Agrawal Gaurav, Clancy Annabel, Sharma Rijata, Huynh Roy, Ramrakha Sanjay, Borody Thomas
Centre for Digestive Diseases, 1/229 Great North Rd, Five Dock, NSW 2046, Australia.
Microorganisms. 2020 Mar 6;8(3):371. doi: 10.3390/microorganisms8030371.
Prospective trials of anti-mycobacterial antibiotic therapy (AMAT) have proven efficacious in Crohn's disease (CD) but use as first-line treatment in CD has not been evaluated. This paper reports the outcomes of patients with CD treated with first-line AMAT. This paper consists of a case series of treatment-naïve CD patients who received AMAT as first-line treatment between 2007 and 2014 at a single center. AMAT treatment consisted of rifabutin, clofazimine and clarithromycin, plus either ciprofloxacin, metronidazole or ethambutol. Symptoms, inflammatory blood markers, colonoscopy and histology results, in addition to, the Crohn's Disease Activity Index (CDAI) were tabulated from patients' clinical records, and descriptive statistics were conducted. A Wilcoxon signed-rank test assessed the difference in CDAI scores before and while on AMAT. The statistical significance was set at 5%. Clinical remission (CDAI < 150) with rapid improvement in clinical symptoms and inflammatory markers was seen in all eight patients receiving AMAT as sole therapy by 6 weeks. In all eight patients, the median CDAI score decreased significantly, from 289 prior to treatment to 62 at the 12-month follow-up ( < 0.001). Follow-up colonoscopies showed healing of CD ulcers, no visible mucosal inflammation, restoration of normal vascular patterns and complete mucosal healing on histology samples. AMAT as first-line therapy demonstrated a rapid improvement of Crohn's disease (not previously seen when used as second-line therapy).
抗分枝杆菌抗生素疗法（AMAT）的前瞻性试验已证明对克罗恩病（CD）有效，但尚未评估其作为CD一线治疗方法的应用情况。本文报告了接受一线AMAT治疗的CD患者的治疗结果。本文包含一系列未经治疗的CD患者病例，这些患者于2007年至2014年在单个中心接受了AMAT一线治疗。AMAT治疗包括利福布汀、氯法齐明和克拉霉素，加环丙沙星、甲硝唑或乙胺丁醇。从患者临床记录中列出症状、炎症血液标志物、结肠镜检查和组织学结果，以及克罗恩病活动指数（CDAI），并进行描述性统计。采用Wilcoxon符号秩检验评估AMAT治疗前和治疗期间CDAI评分的差异。设定统计学显著性水平为5%。所有8例接受AMAT单一疗法的患者在6周时均出现临床缓解（CDAI < 150），临床症状和炎症标志物迅速改善。在所有8例患者中，CDAI评分中位数显著下降，从治疗前的289降至12个月随访时的62（< 0.001）。随访结肠镜检查显示CD溃疡愈合，无可见黏膜炎症，血管形态恢复正常，组织学样本显示黏膜完全愈合。AMAT作为一线治疗方法显示出克罗恩病的快速改善（此前作为二线治疗方法时未见此效果）。
