胃と腸39巻2号

2004年02月発行

今月の主題 Crohn病経過例における新しい治療の位置づけ 主題

Crohn病長期経過例における抗TNF-α抗体療法の効果

著者： 松本主之¹ 矢田親一朗¹ 中村昌太郎¹ 江崎幹宏¹ 堺勇二² 小林広幸² 清水香代子³ 古賀秀樹³ 青柳邦彦⁴ 渕上忠彦² 飯田三雄¹

所属機関： ¹九州大学大学院医学研究院病態機能内科学 ²松山赤十字病院胃腸センター ³川崎医科大学内科学（食道・胃腸科） ⁴福岡大学第3内科

ページ範囲：P.171 - P.184

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．

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