Objective: To evaluate the mucosal healing in the terminal ileum, colon and small bowel in patients receiving infliximab treatment for small bowel Crohn's disease (SBCD).
Methods: The clinical data of 18 patients with SBCD treated with infliximab were analyzed for laboratory findings (routine blood tests, C-reative protein, and albumin), Crohn's disease activity index (CDAI), Lewis score (LS), Crohn's disease simplified endoscopic score (SES-CD) and adverse effects before and after 30 weeks of infliximab treatment.
Results: SES-CD, LS, CDAI and CRP were all decreased significantly, but the body mass index and albumin were significantly increased in the 18 patients after 30 weeks of IFX treatment. Sixteen (88.9%) of the patients were in clinical remission, 10 (58.8%) showed terminal ileum and colonic mucosal healing, 4 (22.2%) showed small bowel mucosal healing, and 3 (17.6%) were in deep remission. The 4 patients with small bowel mucosal healing all showed terminal ileum and colon mucosal healing, and 6 patients with terminal ileum and colon mucosal healing did not show small bowel mucosal healing.
Conclusion: Infliximab treatment can effectively reduce inflammatory activity, induce and maintain clinical remission of SBCD and achieve mucosal healing; small bowel mucosal healing occurs later than terminal ileum and colonic mucosal healing, indicating the importance of small bowel mucosal healing in efficacy analysis of the treatment.
目的: 探讨小肠受累的克罗恩病（CD）患者使用英夫利西单抗（IFX）治疗第30周回末及结肠和小肠黏膜愈合情况。
方法: 回顾性分析了18例接受IFX治疗的小肠受累CD患者的临床资料。观察治疗前和治疗后第30周时患者实验室指标（血常规、CRP、白蛋白）、克罗恩病活动度指数、胶囊内镜Lewis评分、克罗恩病简化内镜评分及不良反应的情况。
结果: 与治疗前相比，治疗后第30周18例小肠CD患者的内镜下克罗恩病简化内镜评分、Lewis评分、克罗恩病活动度指数评分、C反应蛋白均显著下降，体质量指数和白蛋白明显升高。临床缓解率为88.9%（16/18），回末及结肠黏膜愈合率58.8%（10/17，1例患者治疗后未复查结肠镜），小肠黏膜愈合率22.2%（4/18），深度缓解率17.6%（3/17）。在IFX治疗第30周，4例小肠黏膜愈合者回末及结肠黏膜均达到愈合，而回末及大肠黏膜愈合而小肠黏膜未愈合者6例。
结论: IFX可有效诱导和维持小肠CD患者的临床缓解及黏膜愈合，减轻炎性活动。小肠黏膜愈合滞后于回末及结肠的黏膜愈合。小肠CD治疗疗效评价除关注回末及结肠的黏膜愈合外，还应结合小肠黏膜愈合情况。