CAS
2019年第17期63-70,共8页
China Journal of Modern Medicine
基金
国家自然科学基金(No:81370509)
