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Objective To analyze the efficacy and tolerance of methotrexate(MTX)in remission maintenance of Crohn′s disease (CD).Methods From June 2012 to August 2015 ,49 CD patients who received MTX as mainly treatment medication to maintain remission were enrolled.The pre-medication history,efficacy,dosage and side effects of MTX were analyzed.The effects of inducing strategy on disease recurrence were analyzed.Chi-square test and t test were used for statistical analysis.Results Among the 49 patients,34 (69.4%)received steroids for remission inducing,nine (18.4%)received infliximab for remission inducing and six (12.2%)achieved remission after operation.In the 44 patients treated with azathioprine (AZA)before,the median treatment time was one month and the dosage for withdrawal of AZA was (42.0 ± 14.8)mg/d.The most common reason was leucopenia (81 .8%, 36/44).Till the time point of follow-up,46 of the 49 CD patients still took MTX orally with a median treatment time of 16 months,and the weekly dosage was (12.7 ±2.0)mg.Thirty-one cases (67.4%) achieved clinical stability,while 15 cases (32.6%)underwent clinical recurrence.The median Crohn′s disease activity index (CDAI)was 123.5 ± 66.6.The weekly dosage of clinical stability group was (12.5 ±2.1)mg,and that of clinical recurrence group was (13.0 ±1 .7 )mg,there was no statistically significant difference between the two groups (t =0.802,P =0.426 ).The recurrence rate of steroids-induced remission group was 41 .2% (14/34 ),which was higher than that of infliximab and surgery-induced remission group (1/15),and the differnce was statistically significant (χ2 =5 .177,P =0.023 ). The common side effects were gastrointestinal reaction (26.5 %, 13/49 ), impaired liver function (20.4%,10/49)and leukopenia (12.2%,6/49).Only three cases could not tolerate the side effects and underwent medication withdrawal.Conclusions As a second-line immunosuppressant for maintanence remission in CD,MTX is effective and well-tolerated in patients.So it can be an important option during the long course of CD.
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ObjectiveTo investigate the clinical features and the efficacy of medium-and long-term immune suppression in the treatment of Crohn's disease (CD) in Chinese Han nationality.MethodsThe clinical data and diagnosis methods of 178 CD patients between 2003 and 2010 were analyzed.All patients received predinisone and immune suppression (azathioprine) treatment.The patients were followed up every 2 weeks.Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were reviewed every 4 weeks.CD activity index (CDAI) was scored every 3 to 6 months.ResultsThe peak age for onset of CD was between 18 to 30 years old,and the mean time from the appearance of symptoms to diagnosis was (8.3±3.7) months.About 34.8％ (62/178 cases) patients had corresponding complications at time of diagnosis due to the progress of the disease.The average dosage of azathioprine was (1.24±0.16) mg/kg,and the total withdrawal rate due to adverse effect was 15％ (25/167 cases).The surgical intervention rate was 15.1％ (22/146 cases) during long-term follow-up.ESR and CRP of patients decreased obviously and tended to normal after 3 months treatment.The CDAI score significantly decreased after 6 months treatment.Conclusions Most Chinese patients had a good tolerance of immune suppression and achieved better medium- and long-term clinical efficacy at the dosage lower than that recommended by European and United States guidelines.
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Objective To evaluate the clinical efficacy of infliximab (IFX) in Crohn′s disease (CD) and its effects on mucosal healing and promoting fistula closure.Methods Between September 2007 and February 2011,relevant clinical data of CD patients treated with IFX in the Department of Gastroenterology,Ruijin Hospital were collected and the efficacy and safety of IFX were retrospectively analyzed.After IFX therapy,the efficacy evaluation included laboratory index,clinical efficacy,efficacy of fistula closure and mucosal healing.The data were analyzed using t test and Wilcoxon signed-rank test.Results A total of 22 patients were enrolled in this study,11 males and 11 females; the mean age was 29.3 years.The dosage of IFX was 5 mg/kg to 10 mg/kg at week 0,2,6to induce remission,and every 8 weeks on maintenance therapy.Of 22 patients,16 patients were active CD.One case dropped out.At week 14,of the remaining 15 cases,11 cases achieved clinical remission,two cases achieved clinically effective and two cases were ineffective.Crohn′s disease activity index (CDAI) (112±80) and ESR [(13±11) mm/1 h] of week 14 decreased compared with that of week 0 [(186±88),(21± 15) mm/1 h,P=0.04 and 0.007].Two cases of 10 patients with fistula dropped out as a result of ineffective,while eight cases had a partial response and six patients sustained response during the maintenance therapy,but no fistula closed and completely disappear.Seven patients reviewed by endoscopy after five times IFX therapy (24 weeks),after therapy the simple endoscopic score for Crohn′ s disease (SES-CD) ( 3.21 ± 2.89 ) decreased compared with that before treatment (5.86±3.02) (Z＝-2.38,P＝0.018).Eleven times of adverse events were found in nine patients,infusion reaction and respiratory tract infection were more common and no severe adverse effect was observed.Conclusions IFX can rapidly improve clinical symptoms and with good safety.The effects in mucosal healing and fistula closure may occur at early medication.
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Objective To retrospectively investigate the clinical features of localized primary small bowel stromal tumors (SBSTs) and the impacting factors for prognosis.Methods The clinical and pathological data of 89 consecutive SBSTs patients,with pathologically confirmed,who underwent complete resection in Ruijin hospital between January 2003 and September 2007 were collected and analyzed.All patients were followed up for assessment of tumor recurrence and metastasis.The impacts of clinical and pathologic factors on rate of disease free survival (DFS) of the patients was evaluated.Results In total of 89 follow-up patients,15 patients were diagnosed with tumor recurrence and 9 of them died.The tumor size,mitotic index and pathological risk stratification were statistically related with DFS (P=0.000,P=0.006,P=0.000,respectively) by using Kaplan-Meier univaritate analysis.Tumor size and mitotic index were proved to be independent prognostic factors for tumor recurrence by multivariate analysis COX regression model.Conclusions Tumor size and mitotic index are related with tumor recurrence,and can be regarded as independent predictive factors of tumor recurrence.