Crohn病に対するinfliximab治療―維持投与例における粘膜治癒効果の解析

Infliximab Therapy for Crohn's Disease with a Reference to Mucosal Healing

要旨　自験Crohn病に対するinfliximabの維持投与効果を臨床的活動性と消化管病変から検討した．①30週以上維持投与した27例において，臨床的活動指数による治療効果判定に影響を及ぼしたのはinfliximabの投与理由で，非有効例の50％は瘻孔性病変であったが，有効例にはこの投与理由はなかった．②治療前と経過観察最終時の大腸X線・内視鏡所見を検討できた10例中7例では活動性病変(縦走潰瘍，敷石像，多発潰瘍)が改善したが，3例では不変であった．改善例は不変例よりも投与開始時の年齢が高かった．一方，小腸病変の推移は3例で検討可能で，1例では開放性潰瘍が残存し，他の2例では非活動性病変が不変のまま経過した．③臨床的活動指数による評価と大腸病変の判定が一致したのは3例，乖離したのは7例であった．以上より．infliximabはCrohn病の粘膜病変に有効であるが，その効果は臨床的活動性からは推測困難と考えた．

　We assessed the clinical activity indices and the mucosal healing in patients treated by scheduled maintenance therapy with infliximab. Among 27 patients treated by infliximab for more than a 30 week-period, the medication was more efficacious in patients with inflammatory disease than in those with fistulous disease. Among 10 patients in whom possible healing of the colorectal lesions could be evaluated by radiography or colonoscopy, active mucosal lesions in seven patients had healed, while those in the three other patients remained unchanged. The former patients were older than the latter patients. In three patients whose ileum could be assessed, the ileal lesions remained unchanged. The therapeutic effects of infliximab as determined by clinical activity indices and by mucosal lesions were unable to be associated in 7 of 10 patients examined. These observations suggest that scheduled maintenance therapy with infliximab is effective on mucosal lesions, as well as on clinical activities, in patients with Crohn's disease. The grade of mucosal healing, however, is presumably independent of clinical activities.