关键词:

活动期克罗恩病, 抗肿瘤坏死因子, C?反应蛋白, 白蛋白, 腹部超声, 弹性成 像, 治疗疗效, 预测

Abstract:

Objective The purpose of this research is to evaluate the predictive value of serum CRP，albu⁃ min，bowel wall thickness under transabdominal ultrasound，and intestinal wall elasticity modulus SD value of intestinal stenosis before treatment in patients with active Crohn′ s disease. Methods Prospectively，all patients treated for the first time with either infliximab or adalimumab for active Crohn′s disease between January 2018 and June 2021 were included. All patients were tested for serum albumin ，CRP ，bowel wall thickness under trans⁃ abdominal ultrasound and intestinal wall elastic modulus SD value of intestinal stenosis and were followed up until June 2021. Results A total of 45 active Crohn′s disease patients were included in the study. Forty ⁃three patients（96%）received first ⁃line treatment with infliximab，and 2 patients（4%）received first ⁃line treatment with adalimumab，of which 8 patients had intestinal stenosis before treatment. Clinical responses occurred in all 14weeks of observation；there were no primary non⁃responders ；38 patients（84.4%）showed sustained clinical remission，and 7 patients（15.6%）developed a secondary loss of response. Meantime to develop secondary loss of response was（11.4 ± 7.4）months. There was no statistical difference between the CRP level in the sustained clinical remission group and the secondary failure group，while the serum albumin concentration，intestinal wall thickness， and SD value of stenotic intestine were statistically different. The serum albumin concentration in the sustained clinical remission group was significantly higher than that in the secondary failure group［（38.1 ± 5.2）g/L vs.（31.1 ± 4.6）g/L］；the thickness of the bowel wall under ultrasound was significantly lower than that in the secondary loss of response group［（5.8 ± 1.9）mm vs.（8.2 ± 1.5）mm］，and the SD value of patients with sustained clinical response was also lower［（7.6 ± 1.2）vs.（9.9 ± 2.0）］. Hypoalbuminemia，bowel wall thickness ≥ 8 mm，and SD value ≥ 9 were related to early loss of response. Conclusion Serum albumin concentration，bowel wall thickness and elastic modulus SD value before treatment in patients with active Crohn′s disease are related to the therapeutic effect of anti⁃tumor necrosis factor⁃α monoclonal antibody，while the serum CRP level has nothing to do with the therapeutic effect. Hypoalbuminemia，bowel wall thickness ≥ 8 mm under transabdominal ultrasound and elastic modulus SD value ≥ 9 are closely associated with a higher risk for early loss of response to the anti TNF⁃α monoclonal antibody treatment.

Key words:

active Crohn′s disease, anti?tumor necrosis factor, CRP, albumin, abdominal ultra? sound, elastography, therapeutic effect, prediction