手术联合抗肿瘤坏死因子α制剂治疗克罗恩病合并肛瘘临床疗效的Meta分析

Clinical efficacy of surgery combined with anti TNF alpha in treatment of Crohn′s disease with perianal fistulas: a Meta analysis

    摘要
  • 摘要: 目的:系统评价手术联合抗肿瘤坏死因子α(TNFα)制剂治疗克罗恩病合并肛瘘患者的临床疗效。
    方法:以Crohn′s disease、anal fistula、fistula、perianal fistula、surgical procedure、surgery、surgical、antitumour necrosis factoralpha、anti-TNF-alpha、TNFalpha、克罗恩病、Crohn′s病、肛瘘、手术治疗、外科手术、抗肿瘤坏死因子α制剂、肿瘤坏死因子、肿瘤坏死因子配体超家族成员2为检索词，检索中国生物医学文献数据库，万方数据库、PubMed、Cochrane Library、EMBASE数据库。检索期限为建库至2016年6月。纳入手术联合TNFα制剂对比单纯手术治疗克罗恩病合并肛瘘患者的回顾性病例对照研究。由2名研究者独立行筛选文献和数据提取，并进行文献质量评价。采用手术联合TNFα制剂治疗的患者设为联合治疗组，单纯手术治疗的患者设为手术组。比较两组患者的完全愈合率、部分愈合率及治疗复发率。计数资料采用优势比(OR)及95%可信区间(95%CI)表示。采用I2对异质性进行分析。
    结果:最终共6篇文献纳入研究，均为回顾性病例对照研究，累计样本量598例，其中联合治疗组256例，手术组342例。Meta分析结果显示：联合治疗组与手术组克罗恩病合并肛瘘患者的完全愈合率、部分愈合率比较，差异均无统计学意义(OR=1.36，1.47，95%CI：0.94～1.97，0.56～3.88，P>0.05)。联合治疗组克罗恩病合并肛瘘患者的治疗复发率低于手术组，差异有统计学意义(OR=0.26，95%CI：0.16～0.44，P<0.05)。
    结论:手术联合抗TNFα制剂治疗克罗恩病合并肛瘘，其完全愈合率和部分愈合率并未优于单纯手术治疗，但治疗复发率低于单纯手术治疗。

     

    Abstract: Objective:To evaluate systematically the clinical efficacy of surgery combined with antiTNFalpha in treatment of Crohn′s disease (CD) with perianal fistula.
    Method:Database including China Biology Medicine disc, Wan Fang Database, PubMed, Cochrane Library and EMBASE were searched with “Crohn′s disease, anal fistula, fistula, perianal fistula, surgical procedure, surgery, surgical, antitumor necrosis factoralpha, antiTNFalpha, TNFalpha, 克罗恩病, Crohn′s病, 肛瘘, 手术治疗, 外科手术, 抗肿瘤坏死因子α制剂, 肿瘤坏死因子, 肿瘤坏死因子配体超家族员2” between the database establishment and June 2016. Literatures of retrospective casecontrol studies about surgery combined with antiTNFalpha therapy and single surgery in treatment of CD with perianal fistula were retrieved. Data were extracted and evaluated by 2 independent researchers. Patients who underwent surgery combined with antiTNFalpha therapy were allocated into the combined therapy group and patients who underwent single surgical treatment were allocated into the surgery group. The complete healing rate, partial healing rate and recurrence rate after therapy were compared between the 2 groups. Count data were represented as the odds ratio (OR) and 95% confidence interval (CI). The heterogeneity was analyzed by the I2 test.
    Result: Six retrospective casecontrol studies were retrieved and total sample size was 598 patients, including 256 in the combined therapy group and 342 in the surgery group. The result of Meta analysis showed that there was no significant difference in postoperative complete healing rate and partial healing rate between the 2 groups (OR=1.36, 1.47, 95%CI: 0.94-1.97, 0.56-3.88, P>0.05), and recurrence rate after therapy in the combined therapy group was significantly lower than that in the surgery group (OR=0.26, 95%CI: 0.16-0.44, P<0.05).
    Conclusion:The complete healing rate and partial healing rate of patients with CD with perianal fistula undergoing surgery combined with antiTNFalpha therapy are not superior to that undergoing single surgical treatment, however, recurrence rate after therapy is lower for patients undergoing surgery combined with antiTNFalpha therapy.

     

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