| Background and purpose: Inflammatory bowel disease(IBD)including ulcerative colitis(UC)and Crohn's disease(CD)is a chronic,recurrent intestinal inflammatory disease,which is one of the most serious gastrointestinal diseases except the tumor.It impacts on the quality of life and mental health of patients.At present,there is a very definite effect on the treatment of biological drugs,and infliximab(IFX)is used as a first-line drug for biotherapy.Since 2012 our hospital has used infliximab to treat inflammatory bowel disease.26 patients of inflammatory bowel disease were treated with infliximab in our hospital,and in this paper we will study the therapeutic effect of infliximab on inflammatory bowel disease(including UC,CD).Materials and Methods: Subjects: We analyzed the clinical data of 26 patients treated with infliximab of inflammatory bowel disease from January 2012 to December 2016 at the First Hospital of Jilin University.Inclusion and exclusion criteria: The clinical symptoms,colonoscopy and pathology results are in line with " Consensus of diagnosis and treatment of inflammatory bowel disease " [2].Methods:Infliximab is treated as inducing remission at a dose of 5mg / kg at 0,2,and 6 weeks,followed by the same dose every 8 weeks to maintain remission.For patients who are still ineffective after the second dose,no further administration of IFX is given.For patients who response to treatment lately,the interval can be shortened or the dose will be increased to 10mg/kg.Patients who have received glucocorticoid and/or immunosuppressive therapy at the beginning of the treatment of IFX will continue the original treatment.When they reach clinical remission,the hormones should be gradually reduced even to be discontinued,meanwhile,immunosuppressive agents can be used with IFX.Observe indicators: 1)Clinical symptoms and CDAI score or Mayo score;2)Test indicators: inflammatory indicators: White blood cells(WBC),Platelet(PLT),Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP);Nutritional indicators: Hemoglobin(HB),Albumin(ALB);3)Colonoscopy changes:SES-CD score;4)Adverse reactions.Results: 1)General Information: A total of 26 patients(22 males and 4 females),23 CD(20 males and 3 females)and 3 UC(3 males and 2 females).The average age of CD patients was 22.17 ± 8.72,and the average age of UC patients was 22.17± 8.72.The newly diagnosed cases were 8(CD),and the previous diagnosed cases were 18.2)Clinical manifestations(digestive systems,systemic manifestations,parenteral symptoms): Abdominal pain(24 patients,2 patients of UC without abdominal pain),diarrhea(18 patients),abdominal distension(4 patients),bloody stool(11 patients),fistula formation(9 patients,CD),intestinal obstruction(3 patients,CD),perforation(2 patients,CD),perianal abscess(7 patients,CD).Fever(13 patients),weight loss(26 patients),repeated oral,vulvar,perianal ulcers(2 patients,CD),ankylosing spondylitis(1 case).Combined with 5-aminosalicylic acid(11 patients);combined with glucocorticoid(8 patients).The average CDAI of 23 patients with CD was 226.04 ± 92.33.The mean value of CDAI was 144.78 ± 79.57 after 2 weeks of treatment,which was statistically significant compared with that before the treatment(P = 0.003).The mean value of Mayo was 9.33 ± 2.08 of 3 patients with UC,and 0.33 ± 2.08 for Mayo after 2 weeks of treatment,which was statistically significant compared with that before the treatment(P= 0.024).3)Accompaning symptoms:Four patients suffered appendicitis surgery due to abdominal pain(CD).Beforing using IFX the T-spot test for tuberculosis was positive of three patients,and they all were given preventive anti-TB treatments.4)Test indicators: After treatment,the inflammatory and nutritional indicators were significantly different.5)Colonoscopy: 14 patients received the check of colonoscopy,small intestine CT or capsule endoscopic after treatment for 2-3 dose,the intestinal edema reduced significantly,the ulcer area and the numbers were smaller,and and the ulcer surface showed scab or hyperplasia.6)Adverse reactions: One patient suffered laryngeal edema,pain,facial flushing,shortness of breath and rash when infusing IFX,and the symptoms occured every time,but it could be relieved after the treatment of anti-allergic.One patient suffered facial flushing after treatment,and the symptom relieved without special treatment.One patient got the respiratory tract infection(bronchitis)without neutropenia after giving two doses IFX,and it improved after anti-inflammatory treatment.All these patients did not terminate the treatment because of the above adverse reactions.One patient was diagnosed with tuberculosis infection after regular application of IFX for 4 dose(CD).The remaining patientsdid not suffer allergies,infections,autoimmune,liver and kidney function changes,cancer,demyelinating lesions and neurological disorders and other adverse reactions.7)Return: One patient reached the ease of endoscopic and clinical symptoms after 9 dose of IFX,and the disease relapsed 1 year later.The other patient relapsed 3 year later after stoping IFX(CD).The recurrence of IFX is effective to the above two patients.One patient got relief of symptoms after treatment of 7 dose,but the intestinal fistula was not shrink,then he had the total colorectal resection.One patient suffered intestinal perforation after 3 dose,and he got bowel resection of intestinal anastomosis and intestinal fistula.One patient infected with tuberculosis after 4 dose of IFX,then stopped going to cure(CD patients);2 patients with endoscopic and clinical remission treated with 1 year have given withdrawal for about 1 year,the current condition is stable(CD);The relief of one patient's clinical symptoms was not clear after 4 dose,the plasma concentration was low,and he got clinical remission after given increased IFX dose(UC);The remaining 18 patients are still under the treatment of IFX,reaching the remission of clinical symptoms and endoscopy.Conclusion:1)The effect of IFX on the treatment of inflammatory bowel disease is better,but there are adverse reactions in the course of treatment.2)Patients who discontinued the application of infliximab(not consider any other factors)during clinical remission will relapse with time flies,and re-activation of infliximab after relapse is equally effective.3)Inflammatory bowel disease is easy to involve the ileocecal,and the onset of acute inflammation may be misdiagnosed as acute appendicitis,so it is necessary to identify the two diseases.4)The treatment of IFX will increase the risk of tuberculosis infection.Tuberculosis screening is required prior to medication,preventive anti-TB treatment is needed if necessary.5)The treatment of IFX is prone to loss of response,plasma concentrations of IFX are different individually.The determination of IFX concentration has important guiding significance for the treatment of IBD. |
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