英夫利昔单抗治疗类固醇难治性溃疡性结肠炎的临床观察  

Clinical observation of infliximab in treatment of steroid-refractory ulcerative colitis

作　　者：张喆[1] 郑长清[1] 秦芳芳[1] 林艳[1] ZHANG Zhe;ZHENG Chang-qing;QIN Fang-fang;LIN Yan(No.2 Department of Gastroenterology,Shengjing Hospital of Chinese Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学附属盛京医院第二消化内科,辽宁省沈阳市110000

出　　处：《广西医学》2020年第8期945-949,共5页Guangxi Medical Journal

基　　金：辽宁省科技厅科学技术计划(2013225303)。

摘　　要：目的探讨英夫利昔单抗(IFX)治疗类固醇难治性中重度溃疡性结肠炎(UC)的效果。方法回顾性分析因糖皮质激素治疗无效或依赖而接受IFX治疗的42例中重度UC患者的临床资料。记录治疗期间IFX的使用情况、不良反应发生情况及IFX治疗后第1周、第2周、第6周、第14周、第52周的临床应答情况。于治疗后第14周及第52周复查肠镜,根据肠镜下表现及改良Mayo评分进行疗效评定。分析IFX治疗前、IFX治疗第14周及第52周时的相关实验室指标变化。结果治疗期间42例患者的IFX中位使用次数为2(2,6)次。42例患者中,应用IFX后第1周、第2周、第14周时均临床应答28例(66.67%),无效14例(33.33%);第6周、第52周时均临床应答29例(69.05%),无效13例(30.95%)。42例患者中,应用IFX后第14周时,临床缓解22例(52.38%),其中黏膜愈合20例(47.62%);第52周时,临床缓解20例(47.62%),其中黏膜愈合18例(42.86%)。治疗第14周及第52周时患者C反应蛋白、红细胞沉降率、血小板计数、D-二聚体、钙卫蛋白水平均较治疗前降低,血红蛋白及白蛋白水平均较治疗前升高(均P<0.05)。9例(21.43%)患者出现不良反应,其中巨细胞病毒感染2例(4.76%),EB病毒感染2例(4.76%),肺结核1例(2.38%),皮疹、颜面部水肿4例(9.52%)。结论 IFX治疗中重度类固醇难治性UC起效快速,且临床应答率、完全缓解率和临床缓解率均较高。Objective To explore the efficacy of infliximab(IFX) for the management of moderate to severe steroid-refractory ulcerative colitis(UC). Methods The clinical data of 42 moderate to severe UC patients, who suffered failure in glucocorticoid treatment or glucocorticoid dependence prior to infliximab therapy, were analyzed retrospectively. Usage of IFX and incidence of adverse reactions during treatment period, clinical responses in the 1 st, 2 nd, 6 th, 14 th and 52 nd week after IFX treatment were recorded. In the 14 th and 52 nd week after treatment colonoscopy review was performed, and efficacy assessment was conducted according to manifestations on colonoscopy and modified Mayo scores. Changes in relevant laboratory indicators before IFX treatment and in the 14 th and 52 nd week after IFX treatment were analyzed. Results Forty-two patients had a median frequency of IFX use of 2(2,6) during treatment. Among the 42 patients, clinical response was observed in 28(66.67%) cases, invalidation in 14(33.33%) cases in the 1 st,2 nd and 14 th week after IFX treatment;in the 6 th and 52 nd week clinical response was observed in 29(69.05%) cases, invalidation in 13(30.95%) cases. In the 14 th week after IFX use, 22(52.38%) out of 42 patients achieved clinical remission, including 20(47.62%) cases of mucosal healing;in the 52 nd week, 20(47.62%) cases had clinical remission, including 18(42.86%) cases of mucosal healing. In the 14 th and 52 nd week of treatment, compared with the pre-treatment levels, the levels of C-reactive protein, erythrocyte sedimentation rate, platelet count, D-dimer and calprotectin were decreased, and the levels of hemoglobin and albumin were increased(all P<0.05). Nine(21.43%) patients experienced adverse reactions, including 2(4.76%) cases of cytomegalovirus infection, 2(4.76%) cases of EB virus infection, 1(2.38%) case of pulmonary tuberculosis, and 4(9,52%) cases of rash and facial edema.Conclusion IFX therapy exerts effect rapidly on moderate to severe steroid-refractory UC, with higher clinica

关 键 词：溃疡性结肠炎 英夫利昔单抗 激素无效 激素依赖 

分 类 号：R574.1[医药卫生—消化系统]