Crohn病小腸病変に対する治療効果―インフリキシマブの術後再発予防効果

Prophylactic Effect of Infliximab on Postoperative Recurrence of Small Intestinal Lesions of Crohn's Disease

要旨　小腸病変を有するCrohn病60例の術後臨床経過を遡及的に検討し，インフリキシマブ（IFX）の術後再発抑制効果を評価した．非IFX群では平均24.2か月の観察期間において，34例中21例で臨床的再発が確認された．一方，IFX群では平均20.8か月の観察期間中の臨床的再発は26例中2例のみであり，再発率はIFX群で有意に低かった（p＜0.005）．また，術後画像評価を行ったIFX群13例のうち，臨床的再発を来した1例では大腸に活動性病変を認めた．臨床的非再発と判断された12例中1例は，術後29か月目に吻合部口側小腸に浮腫性変化と不整形バリウム斑が出現し吻合部再発と判断したが，11例では活動性病変は指摘しえなかった．以上より，IFXは小腸病変を有するCrohn病の有効な術後維持治療になりうる可能性が示唆された．

　We retrospectively investigated the prophylactic effect of IFX（infliximab）on postoperative recurrence among 60 patients with CD（Crohn's disease）presenting small intestinal lesions. Of 34 patients who were not administered IFX, 21 patients experienced recurrence during of the follow-up period. On the other hand, only 2 patients showed postoperative recurrence out of 26 patients for whom maintenance IFX treatment was applied. Postoperative follow-up using small intestinal radiography was performed in 13 patients receiving IFX treatment. One patient showed clinical recurrence because of the deterioration of colonic lesions, while his small intestinal lesions were inactive under radiography. Among 12 patients enjoying clinical remission, edematous mucosa with small barium flecks proximal to the ileocolonic anastomosis was detected in one patient under small intestinal radiography, thus indicating radiographic recurrence of CD. No active small intestinal lesion was found in the remaining 11 patients. Considering such favorable clinical and radiographic courses of CD patients undergoing IFX treatment, IFX can be assumed to be a possible maintenance treatment for CD patients after surgery.