Perianal fistulae following infliximab treatment - Clinical and endosonographic outcome
Perianal fistulae following infliximab treatment - Clinical and endosonographic outcome
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DOI：
10.1097/00054725-200403000-00005
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发表时间：
2004-03-01
影响因子：
4.9
通讯作者：
Porro, GB
中科院分区：
文献类型：
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作者：
Ardizzone, S;Maconi, G;Porro, GB
背景：肛周和直肠阴道瘘合并克罗恩病（CD）的处理是不令人满意的。英夫利昔单抗在治疗瘘管性乳糜泻方面是有效的。然而，瘘管重新开放是频繁的，这表明尽管表面愈合，深瘘管束仍然存在。在本研究中，评估了英夫利昔单抗输注后肛周瘘的临床和超声行为，以及肛门超声（AE）在预测其预后中的作用。方法：30例出现肛周和/或直肠阴道瘘的CD患者在第0周（进入研究）、第2周和第6周接受了剂量为5mg /kg的英夫利昔单抗输注。在相同的时间间隔和第10周重复实验室和临床评估。在入组和第10周进行AE。此后，每6个月复查一次肛周区域，并调查患者前几个月的瘘管引流情况。结果：15例患者（53.6%）在第10周瘘道闭合，但仅有5例患者在AE时瘘道消失。直肠阴道瘘的临床和AE闭合率低于肛周瘘[14.3%对63.6%，第6周（p = 0.035）；28.6% vs .第10周59.1% (p = 0.21)；AE时14.3% vs 22.7% (p = 1.00)]。瘘的行为不受其数量和AE分类、直肠疾病的存在或setons的影响。对20例肛周瘘管患者进行随访，中位时间为15.5个月。术后第10周闭合性肛周瘘在AE时瘘道消失的患者复发率低于超声显示瘘道持续存在的患者。结论：英夫利昔单抗治疗肛周瘘和直肠阴道瘘的成功率分别约为60%和30%。尽管关闭，大多数瘘管束在AE仍可检测到。持续的内道是瘘复发的高风险条件。
Background: Management of perianal and rectovaginal fistulae complicating Crohn's disease (CD) is unsatisfactory. Infliximab is effective in the treatment of fistulating CD. However, reopening of fistulae is frequent, suggesting the persistence of deep fistula tracts despite superficial healing. In this study, the clinical and endosonographic behavior of perianal fistulae were evaluated following infliximab infusions, as well as the role of anal endosonography (AE) in predicting their outcome.Methods: Thirty CD patients presenting with perianal and/or rectovaginal fistulae received an infusion of infliximab at a dose of 5 mg/kg at weeks 0 (entry into the study), 2, and 6. Laboratory and clinical assessments were repeated at same intervals and at week 10. AE was performed at entry and at week 10. Thereafter, the perianal region was re-examined every 6 months, and patients were investigated regarding draining of the fistula in the previous months.Results: Fifteen patients (53.6%) showed closure of the fistulae at week 10, but only 5 patients had the fistula tracts disappeared at AE. Clinical and AE closure of rectovaginal fistulae was less prevalent than that of perianal fistulae [14.3% versus 63.6% at week 6 (p = 0.035); 28.6% versus 59.1% at week 10 (p = 0.21); 14.3% versus 22.7% at AE (p = 1.00)]. The behavior of fistulae was not affected by their number and AE classification, presence of rectal disease, or setons. Twenty patients with perianal fistulae were followed for a median of 15.5 months. Patients with closed perianal fistulae at week 10 and disappearance of fistulae tract at AE showed a lower relapse rate than those with endosonographic persistence of fistula tract.Conclusions: Infliximab can heal perianal and rectovaginal fistulae in approximately 60% and 30% of patients, respectively. Despite closure, most fistula tracts are still detectable at AE. Persistence of the internal tract is a condition at higher risk of fistula recurrence.