目的目前关于上消化道克罗恩病(L4-CD)的药物治疗研究较少。文中旨在比较5-氨基水杨酸(5-ASA)类药物与免疫抑制剂药物预防L4-CD的疗效与安全性分析。方法回顾性分析东部战区总医院2012年1月至2018年12月收治的48例L4-CD患者的临床资料。根据临床用药分为5-ASA组(使用5-ASA,n=30)和免疫抑制剂组(免疫抑制剂硫唑嘌呤、甲氨蝶呤、雷公藤,n=18)。在L4-CD的亚型中,屈氏韧带以上为L4-EGD者(n=28),屈氏韧带以下为L4-空肠与近端回肠者(n=20)。其中L4-EGD者分为5-ASA亚组(使用5-ASA,n=18),免疫亚组(使用免疫抑制剂,n=10);L4-空肠与近端回肠者分为5-ASA空回肠亚组(使用5-ASA,n=12),免疫空回肠亚组(使用免疫抑制剂,n=8)。分别记录在6、12、24个月的临床复发率、内镜复发率、手术复发率,并进行疾病行为(非狭窄非穿透、狭窄、穿透、肛周病变)的比较。结果5-ASA组6个月内内镜、临床复发率(30%、26.7%)较免疫抑制剂组(0%、0%)明显升高(P<0.05),12个月内内镜及临床复发率、24个月内内镜复发及临床复发与手术复发率亦明显升高(P<0.05)。L4-EGD组肛周病变多(P<0.05),L4-空肠与近端回肠组狭窄多(P<0.05)。L4-空肠与近端回肠者5-ASA空回肠亚组6个月内内镜、临床复发率显著高于免疫空回肠亚组(P<0.05),12月及24个月内镜、临床、手术复发率亦显著升高(P<0.05)。结论免疫抑制剂治疗L4-CD较5-氨基水杨酸复发率低、疗效好,有助于维持临床缓解和延迟手术,从而改变疾病的进展和改善预后。Objective At present,there are few studies on the drug treatment of upper gastrointestinal Crohn′s disease(L4-CD).This study aims to compare the efficacy and safety of 5-aminosalicylic acid(5-ASA)drugs and immunosuppressant drugs in the prevention of L4-CD.Methods The clinical data of 48 patients with L4-CD admitted to the General Hospital of Eastern Theater Command from January 2012 to December 2018 were retrospectively analyzed.According to clinical medication,they were divided into 5-ASA group(5-ASA,n=30)and immunosuppressant group(immunosuppressant,n=18).Among the subtypes of L4-CD,L4-EGD was found above the flexor ligament(n=28),and L4-jejunum and proximal ileum were found below the flexor ligament(n=20).L4-EGD patients were divided into 5-ASA group(n=18)and immunosubgroup(n=10).L4-jejunum and proximal ileum were divided into 5-ASA ileum subgroup(n=12)and immune ileum subgroup(n=8).The clinical,endoscopic,surgical recurrence and adverse reactions were recorded at the 6th,12th,and 24th months,and the disease behaviors(non-stenosis,non-penetrating,stenosis,penetrating,perianal lesions)were compared.Results The endoscopic and clinical recurrence rates(9%,8%)in 5-ASA group within 6 months were significantly higher than those in immunosuppressant group(0%,0%)(P<0.05).Those rates within 12 months,and the rates of endoscopic,clinical and surgical recurrence within 24 months were also significantly higher than those in 5-ASA group(P<0.05).L4-EGD patients with proximal ileum stenosis and perianal lesions were significantly more than those with L4-jejunum and proximal ileum(P<0.05).The endoscopic and clinical recurrence rates at 6 months in 5-ASA ileum subgroup were significantly higher than those in immuno ileum subgroup(P<0.05),and the endoscopic,clinical and surgical recurrence rates at 12 and 24 months also increased significantly(P<0.05).Conclusion Immunosuppressant treatment of L4-CD has lower recurrence rate and better efficacy than 5-aminosalicylic acid,which is helpful to maintain clinical remission and del
机构地区蚌埠医学院 东部战区总医院（原南京军区南京总医院）消化内科
出处《医学研究生学报》 CAS 北大核心 2021年第3期252-257,共6页Journal of Medical Postgraduates
基金国家自然科学基金(81873559)。
关键词5-氨基水杨酸 免疫抑制剂 上消化道克罗恩病 临床复发 内镜复发5-Aminosalicylic acid immunosuppressive agent upper gastrointestinal tract phenotype of Crohn′s disease the clinical relapse endoscopic recurrence
分类号R751 [医药卫生—皮肤病学与性病学]
