Crohn病長期経過例における抗TNF-α抗体療法の効果

Therapeutic Effect of Infliximab on Intestinal Lesions in Patients with Crohn's Disease

要旨　Crohn病30例に対するinfliximabの効果を臨床的活動指数(CDAI)および痔瘻と腸管・皮膚瘻について解析し，18例では活動性病変(敷石像，縦走潰瘍，小潰瘍・アフタ様病変，裂溝)と腸管合併症(狭窄，内瘻)に対する効果を検討した．8例では完全静脈栄養療法の効果と比較した．①初回投与2週後にCDAIは有意に低下した．②8週以内の活動性腸病変に対する有効率は敷石像で100％，縦走潰瘍で100％，小潰瘍・アフタ様病変で75％であったが，8週以降の縦走潰瘍に対する有効率は33％と低下した．腸管合併症のうち内瘻に対する有効率は8週後までは100％であったが，その後は40％に低下した．③活動性病変に対して完全静脈栄養とinfliximabの効果に明らかな違いはなかったが，内瘻の改善率は前者で0％，infliximabで100％であった．以上から，infliximabはCrohn病の臨床的活動性のみならず活動性病変と内瘻に有効であるが，その効果は短期間にとどまると考えられた．

　The effect of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-α, on Crohn's disease was retrospectively investigated regarding its clinical activity index (CDAI) and serial changes in intestinal lesions. The CDAI decreased significantly two weeks after infliximab administration. The efficacy rates of infliximab within 8 weeks for cobblestone appearance, longitudinal ulcer, and other small ulcers were 100％, 100％, and 75％ respectively. However, the efficacy rate for longitudinal ulcer decreased to 33％ during the subsequent period. Similarly, infliximab improved all the internal fistula within8weeks of administration, but the efficacy rate during the subsequent period fell to4 0％. In 8 patients, for whom total parenteral nutrition had been applied, there was no difference in therapeutic effect on active intestinal lesions between TPN and infliximab. However, infliximab was more effective on internal fistula than TPN (100％ vs 0％). These observations suggest infliximab to be effective against active intestinal lesions and fistula in patients with Crohn's disease, although the effect is limited to a short term.

　1) Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan