Abstract: Objective:To investigate the clinical characteristics of perianal Crohn′s disease (CD) with or without proctitis and compare the treatment effect of surgery combined with biological preparation.
Methods:The retrospective cohort study was conducted. The clinical data of 52 patients with perianal CD who were admitted to the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from June 2011 to October 2014 were collected. Thirty patients with inflammation involvement of the rectum and 22 patients without inflammation involvement of the rectum were respectively divided into the proctitis group and nonproctitis group. All the 52 patients underwent surgery combined with infliximab therapy. Observation indicators included: (1) clinical characteristics: gender, age, body mass index (BMI), lesion location, disease behavior, type of perianal lesions, history of perianal surgeries, CD activity index (CDAI), perianal disease activity index (PDAI), Creactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC), platelet (PLT) and albumin (Alb), (2) treatment and followup. Followup using outpatient examination was performed to evaluate the perianal lesions up to December 2015. Measurement data with normal distribution were described as ±s and comparison between groups was analyzed by the t test. Count data were described as the percentage, and comparison between groups was analyzed by the chisquare test and Fisher′s exact probability.
Results:(1) Clinical characteristics: number of patients with BMI<18.5 kg/m2 and with normal BMI were respectively 17, 13 in the proctitis group and 6, 16 in the nonproctitis group. Lesions located at ileum, colon and ileocolon were respectively detected in 3, 9, 18 patients in the proctitis group and 9, 4, 9 patients in the nonproctitis group. CDAI≥150 and <150, CRP≥8 mg/L and <8 mg/L, ESR>normal level and =normal level, Alb<35 g/L and between 35 g/L and 50 g/L were respectively detected in 23, 7, 25, 5, 24, 6, 12, 18 patients in the proctitis group and 8, 14, 8, 14, 8, 14, 2, 20 in the nonproctitis group, with statistically significant differences between the 2 groups (χ²=4.446, 6.855, 8.563, 12.076, 10.211, 6.163, P<0.05). (2) Treatment and followup: all the 52 patients underwent more than 3 times infliximab therapies and perianal surgeries within 1 week after infliximab therapy. All the patients were followed up for a median time of 28 months (range, 8- 52 months). Thirtyfour patients still underwent maintenance therapy of immunosuppressive agents and 18 didn′t undergo maintenance therapy up to the end of followup. Twentytwo patients in the proctitis group and 12 patients in the nonproctitis group underwent maintenance therapy, with no statistically significant difference between the 2 groups (χ²=1.979, P>0.05). The total healed rate, improvement rate and unhealed rate of perianal lesion were 55.8%(29/52), 34.6%(18/52) and 9.6%(5/52), respectively. The number of patients with healed, improved and unhealed perianal lesions were 16, 11, 3 in the proctitis group and 13, 7, 2 in the nonproctitis group, respectively, showing no significant difference in treatment effects between the 2 groups (χ²=0.173, P>0.05).
Conclusions:Patients with perianal CD combined with proctitis have higher activity of intestinal inflammation and worse nutritional status compared with patients without proctitis. However, there is no significant difference in the type and activity of perianal lesion between patients with or without proctitis. Surgery combined with biological preparation could render better clinical outcomes in treatment of perianal CD with proctitis.