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Objective To investigate the application value of magnetic resonance imaging (MRI) examination in the efficacy evaluation of infliximab combined with seton placement for perianal fistulizing Crohn's disease (PFCD) and influencing factors of deep remission.Methods The retrospective case-control study was conducted.The clinicopathological data of 57 patients with PFCD who were admitted to the Affiliated Hospital of Nanjing University of Chinese Medicine from August 2010 to October 2017 were collected.There were 39 males and 18 females,aged (24±9)years,with a range of 14-58 years.Patients underwent MRI examination preoperatively and postoperatively.Observation indicators:(1) follow-up situations;(2) influencing factors analysis of deep remission of PFCD.Follow-up using outpatient and inpatient reexamination was performed to detect clinical recovery of patients up to October 2017.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were described as M (range).Count data were represented as absolute number or percentage.The univariate analysis was performed using the chi-square test.The multivariate analysis was done using the logistic regression model,using P＜0.15 as an inclusion criteria in the univariate analysis.Results (1) Follow-up situations:57 patients with PFCD undergoing inflixmab combined with seton placement were followed up for (40±24)months.During the follow-up,24 of 57 patients had clinical response,33 had long-term clinical healing.The fistulas of 24 patients with clinical response presented as high signal on T2 weighted image (T2WI) of postoperative MRI.Of 33 patients with long-term clinical healing,the fistulas of 16 patients with deep remission presented loss of high signal and replacement of fibrosis tissue on T2WI of postoperative MRI,the fistulas of 17 patients without deep remission presented as high signal on T2WI of postoperative MRI.(2) Influencing factors analysis of deep remission of PFCD:results of univariate analysis showed that extent of fistula was related factors affecting deep remission of PFCD (x2 =4.312,P＜0.05).Results of multivariate analysis showed that a single fistula complicated with branches and times of infliximab maintenance treatment ≤3 were independent risk factors affecting deep remission of PFCD (odds ratio=4.377,4.296,95％ confidence interval:1.124-17.043,1.158-15.940,P＜0.05) and fistula under levator ani muscle was an independent protective factor affecting deep remission of PFCD (odds ratio =0.182,95％ confidence interval:0.041-0.815,P＜ 0.05).Conclusions Partial patients with long-term clinical healing can achieve deep remission after Infliximab combined with seton placement for perianal fistulizing Crohn's disease,requiring MRI examination to further evaluate recovery situations.A single fistula complicated with branches and times of infliximab maintenance treatment ≤ 3 are independent risk factors affecting deep remission of PFCD and fistula under levator ani muscle is an independent protective factor affecting deep remission of PFCD.
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This study was aimed to observe yang-warming therapy in the overall treatment and deep remission of inflammatory bowel disease (IBD).According to the randomized controlled method,86 IBD cases were divided into the control group and the treatment group,with 43 cases in each group.Salad oxazine zyban was given as conventional treatment.In the treatment group,traditional Chinese medicine (TCM) yang-warming compound treatment was added.After 12-week treatment,observations were made on mucosal changes by colonoscopy and TCM syndrome integral in order to compare the therapeutic effects of both groups.Detections were made on intestinal flora,serum biochemical indexes (WBC,ESR,CRP,STP),and inflammation related factors (NO,TNF-α,IL-17,IL-23).The results showed that the total effective rate of the treatment group was higher than that of the control group (P ＜ 0.05).The number of escherichia coli and enterococcus in patient's intestinal tract decreased significantly;the number of bifidobacterium and lactobacillus significantly increased (P ＜ 0.05).The patient's serum WBC,CRP and ESR significantly decreased;ALB increased significantly.The effect of the treatment group was better than that of the control group (P ＜ 0.05).The patient's serum IL-17 and IL-23 content in the treatment group was significantly lower than those of the control group (P ＜ 0.05).It was concluded that yangwarming therapy has the identified effect for IBD treatment.In addition to improve patient's clinical symptoms,reduce TCM syndrome integral,it also improves the mucosal healing,affects the biochemical indexes of serum and related inflammation factors in order to have a deep remission effect of IBD.
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Objective To investigate the predictors of deep remission in patients with Crohn′s disease (CD)treated with infliximab.Methods From February 2008 to February 2015 ,the clinical, laboratory and follow up data of 44 CD patients who received infliximab treatment and maintained clinical remission over six months were retrospectively analyzed.Mucosal healing was defined as no ulcer under endoscopy.Deep remission was defined as clinical remission with mucosal healing.According to results of endoscopy examination,the enrolled patients were divided into deep remission group and non-deep remission group.T test or Wilcoxon rank sum test was used for comparison of measurement data between groups,and chi square test was performed for the rate comparison.Multivariate analysis was made with Logistic regression.Results Median age of 44 patients was 19.5 yeares,39 males (88.6%),five females (11 .4%),and the median disease duration was 35 .0 months (18.5 to 73.5 months).Deep remission was achieved in 20 CD patients with long-time follow-up (median follow-up time 19 months,12 to 29 months). The mean duration of achieving deep remission was (28.9 ± 14.3 )weeks.There was no statistically significant difference between 20 patients with deep remission and 24 patients without deep remission in age of onset,disease duration,smoking status,Montreal phenotype,concurrent medications (mesalazine, steroids and azathioprine ), as well as body mass index (BMI ) and laboratory tests (erythrocyte sedimentation rate (ESR),high-sensitivity C-reactive protein (hsCRP),hemoglobin (Hb)and platelet (PLT)count)before administrating.The results of Logistic regression demonstrated that extraintestinal manifestations (arthralgia)(odds ratio (OR)=29.9,95 % confidence interval (CI )1 .26 -714.20,P =0.036),normalization of hs CRP at 14 th week after induced remission (OR=0.88,95 %CI 0.78-0.99, P =0.045)and thrombocytopenia (OR = 0.98,95 %CI 0.96 - 0.99,P = 0.016 )were independent predictive factors of deep remission.Conclusions Infliximab could effectively maintain long term deep remission in treatment of CD.Arthralgia,normalization of hsCRP and PLT counts at 14 th week after induced remission are predictive factor of deep remission.
