克罗恩病患者经英夫利昔单抗治疗后血管内皮生长因子-A的变化及其临床意义

目的：分析克罗恩病（CD）经英夫利昔单抗治疗后患者血管内皮生长因子-A（VEGF-A）的变化及其临床意义。方法：选取2016年1月至2020年9月绍兴第二医院消化内科收治的30例重度CD患者及同期30例健康志愿者。用英夫利昔单抗治疗重度CD患者6 个月，收集CD患者治疗前、治疗后及健康志愿者的血清及肠道黏膜组织，分别用酶联免疫吸附及免疫组化染色检测血清和肠道黏膜组织中VEGF-A的表达水平，用散射光比浊法检测C反应蛋白（CRP），用魏氏法检测红细胞沉降率（ESR）。结果：酶联免疫吸附测定发现，英夫利昔单抗治疗后CD患者血清VEGF-A表达水平较治疗前明显下降，但高于健康对照组（P ＜0.05）。散射光比浊法及魏氏法检测发现，治疗后CD患者血清CRP及ESR水平较治疗前明显下降；治疗后CD患者血清CRP水平高于健康对照组（P ＜0.05），但ESR水平差异无统计学意义（P =0.521）。治疗前CD患者血清CRP、ESR与VEGF-A均呈正相关（r =0.727、0.450，P ＜0.05）。免疫组化染色发现，治疗后CD患者病变肠道黏膜组织中VEGF-A表达强度较治疗前明显下降，但高于健康对照组（P ＜0.05）。治疗前后血清VEGF-A表达水平与肠道黏膜组织VEGF-A表达强度呈正相关（r =0.714、0.926，P ＜0.05）。结论：VEGF-A可能参与了CD的发生、发展，血清及肠道黏膜中VEGF-A水平与CD疾病活动度呈正相关，可作为评估CD疗效的指标。

Changes of vascular endothelial growth factor-A in patients with Crohn’s disease after treatment with infliximab and its clinical significance

Objective: To investigate the changes and clinical significance of vascular endothelial growth factor-A (VEGF-A) in patients with Crohn’s disease after treatment with infliximab. Methods: From January 2016 to September 2020, 30 patients with severe CD and 30 healthy volunteers were selected. Patients with severe CD were treated with infliximab for 6 months. The serum and intestinal mucosa were collected from CD patients before and after treatment and from healthy volunteers as well. Enzyme linked immunosorbent assay (ELISA) and immunohistochemical staining were used to detect the expression of VEGF-A in serum and intestinal mucosa.C-reactive protein (CRP) was detected by scattered light turbidimetry and erythrocyte sedimentation rate (ESR) was detected by Windmanstatten method. Results: ELISA showed that VEGF-A expression in the serum of CD patients was significantly lower than that before treatment, but higher than healthy volunteers (P<0.05).After treatment, CD patients had significantly decreased CRP and ESR serum levels, compared with the healthy volunteers. The serum CRP level in the post-treatment group increased significantly (P<0.05), but there was no significant difference in ESR level (P=0.521). There were positive correlations between CRP, ESR and VEGF-A in CD patients before treatment (r=0.727, 0.450, P<0.05). Immunohistochemical staining showed that VEGF-A expression in the diseased intestinal tissue of CD patients was significantly lower than that before treatment, but higher than the healthy controls (P<0.05). The expression level of VEGF-A in serum was positively correlated with the expression intensity of VEGF-A in intestinal mucosa tissue before and after treatment (r=0.714, 0.926,P<0.05). Conclusion: The VEGF-A level in serum and intestinal mucosa is positively correlated with the CDdisease activity, which has the potential to be used as an indicator to evaluate the treatment efficacy of CD.