抗肿瘤坏死因子-α抗体治疗狭窄型克罗恩病的争议与共识  

Controversy and consensus of the anti-tumor necrosis factor alpha in the treatment of Crohn＇s disease with intestinal stricture

作　　者：余乔 李清海[2] 宋永茂[3] 徐栋[3] 陈焰[1] Yu Qiao;Li Qinghai;Song Yongmao;Xu Dong;Chen Yah(Department of Gastroenterology,Zhefiang University School of Medicine Second Affiliated Hospital,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属第二医院消化内科,杭州310000 [2]浙江大学医学院附属第二医院影像科,杭州310000 [3]浙江大学医学院附属第二医院肿瘤外科,杭州310000

出　　处：《中华消化外科杂志》2018年第9期905-909,共5页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金青年基金（81700455）

摘　　要：抗肿瘤坏死因子（TNF）-α单克隆抗体的出现为炎症性肠病（IBD）患者带来了福音。然而．目前关于抗TNF-α制剂对于狭窄型克罗恩病的用药指征和确切效果均存在争议。有研究者认为狭窄型克罗恩病患者使用生物制剂后出现肠梗阻和肠穿孔的风险增高：但也有观点认为两者之间并无因果关系。其根本问题在于抗TNF-α制剂只针对炎症，不能抗纤维化乃至改变克罗恩病的远期结局。为了避免和预防肠梗阻和肠穿孔发生，临床IBD医师使用抗TNF-α制剂治疗前，须评估肠道狭窄的病理学组成成分和类型，准确把握用药适应证和时机；并推进研发特异性抗肠道纤维化药物治疗狭窄型克罗恩病。The emergence of the anti-tumor necrosis factor alpha （anti-TNF-α） therapies has brought lots of benefits to patients with inflammatory bowel disease （IBD）. However, controversies exist over whether anti-TNF-α could be used for Crohn＇s disease （CD） patients with intestinal stricture. Some articles found stricturing CD patients under anti-TNF therapy had a high risk of intestinal obstruction or even perforation while others found that there was no association between anti-TNF-α and intestinal obstruction. The fundamental cause lies in that anti-TNF-α only target at inflammation, but cannot be resistant to intestinal fibrosis or change long term outcome. To avoid and prevent intestinal obstruction or perforation, authors should evaluate the component and type of intestinal stricture cautiously before starting anti-TNF-α therapy. Exploring new specific anti- fibrotic therapy will be a promising way for all stricturing CD patients.

关 键 词：克罗恩病 抗肿瘤坏死因子-Α 英夫利昔单克隆抗体 肠道狭窄 

分 类 号：R574.62[医药卫生—消化系统]