Rayen J, Currie T, Gearry R B, Frizelle F, Eglinton T
Department of Surgery, Middlemore Hospital, Auckland, New Zealand.
Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
Tech Coloproctol. 2017 Feb;21(2):119-124. doi: 10.1007/s10151-016-1578-4. Epub 2017 Jan 9.
The aim of the present study was to evaluate the long-term outcomes of anti-tumour necrosis factor alpha therapy in perianal Crohn's disease and identify factors predicting response to treatment.
Data from hospital clinical records and coding databases were retrospectively reviewed from a tertiary care hospital in Christchurch, New Zealand. The study included 75 adult patients with perianal Crohn's disease commenced on anti-tumour necrosis factor alpha therapy from January 2000 to December 2012. Response to treatment was determined from records relating to clinical evaluation, magnetic resonance imaging follow-up and whether further surgical intervention was required.
73% (55) of all patients and 38 of the 57 (67%) patients with perianal fistulas responded to anti-tumour necrosis factor alpha therapy. Patients with complex fistulas were less likely to improve as compared to patients without fistulising disease. Five of the 57 (13%) patients with perianal fistulas demonstrated complete healing on clinical evaluation; however, magnetic resonance imaging confirmed complete healing in only two. Patients that had taken antibiotics and those that had previously required abscess drainage were less likely to respond to treatment [relative risk (RR) = 0.707 and 0.615, respectively; p = 0.03, p = 0.0001]. Responders were less likely to require follow-up surgery (RR = 0.658, p = 0.014) including ileostomy or proctectomy.
Although anti-tumour necrosis factor alpha tends to improve symptoms of perianal Crohn's disease, in the long term, it rarely achieves complete healing. Perianal fistulising disease, a history of perianal abscess and antibiotic treatment are predictors of poor response to therapy.
本研究旨在评估抗肿瘤坏死因子α治疗肛周克罗恩病的长期疗效，并确定预测治疗反应的因素。
对新西兰克赖斯特彻奇一家三级护理医院的医院临床记录和编码数据库中的数据进行回顾性分析。该研究纳入了2000年1月至2012年12月开始接受抗肿瘤坏死因子α治疗的75例成年肛周克罗恩病患者。根据临床评估记录、磁共振成像随访结果以及是否需要进一步手术干预来确定治疗反应。
所有患者中有73%（55例）以及57例肛周瘘管患者中的38例（67%）对抗肿瘤坏死因子α治疗有反应。与无瘘管疾病的患者相比，复杂性瘘管患者改善的可能性较小。57例肛周瘘管患者中有5例（13%）在临床评估中显示完全愈合；然而，磁共振成像仅证实2例完全愈合。服用过抗生素的患者和先前需要脓肿引流的患者对治疗反应的可能性较小[相对风险（RR）分别为0.707和0.615；p = 0.03，p = 0.0001]。有反应的患者需要进行包括回肠造口术或直肠切除术在内的后续手术的可能性较小（RR = 0.658，p = 0.014）。
虽然抗肿瘤坏死因子α倾向于改善肛周克罗恩病的症状，但从长期来看，它很少能实现完全愈合。肛周瘘管疾病、肛周脓肿病史和抗生素治疗是治疗反应不佳的预测因素。