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Objective To investigate the efficacy of short-term biological agent infliximab and immunosuppression combined therapy in patients with active ileocolonic Crohn′s diseases (CD)and to evaluate the mucosal healing.Methods From January 2013 to July 2014,forty hospitalized patients with active ileocolonic CD received at least six times scheduled infliximab injection were enrolled.At week 0, second,and sixth,infliximab 5 mg/kg was administered to induce remission.From the second week, immunosuppression was added.After that,infliximab 5 mg/kg was administered every eight weeks for maintenance treatment.The 36th week after treatment was the end point of follow-up.Before treatment and at the end point of follow-up,the levels of C-reactive protein (CRP),hemoglobin (Hb),clinical remission Crohn′s disease activity index (CDAI)2 ) and deep remission (achieved both clinical remission and mucosal healing)were compared.T test and Wilcoxon rank sum test were performed for comparison before and after treatment.Results At the 36 th week after treatment,the clinical remission rate was 95 .0% (38/40 ),mucosal healing rate,partial mucosal healing rate and deep remission rate were 62.5 % (25/40),35 .0% (14/40)and 62.5 % (25/40), respectively.The mucosal inflammation of only one case (2.5 %)was not improved.After treatment,the CDAI was 99.3 ±29.3,which was lower than that before treatment (301 .3 ±73.1 )and the difference was statistically significant (t = 17.2,P <0.01 ).Median blood CRP level was 0.8 mg/L(0.1 mg/L, 8.1 mg/L),which was lower than that before treatment (26.8 mg/L(16.1 mg/L,61 .0 mg/L)),the difference was statistically significant (Z = - 5 .3,P < 0.01 ).However,the level of Hb ((134.0 ± 16.0)g/L)was higher than that before treatment ((117.0 ±20.0)g/L),the difference was statistically significant (t=-6.3,P <0.01 ).The median SES-CD was 0 (0,5 ),which was lower than that before treatment (14(8,24)),and the difference was statistically significant (Z =-5 .4,P <0.01 ).Conclusion The short-term (36 weeks)infliximab and immunosuppression combined therapy can achieve high mucosal healing rate and deep remission rate in active ileocolonic CD patients.
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Objective To explore the efficacy and safety of infliximab (IFX) treatment in inducing and maintaining deep remission (DR) in patients with moderate to severe Crohn's disease (CD).Methods From February 2012 to April 2014,the clinical data of 26 patients with moderate to severe CD received IFX treatment were retrospectively analyzed.Laboratory indexes (erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),albumin),Crohn's disease activity index (CDAI),Crohn's disease simplified endoscopic score (SES-CD),rate of DR and side effects were observed before treatment,at week 14 and week 30.The t test was performed for normal distribution measurement data comparison between two groups.Wilcoxon signed rank test was performed for non normal distribution measurement data comparison between two groups.Chi square test and Fisher exact probability method were used for rate comparison.Results In 26 patients with CD,at week 14,the CDAI significantly decreased compared with that before treatment (225.0(124.0,265.0) vs 80.0(67.0,124.7),Z=-4.265,P＜0.01); ESR and CRP levels also significantly decreased while body mass index (BMI) and albumin levels increased.The rate of clinical remission,mucosal healing under endoscope and DR was 80.0 ％ (21/26),42.3 ％ (11/ 26) and 34.6％ (9/26),respectively.The rate of clinical remission was higher in patients with the disease course less than one year (92.3％ vs 69.2％,P=0.32).At week 30,the CDAI of patients significantly decreased compared with that before treatment (225.0(124.0,265.0) vs 81.5(67.0,111.0),Z=-4.877,P＜0.01); the ESR and CRP levels significantly decreased; while the BMI and albumin levels increased.The rate of clinical remission,mucosal healing under endoscope and DR was 88.5 ％ (23/26),57.7％(15/26) and 53.8％ (14/26),respectively.Rate of clinical remission was higher in patients with the disease course less than one year (100.0％ vs 76.9％,P=0.22).The differences in the rates of clinical remission,mucosal healing and DR between week 14 and week 30 were not statistically significant.Conclusion IFX could induce and maintain DR in patients with moderate to severe CD.