英夫利昔单抗对活动性肛瘘的克罗恩病患者身心健康的影响

doi:10.16138/j.1673-6087.2021.04.001

摘要/Abstract

摘要：

目的：了解活动性肛瘘（active anal fistula,AAF）的缓解是否直接影响克罗恩病（Crohn’s disease,CD）患者的生活质量（quality of life,QoL）、自尊和身体形象,以及英夫利昔单抗（infliximab,IFX）治疗是否可以改善其社会心理障碍。方法：回顾性收集我院炎症性肠病（inflammatory bowel disease,IBD）数据库中AAF的CD患者的基线信息、CD相关临床特征、肛瘘类型、肛周CD活动指数、IBD简化问卷、身体形象量表、罗森伯格自尊量表,以及6~12个月的治疗和随访数据。评估IFX治疗对改善心理社会状况的影响。结果：297例CD患者中103例（34.7%）存在AAF。IFX治疗AAF患者的缓解率为64.0%,显著高于未接受IFX治疗AAF患者的缓解率（38.5%,P=0.010）。此外,与未接受IFX治疗的AAF患者相比,接受IFX治疗的AAF患者的QoL、身体形象满意度和自尊的改善更显著（均P<0.05）。结论：肛瘘缓解可改善AAF CD患者的自卑心理、形象满意度和QoL。IFX通过显著改善CD患者的肛瘘病情,促进患者身心健康,提高患者QoL。

关键词: 身体形象, 克罗恩病, 瘘管, 生活质量

Abstract:

Objective To understand whether the remission of active anal fistula (AAF) directly affects the quality of life, self-esteem and body image in the patients with Crohn’s disease (CD), and whether infliximab (IFX) treatment can improve their psychosocial disorders. Methods The data including baseline information of CD patients with AAF in the inflammatory bowel disease(IBD) database of our hospital, CD-related clinical features, anal fistula types, perianal CD activity index, IBD simplified questionnaire, body image scale, Rosenberg self-esteem scale, and 6-12 months follow-up information were collected and analyzed retrospectively. To evaluate the effect of IFX treatment on improving psychosocial state. Results Among the 297 CD patients, 103 patients (34.7%) had AAF. The remission rate of IFX treatment was 64.0% in CD patients with perianal fistula, which was significantly higher than that in the patients who did not receive IFX treatment (38.5%, P=0.010). In addition, compared with CD patients who did not receive IFX treatment for AAF, IFX treatment improved the quality of life, body image satisfaction and self-esteem in CD patients with AAF significantly(all P<0.05). Conclusions Anal fistula remission can improve the inferiority complex, body image satisfaction and quality of life in CD patients with AAF. IFX treatment promotes the physical and mental health of patients, and improves the quality of life through significantly alleviating the condition of anal fistula in the patients with CD.

Key words: Body image, Crohn’s disease, Fistula, Quality of life

中图分类号:

R574

周洁, 洪理文, 王蕾, 张晨, 王正廷, 张天宇, 范嵘. 英夫利昔单抗对活动性肛瘘的克罗恩病患者身心健康的影响[J]. 内科理论与实践, 2021, 16(04): 225-229.

ZHOU Jie, HONG Liwen, WANG Lei, ZHANG Chen, WANG Zhengting, ZHANG Tianyu, FAN Rong. Study the effect of infliximab on physical and mental health in Crohn’s disease patients with active anal fistula[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(04): 225-229.

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项目	治疗应答组	非治疗应答组	χ²/t	P
项目	(n=52)	(n=50)	χ²/t	P
AF类型[n(%)]			6.796	0.009
单纯型AF	30(57.7)	16(42.3)
复杂型AF	22(39.2)	34(60.7)
治疗[n(%)]			6.653	0.01
使用IFX	32(64.0)	18(36.0)
未使用IFX	20(38.5)	32(61.5)
PCDAI改善(分)	-0.90±2.89	0.70±2.97	2.763	0.007
SIBDQ改善(分)	12.6±6.68	-0.76±4.29	12.04	<0.001
RSE改善(分)	3.17±5.94	-1.16±6.01	3.662	<0.001
BIS改善(分)	-0.38±1.80	0.72±2.30	3.723	<0.001

项目	IFX治疗组	非IFX治疗组	χ²/t	P
项目	(n=50)	(n=52)	χ²/t	P
治疗应答[n(%)]	32(64.0)	20(38.5)	6.653	0.010
PCDAI改善(分)	-0.72±2.70	0.46±3.23	2.008	0.047
SIBDQ改善(分)	8.18±8.95	3.98±8.09	2.487	0.015
RSE改善(分)	2.32±5.74	-0.17±6.68	2.019	0.046
BIS改善(分)	-0.34±1.60	0.63±1.44	3.236	0.002

项目	治疗应答组 (n=32)	非治疗应答组 (n=18)	χ²/t	P
AF类型[n(%)]			1.937	0.164
单纯型AF	19(59.4)	7(38.9)
复杂型AF	13(40.6)	11(61.1)
PCDAI改善(分)	-1.34±2.67	0.39±2.45	-2.265	0.026
SIBDQ改善(分)	12.8±7.56	-0.11±3.63	8.168	<0.001
RSE改善(分)	3.66±5.47	-0.06±5.57	2.289	0.027
BIS改善(分)	-0.56±1.56	0.06±1.63	-1.322	0.192