Keighley M R
Can J Surg. 1984 Sep;27(5):438-41.
Many patients with Crohn's disease present with the complications of infection. Hence, antibiotics play an important role in the medical management of acute inflammatory disease, persistent perianal disease and as prophylaxis for surgical operations. The author's group has demonstrated that bacteria colonize the serosa of the bowel in patients with Crohn's disease in 27% of cases. Furthermore, pathogenic bacteria could be recovered from the lymph nodes in 33% of patients with Crohn's disease, compared with only 5% in a controlled population. Extraintestinal bacterial colonization was, therefore, present in approximately half of all patients requiring an operation for Crohn's disease. The principal bacteria isolated at these sites were Escherichia coli, Streptococcus faecalis, Bacteroides fragilis, Proteus sp and diphtheroids. A prospective controlled trial on the use of 1 month's antimicrobial therapy in patients with relapse of Crohn's disease revealed that metronidazole was associated with a 57% response rate, compared with a response of only 17% in patients receiving no metronidazole. These interim findings suggest that metronidazole may have a role in the management of acute relapse in patients with Crohn's disease.
许多克罗恩病患者会出现感染并发症。因此，抗生素在急性炎症性疾病、持续性肛周疾病的治疗以及手术预防中发挥着重要作用。作者团队已证实，27%的克罗恩病患者肠道浆膜存在细菌定植。此外，33%的克罗恩病患者淋巴结中可检测到病原菌，而在对照人群中这一比例仅为5%。因此，在所有因克罗恩病需要手术的患者中，约一半存在肠外细菌定植。在这些部位分离出的主要细菌为大肠杆菌、粪肠球菌、脆弱拟杆菌、变形杆菌属和类白喉杆菌。一项针对克罗恩病复发患者使用1个月抗菌治疗的前瞻性对照试验显示，甲硝唑治疗的缓解率为57%，而未使用甲硝唑的患者缓解率仅为17%。这些初步研究结果表明，甲硝唑可能在克罗恩病患者急性复发的治疗中发挥作用。
