选择性白细胞吸附疗法治疗炎症性肠病疗效分析

摘要

近年来我国炎症性肠病(IBD)就诊人数逐年增加,目前临床常用的治疗方法在疗效和安全性方面有其局限性.选择性白细胞吸附疗法(GMA)是国外治疗IBD的有效方法之一,国内则缺乏此类研究.目的:探讨GMA治疗IBD的疗效和安全性.方法:回顾性收集2013年5月-2014年7月在上海瑞金医院接受GMA治疗的21例IBD患者的临床资料,其中13例为溃疡性结肠炎(UC),8例为克罗恩病(CD).入组患者均为5-氨基水杨酸(5-ASA)疗效不佳或激素抵抗者.分析GMA治疗前和治疗结束后第2周末疾病临床活动度指数(CAI)、内镜活动度指数(EAI)、实验室指标[血清白蛋白(Alb)、血红蛋白(Hb)、红细胞沉降率(ESR)、C-反应蛋白(CRP)、白细胞(WBC)计数、中性粒细胞百分率(N%)]以及不良反应情况.结果:GMA治疗后,UC和CD组CAI、EAI评分均较治疗前显著降低(P均<0.05);实验室指标中,UC组治疗后Alb显著升高(P<0.05),CRP显著降低(P<0.05),CD组仅CRP显著降低(P<0.05),其余指标治疗前后差异均无统计学意义(P均>0.05).观察显示GMA治疗安全性良好,无严重不良反应发生.结论:GMA治疗可有效减轻5-ASA或激素治疗无效IBD患者的临床症状和肠道黏膜损伤、控制炎症反应活动且安全性良好,但该结论需更大样本的前瞻性研究证实.%The prevalence of inflammatory bowel disease (IBD) in China is increasing year by year, however, the efficacy and safety of commonly used therapeutic methods are limited.Granulocyte and monocyte adsorptive apheresis (GMA) is one of the effective methods for treatment of IBD used abroad, however, there is still lacking of such research in China.Aims: To investigate the efficacy and safety of GMA in IBD patients.Methods: A retrospective study was conducted in 21 cases of IBD patients [13 cases with ulcerative colitis (UC) and 8 with Crohn's disease (CD)] who accepted GMA treatment from May 2013 to July 2014 at the Shanghai Rui Jin Hospital.All the cases were poor responders to 5-aminosalycylic acid (5-ASA) or steroid-refractory.The clinical data were collected, and the clinical activity index (CAI), endoscopic activity index (EAI), laboratory parameters including serum albumin (Alb), hemoglobin (Hb), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), leukocyte count and percentage of neutrophils, as well as the adverse effects before and two weeks after the end of GMA treatment were analyzed.Results: After GMA treatment, both CAI and EAI were decreased significantly in UC and CD groups as compared with those before treatment (P all <0.05).Among laboratory parameters, Alb was increased in UC group and CRP was decreased in both UC and CD groups after treatment (P all <0.05).No significant differences were found in other laboratory parameters in both UC and CD groups before and after treatment (P all >0.05).The treatment was well tolerated with no severe adverse effects.Conclusions: GMA is safe and effective for ameliorating clinical symptoms, attenuating intestinal mucosal injury and controlling active inflammation in IBD patient that has not responded to 5-ASA or steroid treatment.Prospective clinical studies with large samples are needed to confirm these findings.