血清英夫利西单抗谷浓度、抗英夫利西单抗抗体水平监测在英夫利西单抗维持治疗克罗恩病患者中的临床应用  

Clinical Applications of Monitoring Serum Infliximab Trough Levels and Antibodies to Infliximab in Crohn's Disease Patients Treated With Infliximab

作　　者：张启维 孙颖[1] 王天蓉[1] 沈骏[1] 冉志华[1] 郑青[1] ZHANG Qiwei;SUN Ying;WANG Tianrong;SHEN Jun;RAN Zhihua;ZHENG Qing(Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease; Shanghai Inflammatory Bowel Disease Research Center, Shanghai (200001))

机构地区：[1]上海交通大学医学院附属仁济医院消化内科,上海市消化疾病研究所,上海市炎症性肠病研究中心,200001

出　　处：《胃肠病学》2017年第12期723-727,共5页Chinese Journal of Gastroenterology

基　　金：国家自然科学基金(81770545、81470820)资助

摘　　要：背景:随着英夫利西单抗(IFX)广泛用于克罗恩病(CD)的治疗,部分患者对IFX治疗失应答,具体机制尚未明确,可能与抗英夫利西单抗抗体(ATI)的形成密切相关。目前国内尚无ATI阳性率的相关报道。目的:评估血清英夫利西单抗谷浓度(IFX-TLs)、ATI水平监测在IFX维持治疗CD患者中的临床作用。方法:连续纳入2016年1月—2017年3月上海仁济医院接受IFX治疗的CD患者76例。检测血清IFX-TLs和ATI水平。根据CDAI评分将患者分为活动期组和缓解期组,比较血清IFX-TLs、ATI、C反应蛋白(CRP)和红细胞沉降率(ESR)水平。结果:76例CD患者中,2例(2.6%)ATI阳性,45例(59.2%)患者处于缓解期,31例(40.8%)为活动期。缓解期组IFX-TLs[2.84(1.30,4.96)μg/mL对4.08(1.29,6.72)μg/mL]、ATI[8.00(5.27,14.89)ng/mL对7.00(4.40,25.00)ng/mL]与活动期组相比无明显差异(P=0.484,P=0.454),而活动期组CRP、ESR水平均显著高于缓解期组(P=0.038,P=0.009)。Logistic回归分析显示CD活动性与CRP相关(OR=6.082,95%CI:1.348~27.436,P=0.019),与IFXTLs、ATI和ESR均无关(P>0.05)。结论:CD活动性可能与CRP相关,而与IFX-TLs、ATI和ESR均无关。With the extensive use of infliximab(IFX)in treatment of patients with Crohn’s disease(CD),some of the patients had losing of response to IFX treatment.The specific mechanism is not clear yet,and may be related to the formation of antibodies to infliximab(ATI).However,there is no report on the positivity rate of ATI in China so far.Aims:To investigate the clinical effects of serum IFX trough levels(IFX-TLs)and ATI in CD patients treated with IFX.Methods:A total of76CD patients receiving IFX treatment from Jan.2016to Mar.2017at Shanghai Renji Hospital were enrolled.Serum IFX-TLs and ATI were detected.CD patients were divided into active stage group and remission group according to CDAI score,and serum IFX-TLs,ATI,C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)levels were analyzed.Results:Of the76patients with CD,positive ATI was found in2patients(2.6%).Forty-five(59.2%)patients were in remission,while31(40.8%)in active stage.No significant differences in IFX-TLs[2.84(1.30,4.96)μg/mL vs.4.08(1.29,6.72)μg/mL,P=0.484],ATI[8.00(5.27,14.89)ng/mL vs.7.00(4.40,25.00)ng/mL,P=0.454]were found between active CD and remission CD.Serum CRP,ESR levels were significantly increased in active CD than in remission CD(P=0.038,P=0.009).Logistic regression analysis showed that activity of CD was related to CRP(OR=6.082,95%CI:1.348-27.436,P=0.019),but not related to IFX-TLs,ATI and ESR(P>0.05).Conclusions:The activity of CD may be correlated with CRP,but not with IFX-TLs,ATI and ESR.

关 键 词：CROHN病 英夫利西单抗 谷浓度 抗体 C反应蛋白质 血沉 治疗 

分 类 号：R574.62[医药卫生—消化系统]