胃と腸45巻10号

2010年09月発行

今月の主題 Crohn病小腸病変に対する診断と治療の進歩

主題

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

著者： 江﨑幹宏¹ 松本主之¹ 矢田親一朗¹ 小川紘太郎¹ 浅野光一¹ 森山智彦¹ 平野敦士¹ 中村昌太郎¹ 古賀秀樹¹ 植木隆² 飯田三雄³

所属機関： ¹九州大学大学院病態機能内科学 ²九州大学大学院臨床腫瘍外科学 ³公立学校共済組合九州中央病院

ページ範囲：P.1656 - P.1666

文献概要

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．

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