Crohn病経過観察例における抗TNF-α抗体療法の効果―画像所見の変化を中心に

Efficacy for Infliximab Infusion Therapy in Crohn's Disease Patients with Special Attention to Morphological Changes

要旨　抗TNF-α抗体(infliximab)を投与したCrohn病35例(男性27例，女性8例，平均年齢は32.3歳)を対象として，infliximab投与前後の注腸X線，小腸X線，そして，大腸内視鏡所見の変化を検討した．対象とした病変は潰瘍性病変で，瘻孔形成8例で，初期病変2例を含んでいた．臨床症状の推移をIOIBDスコアでみると，infliximab投与後，急速に減少し，その値は4～6週後から徐々に元の値に戻った．CRP値もIOIBDスコアと同じ推移を示した．呈示した症例から，縦走潰瘍は短期間に幅の広い瘢痕となる治癒傾向を示した．その際の腸管の狭細化，短縮は著明ではなかった．投与前から小腸に著明な狭窄のあった1例ではイレウスに移行した．大腸，回腸吻合部・皮膚瘻の1例は治癒したが，直腸・膀胱瘻の1例では，いったん治癒したが，2年半後に再発した．腸管・腸管瘻の4例，直腸・腟瘻の2例は治癒しなかった．初期病変の2例ではアフタはinfliximab投与後消失し，経過を観察している．infliximab投与前後の形態的所見を追求することは，この薬剤の効果を知る上で，また，適応を決める上でも，大切なことである．

　Thirty-five Crohn's disease patients (male 27, female 8 with an average age of 32.3 years) were studied to ascertain the morphological changes in barium enema, X-ray of the small intestine and in colonoscopy, before and after infliximab infusion therapy.

　Clinical aspect on the IOIBD index, and laboratory data in CRP decreased in number rapidly and returned to the baseline in four to six weeks after initial infliximab infusion.

　Longitudinal ulcers were healed in a broad-based scar without remarkable stricture and shortening of the colon and small intestine. In one case, severe strictures in the small intestine before infliximab infusion moved to the ileus.

　Skin fistula was closed in one case, rectum-bladder fistula was closed but recurred in two years and a half. Intestinal fistulas in four cases and rect-vaginal fistulas in two cases were not closed.

　Apfta in two cases of early Crohn's disease disappeared after administration of infliximab and they are being followed up.

　It is important to study the morphological changes in the course of infliximab therapy to know the efficacy of and indication for this drug.

　1) Department of Internal medicine, Fujita Health Univerity School of Medicine, Toyoake, Japan