胃と腸42巻13号

2007年12月発行

今月の主題 新しい治療による炎症性腸疾患（IBD）の経過―粘膜治癒を中心に 主題

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

著者： 松本主之¹ 矢田親一朗¹ 梁井俊一¹ 江崎幹宏¹ 古賀秀樹¹ 森山智彦¹ 中村昌太郎¹ 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

ページ範囲：P.1819 - P.1830

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．

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