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高压治疗对克罗恩病患者肛周瘘管活动的影响。

The effects of hyperbaric treatment on perianal fistula activity in patients with Crohn's disease.

作者信息

Piotrowicz Grażyna, Kot Jacek, Babicki Andrzej, Banaszkiewicz Piotr, Piotrowicz Adam, Rzeszutek Magdalena, Rudnik Agata, Zientara Piotr, Adamska-Mieruszewska Joanna, Rydzewska Grażyna

机构信息

Department of Gastroenterology, Self-Dependent Health Care Unit of Ministry of Interior and Administration, Gdansk, Poland.

National Centre for Hyperbaric Medicine Institute of Maritime and Tropical Medicine in Gdynia, Medical University of Gdansk, Poland.

出版信息

Prz Gastroenterol. 2024;19(3):321-332. doi: 10.5114/pg.2024.143439. Epub 2024 Sep 23.

Abstract

INTRODUCTION

Crohn's disease is a chronic, complex inflammatory disorder of the gastrointestinal tract. Among its most challenging complications are perianal fistulas.

AIM

This study aims to explore the efficacy of hyperbaric oxygen therapy (HBOT) in reducing the activity of perianal fistulas in Crohn's disease patients.

MATERIAL AND METHODS

This study enrolled patients diagnosed with Crohn's disease-associated perianal fistulas, with a disease duration of at least 3 years. Participants underwent HBOT in conjunction with standard medical therapy. The therapeutic effects were assessed at predetermined intervals using the Crohn's Disease Activity Index (CDAI), and laboratory parameters including faecal calprotectin levels, C-reactive protein (CRP) activity, serum iron concentration, and peripheral blood haemoglobin levels. Additionally, the Simple Endoscopic Score for Crohn's Disease (SESCD) and the Perianal Disease Activity Index (PDAI) were employed for evaluation.

RESULTS

The adjunctive use of HBOT with conventional therapy yielded significant clinical improvements in patients with Crohn's disease complicated by perianal fistulas. This was shown by an 81.8% improvement in CDAI scores and a 54.5% clinical remission rate, as determined by SESCD and PDAI. Notably, the beneficial effects of HBOT on SESCD, PDAI, and faecal calprotectin levels were statistically significant and persisted for 6 weeks post-HBOT, with sustained improvements observed in a follow-up assessment approximately 9 months after treatment.

CONCLUSIONS

The findings of this study suggest that HBOT may be a viable therapeutic adjunct in the management of complex cases of Crohn's disease, particularly those with recurrent symptoms and limited responsiveness to conventional treatments. HBOT demonstrated potential in improving clinical outcomes and achieving remission rates exceeding 50%, indicating its promise as a treatment modality in this patient population.

摘要

引言

克罗恩病是一种慢性、复杂的胃肠道炎症性疾病。其最具挑战性的并发症之一是肛周瘘管。

目的

本研究旨在探讨高压氧治疗(HBOT)对降低克罗恩病患者肛周瘘管活性的疗效。

材料与方法

本研究纳入诊断为克罗恩病相关性肛周瘘管、病程至少3年的患者。参与者接受HBOT联合标准药物治疗。使用克罗恩病活动指数(CDAI)以及包括粪便钙卫蛋白水平、C反应蛋白(CRP)活性、血清铁浓度和外周血血红蛋白水平在内的实验室参数,在预定时间间隔评估治疗效果。此外,采用克罗恩病简易内镜评分(SESCD)和肛周疾病活动指数(PDAI)进行评估。

结果

HBOT与传统疗法联合使用使克罗恩病合并肛周瘘管的患者取得了显著的临床改善。这表现为CDAI评分改善81.8%,以及根据SESCD和PDAI确定的临床缓解率为54.5%。值得注意的是,HBOT对SESCD、PDAI和粪便钙卫蛋白水平的有益作用具有统计学意义,且在HBOT后持续6周,在治疗后约9个月的随访评估中观察到持续改善。

结论

本研究结果表明,HBOT可能是管理复杂克罗恩病病例的一种可行的治疗辅助手段,特别是那些有复发症状且对传统治疗反应有限的病例。HBOT在改善临床结局和实现超过50%的缓解率方面显示出潜力,表明其在该患者群体中作为一种治疗方式的前景。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8faa/11718499/1e1e44b4a075/PG-19-54860-g001.jpg

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