甲氨蝶呤治疗克罗恩病的黏膜愈合：与巯嘌呤和英夫利昔单抗的前瞻性比较研究。
Mucosal healing with methotrexate in Crohn's disease: a prospective comparative study with azathioprine and infliximab.
机构信息
CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, Pessac, France.
出版信息
Aliment Pharmacol Ther. 2011 Mar;33(6):714-21. doi: 10.1111/j.1365-2036.2010.04569.x. Epub 2011 Jan 16.
BACKGROUND
Mucosal healing has become a new therapeutic goal in Crohn's disease and can be achieved with azathioprine (AZA) or biologics. Methotrexate (MTX) is an effective drug for both the induction and maintenance of remission in Crohn's disease. However, mucosal healing with MTX has been poorly investigated.
AIM
To assess the mucosal healing rate in patients with Crohn's disease with clinical response to MTX as compared with AZA or infliximab (IFX).
METHODS
From October 2007 to May 2009, consecutive patients with Crohn's disease were prospectively enrolled into a single-centre study when they met the following criteria: previous identification of mucosal ulcerations with ileo-colonoscopy, clinical remission within at least 3 months with MTX, AZA or IFX monotherapy, usual indication for colonoscopy in Crohn's disease (dysplasia/cancer screening, suspected stenosis) excluding assessment for mucosal healing. Mucosal healing was defined as absence of mucosal ulceration in all segments.
RESULTS
Fifty-one patients with Crohn's disease (38 female; median age: 42 years) were included: 18 receiving MTX, 18 AZA and 15 IFX. Mucosal healing was achieved in 2/18 (11%) with MTX, in 9/18 (50%) with AZA (P =0.011 vs. MTX) and in 9/15 (60%) with IFX (P=0.008 vs. MTX).
CONCLUSION
In patients with Crohn's disease in sustained clinical remission, mucosal healing is less frequently achieved with MTX as compared with AZA or IFX.
背景
黏膜愈合已成为克罗恩病的新治疗目标，可通过硫唑嘌呤（AZA）或生物制剂实现。甲氨蝶呤（MTX）是一种有效的药物，可诱导和维持克罗恩病缓解。然而，MTX 对黏膜愈合的作用尚未得到充分研究。
目的
评估 MTX 治疗后临床缓解的克罗恩病患者的黏膜愈合率，与 AZA 或英夫利昔单抗（IFX）进行比较。
方法
2007 年 10 月至 2009 年 5 月，连续入组满足以下标准的克罗恩病患者：先前通过回结肠镜检查发现黏膜溃疡，MTX、AZA 或 IFX 单药治疗至少 3 个月后临床缓解，克罗恩病通常需要行结肠镜检查（筛查异型增生/癌症，疑似狭窄），不评估黏膜愈合。黏膜愈合定义为所有肠段均无黏膜溃疡。
结果
共纳入 51 例克罗恩病患者（38 例女性；中位年龄：42 岁）：18 例接受 MTX，18 例接受 AZA，15 例接受 IFX。MTX 组中 2/18（11%）例患者达到黏膜愈合，AZA 组中 9/18（50%）例患者达到黏膜愈合（P=0.011 对比 MTX），IFX 组中 9/15（60%）例患者达到黏膜愈合（P=0.008 对比 MTX）。
结论
在持续临床缓解的克罗恩病患者中，MTX 诱导黏膜愈合的频率低于 AZA 或 IFX。
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