Department of Gastroenterology, University Hospital Leuven, 3000 Leuven, Belgium.
Nat Rev Gastroenterol Hepatol. 2010 Feb;7(2):79-85. doi: 10.1038/nrgastro.2009.220.
The natural history of Crohn's disease is characterized by progression to complicated and disabling disease, often necessitating surgical interventions. There is either circumstantial or direct evidence to support the disease-modifying potential of several therapeutic agents. Healing of endoscopic lesions is an emerging surrogate marker of disease modification, as mucosal lesions are considered to reflect ongoing inflammation and tissue damage that lead to the formation of fistulas and fibrotic strictures, which are the main indications for surgery. In contrast to systemic steroids, both azathioprine and anti-tumor necrosis factor (TNF) agents have demonstrated the potential of mucosal healing. Prevention of hospitalization and surgery in the short and medium term has been demonstrated for the anti-TNF agents infliximab and adalimumab. The evidence supporting a role for medical therapy in the prevention of fibrotic wall thickening and in the obliteration of fistula tracks is limited and should be the focus of further prospective studies. These studies should validate predictors of complicated disease and randomized studies should be performed in high-risk groups to investigate whether early introduction of immunosuppressive agents or biologic therapies slows down disease progression and alters the natural history of the disease.
克罗恩病的自然病程特点是进展为复杂和致残性疾病，常需要手术干预。有间接或直接证据支持几种治疗药物具有疾病修饰作用。内镜下病变的愈合是疾病修饰的一个新兴替代标志物，因为黏膜病变被认为反映了持续的炎症和组织损伤，导致瘘管和纤维性狭窄的形成，这是手术的主要指征。与全身皮质类固醇不同，硫唑嘌呤和抗肿瘤坏死因子（TNF）药物都显示出黏膜愈合的潜力。抗 TNF 药物英夫利昔单抗和阿达木单抗已证明在短期和中期有预防住院和手术的作用。医学治疗在预防纤维性壁增厚和瘘管轨道闭塞方面的作用的证据有限，应成为进一步前瞻性研究的重点。这些研究应验证复杂疾病的预测因素，并在高危人群中进行随机研究，以探讨早期使用免疫抑制剂或生物疗法是否能减缓疾病进展并改变疾病的自然病程。
