Alourfi Mansour, Mosli Mahmoud, Saadah Omar I
Internal Medicine, King Faisal Medical City for Southern Regions, Abha, SAU.
Internal Medicine, King Abdulaziz University, Jeddah, SAU.
Cureus. 2020 Sep 8;12(9):e10315. doi: 10.7759/cureus.10315.
Introduction Crohn's disease (CD) is a chronic inflammatory disease. Current treatment aims to prevent complications and the need for surgical intervention. In patients with symptomatic complications, such as strictures, the possible benefits of anti-tumor necrosis factor-alpha (anti-TNF-α) therapy are currently the subject of considerable debate. This study aims to determine whether anti-TNF-α therapy could decrease the need for or delay the time until surgery in patients with CD presenting with symptomatic strictures of the small bowel in the King Abdulaziz University Hospital (KAUH), Saudi Arabia. Methods We conducted a retrospective, single-center study that assessed the need for surgical treatment in adult patients with symptomatic stricturing CD who were treated conventionally or with TNF-α inhibitors. Simple logistic regression was used to examine the association between surgical resection and biologics therapy and stepwise elimination logistic regression analysis was used to identify predictors of surgical resection. Results In total, 75 patients fulfilled the study criteria with 50 in the anti-TNF-α arm and 25 in the conventional arm. Surgical resection was required for six patients (12.2%) in the anti-TNF-α treatment arm and one patient (4%) in the conventional treatment arm (P=0.26). Endoscopic balloon dilatation was performed in two patients (4%) in the anti-TNF-α arm and one patient (4%) in the conventional arm (P=0.69). No statistically significant association was observed between surgical resection and treatment with biologic therapy (odds ratio [OR]=0.50, 95% CI: 0.16-1.53, P=0.22). Stepwise elimination identified age (OR=4.54, 95% CI: 0.79-25.11, P=0.09) and disease duration (OR=1.01, 95% CI: 1.00-1.02, P=0.004) as significant predictors of surgery. Conclusions In this cohort, anti-TNF-α therapy did not provide additional benefits with regards to avoiding or delaying surgery in CD patients with stricturing of the small bowel.
引言
克罗恩病（CD）是一种慢性炎症性疾病。当前的治疗旨在预防并发症以及避免手术干预。对于出现诸如狭窄等症状性并发症的患者，抗肿瘤坏死因子-α（抗TNF-α）治疗的潜在益处目前是相当多争论的主题。本研究旨在确定抗TNF-α治疗能否减少沙特阿拉伯阿卜杜勒阿齐兹国王大学医院（KAUH）中出现小肠症状性狭窄的CD患者的手术需求或延迟手术时间。
方法
我们进行了一项回顾性单中心研究，评估接受传统治疗或TNF-α抑制剂治疗的有症状性狭窄CD成年患者的手术治疗需求。使用简单逻辑回归来检验手术切除与生物制剂治疗之间的关联，并使用逐步消除逻辑回归分析来确定手术切除的预测因素。
结果
总共75名患者符合研究标准，其中抗TNF-α组50名，传统治疗组25名。抗TNF-α治疗组中有6名患者（12.2%）需要手术切除，传统治疗组中有1名患者（4%）需要手术切除（P = 0.26）。抗TNF-α组中有2名患者（4%）接受了内镜球囊扩张，传统治疗组中有1名患者（4%）接受了内镜球囊扩张（P = 0.69）。未观察到手术切除与生物制剂治疗之间存在统计学上的显著关联（优势比[OR]=0.50，95%置信区间：0.16 - 1.53，P = 0.22）。逐步消除分析确定年龄（OR = 4.54，95%置信区间：0.79 - 25.11，P = 0.09）和病程（OR = 1.01，95%置信区间：1.00 - 1.02，P = 0.004）是手术的显著预测因素。
结论
在该队列中，对于患有小肠狭窄的CD患者，抗TNF-α治疗在避免或延迟手术方面未提供额外益处。
