Regueiro Miguel, Mardini Houssam
University of Pittsburgh School of Medicine, Presbyterian Hospital, Pittsburgh, Pennsylvania 15261, USA.
Inflamm Bowel Dis. 2003 Mar;9(2):98-103. doi: 10.1097/00054725-200303000-00003.
Perianal fistulas occur in approximately 30% of patients with Crohn's disease (CD). Infliximab, a chimeric monoclonal antibody targeting human tumor necrosis factor alpha (TNF), is approved for the treatment of fistulizing CD. Although the initial response to infliximab is dramatic, the median duration of fistula closure is approximately 3 months, and repeated infusions are often required. An exam under anesthesia (EUA) by a surgeon allows for complete inspection of the fistula as well as incision and drainage of an abscess and placement of a seton. Our aim was to compare the rate of perianal fistula healing, relapse rate, and time to relapse in patients with fistulizing CD treated with infliximab alone or as an adjunct to surgical EUA with seton placement. Thirty-two consecutive patients with perianal fistulizing CD who completed at least 3 infusions with infliximab (5 mg/kg at 0, 2, 6 weeks) between October 1999 and October 2001 were analyzed. All patients had at least 3 months of follow-up after the third dose of infliximab. Response was defined as complete closure and cessation of drainage from the fistula. Patients with CD and perianal fistulas who had an EUA prior to infliximab infusions had a better initial response (100% vs. 82.6%, p = 0.014), lower recurrence rate (44% vs. 79%, p = 0.001), and longer time to recurrence (13.5 months vs. 3.6 months, p = 0.0001) compared with patients receiving infliximab alone. In conclusion, patients with fistulizing CD treated with infliximab are more likely to maintain fistula closure if treatment is preceded by EUA and seton placement.
肛周瘘管在约30%的克罗恩病（CD）患者中出现。英夫利昔单抗是一种靶向人肿瘤坏死因子α（TNF）的嵌合单克隆抗体，已被批准用于治疗瘘管性CD。尽管对英夫利昔单抗的初始反应显著，但瘘管闭合的中位持续时间约为3个月，且常常需要重复输注。外科医生在麻醉下进行检查（EUA）可对瘘管进行全面检查，以及切开引流脓肿并放置挂线。我们的目的是比较单独使用英夫利昔单抗治疗或作为EUA手术并放置挂线辅助治疗的瘘管性CD患者的肛周瘘管愈合率、复发率和复发时间。分析了1999年10月至2001年10月期间连续32例完成至少3次英夫利昔单抗输注（0、2、6周时5mg/kg）的肛周瘘管性CD患者。所有患者在第三次英夫利昔单抗剂量后至少随访3个月。反应定义为瘘管完全闭合且停止引流。与单独接受英夫利昔单抗治疗的患者相比，在输注英夫利昔单抗前接受EUA的CD和肛周瘘管患者初始反应更好（100%对82.6%，p = 0.014）、复发率更低（44%对79%，p = 0.001）以及复发时间更长（13.5个月对3.6个月，p = 0.0001）。总之，对于瘘管性CD患者，如果在治疗前进行EUA并放置挂线，使用英夫利昔单抗治疗时更有可能维持瘘管闭合。
