Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy.
Inflamm Bowel Dis. 2013 Aug;19(9):1928-34. doi: 10.1097/MIB.0b013e31829053ce.
Both thiopurines and anti-tumor necrosis factor (TNF) α agents are effective for treating Crohn's disease (CD) as they can induce clinical remission (CR) and mucosal healing (MH) in most patients. Nevertheless, data on transmural healing (TH) induced by thiopurines and anti-TNF-α agents are still lacking. This study aimed to explore the rate of TH evaluated by bowel sonography in patients with CD treated with biologics and immunosuppressors and its correlation with CR and MH.
We performed an observational longitudinal study evaluating TH, CR, and MH in all patients with CD attending our clinic who would complete 2 years of maintenance treatment with biologics or thiopurines. CR and MH were assessed in accordance with current literature, whereas TH was recorded using bowel sonography. All patients underwent endoscopy and bowel sonography before starting treatment and 2 years later.
The study included 66 patients with CD treated with biologics and 67 patients receiving thiopurines. Finally, TH was present in 17 patients on biologics and only 3 patients treated with thiopurines (25% versus 4%; P < 0.01; odds ratio = 6.2). CR was achieved in 37 patients on biologics and in 34 patients on thiopurines (59.7% versus 53%; P = not significant), whereas MH was more frequent in patients treated with anti-TNF-α agents even though without statistical significance (38% versus 25%; P = not significant).
TH can be achieved in approximately 25% of patients with CD treated with anti-TNF-α agents and significantly correlates with MH. Further studies are needed to define the potential role of TH as long-term prognostic factor.
硫嘌呤和抗肿瘤坏死因子 (TNF)α 制剂均可有效治疗克罗恩病 (CD)，因为它们可以使大多数患者达到临床缓解 (CR) 和黏膜愈合 (MH)。然而，关于硫嘌呤和抗 TNF-α 制剂诱导的透壁愈合 (TH)的数据仍然缺乏。本研究旨在探讨生物制剂和免疫抑制剂治疗的 CD 患者通过肠道超声评估 TH 的发生率及其与 CR 和 MH 的相关性。
我们进行了一项观察性纵向研究，评估了所有在我们诊所接受生物制剂或硫嘌呤维持治疗的 CD 患者的 TH、CR 和 MH。CR 和 MH 按照现有文献进行评估，而 TH 则通过肠道超声进行记录。所有患者在开始治疗前和 2 年后均接受内镜和肠道超声检查。
本研究共纳入 66 例接受生物制剂治疗和 67 例接受硫嘌呤治疗的 CD 患者。最终，生物制剂组中有 17 例患者出现 TH，而硫嘌呤组仅 3 例 (25%对 4%；P < 0.01；比值比 = 6.2)。生物制剂组有 37 例患者达到 CR，硫嘌呤组有 34 例患者达到 CR (59.7%对 53%；P = 无统计学意义)，而接受抗 TNF-α 制剂治疗的患者 MH 更为常见，尽管无统计学意义 (38%对 25%；P = 无统计学意义)。
大约 25%接受抗 TNF-α 制剂治疗的 CD 患者可达到 TH，并且与 MH 显著相关。需要进一步研究来确定 TH 作为长期预后因素的潜在作用。
