Yan Xiaohan, Zhu Mingming, Feng Qi, Yan Yunqi, Peng Jiangchen, Xu Xitao, Xu Antao, Ran Zhihua
Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health; Shanghai Inflammatory Bowel Disease Research Center; Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Gastroenterol Rep (Oxf). 2019 Feb;7(1):50-56. doi: 10.1093/gastro/goy036. Epub 2018 Oct 24.
Data on the radiologic evaluation of perianal fistulizing Crohn's disease (PFCD) naïve to anti-tumor necrosis factor therapy are scarce, especially in Asian populations. We assessed the effectiveness of infliximab (IFX) on PFCD and explored predictors of 'deep remission' based on clinical and radiologic assessments.
Patients with Crohn's disease and active anal fistulas attending our care center for IFX therapy were prospectively enrolled. Each patient underwent clinical examination according to the Fistula Drainage Assessment Index, endoscopy for assessment of Crohn's Disease Activity Index (CDAI) and Perianal Crohn's Disease Activity Index (PCDAI), magnetic resonance imaging (MRI) to determine Van Assche score and Ng score, and laboratory tests up to 2 weeks prior to the start of and up to 2 weeks after the sixth IFX therapy (Week 32).
Among 38 patients treated with IFX, 52.6% achieved clinical remission based on the Fistula Drainage Assessment Index and 42.1% achieved deep remission based on Ng score. Van Assche score (from 14.5 ± 4.26 to 7.36 ± 7.53), CDAI (from 170 ± 92 to 71 ± 69) and PCDAI (from 7.45 ± 2.65 to 2.44 ± 3.20) decreased significantly after six IFX treatments. The only predictor of deep remission was simple fistula (=0.004, odds ratio = 3.802, 95% confidence interval: 1.541-9.383).
IFX has been shown to have appreciable effectiveness in Chinese patients with PFCD. MRI is the gold standard for evaluating PFCD, but Van Assche score has some limitations.
关于未接受过抗肿瘤坏死因子治疗的肛周瘘管型克罗恩病（PFCD）的放射学评估数据稀缺，尤其是在亚洲人群中。我们评估了英夫利昔单抗（IFX）对PFCD的疗效，并基于临床和放射学评估探索了“深度缓解”的预测因素。
前瞻性纳入在我们护理中心接受IFX治疗的患有克罗恩病和活动性肛瘘的患者。每位患者根据瘘管引流评估指数进行临床检查，通过内镜检查评估克罗恩病活动指数（CDAI）和肛周克罗恩病活动指数（PCDAI），进行磁共振成像（MRI）以确定范阿舍评分和吴评分，并在开始IFX治疗前2周及第六次IFX治疗后（第32周）2周内进行实验室检查。
在38例接受IFX治疗的患者中，基于瘘管引流评估指数，52.6%实现了临床缓解，基于吴评分，42.1%实现了深度缓解。经过六次IFX治疗后，范阿舍评分（从14.5±4.26降至7.36±7.53）、CDAI（从170±92降至71±69）和PCDAI（从7.45±2.65降至2.44±3.20）显著下降。深度缓解的唯一预测因素是单纯性肛瘘（P = 0.004，比值比 = 3.802，95%置信区间：1.541 - 9.383）。
IFX已被证明对中国PFCD患者有显著疗效。MRI是评估PFCD的金标准，但范阿舍评分有一些局限性。
