炎症性肠病患儿维持治疗期延迟使用英夫利昔单抗3周未改变疾病活动指数  

Postponing infliximab infusion for three weeks during maintenance therapy without changing the disease activity index among children with inflammatory bowel disease

作　　者：周颖[1] 黄瑛[1] 罗优优[2] 陈洁[2] 耿岚岚 龚四堂 游洁玉[4] 房永利 张晶[5] 李中跃[6] 王朝霞 吴捷[8] 肖园[9] 许春娣[9] 方莹 钟雪梅[11] 李小芹 陈競芳[13] 李在玲[14] 徐樨巍 郭红梅[16] 金玉[16] 商丽红 谢晓丽 梅红[18] 朱莉 ZHOU Ying;HUANG Ying;LUO You-you;CHEN Jie;GENG Lan-lan;GONG Si-tang;YOU Jie-yu;FANG Yong-li;ZHANG Jing;LI Zhong-yue;WANG Zhao-xia;WU Jie;XIAO Yuan;XU Chun-di;FANG Ying;ZHONG Xue-mei;LI Xiao-qin;CHEN Jing-fang;LI Zai-ling;XU Xi-wei;GUO Hong-mei;JIN Yu;SHANG Li-hong;XIE Xiao-li;MEI Hong;ZHU Li(Children's Hospital of Fudan University,Shanghai 201102,China;The Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Guangzhou Women and Children's Medical Center,Guangzhou 510623,China;Hunan Children's Hospital,Changsha 410007,China;Beijing Children's Hospital,Capital Medical University,Beijing 100045,China;Childen's Hospital of Chongqing Medical University,Chongqing 401122,China;Shenzhen Children's Hospital,Shenzhen 518038,China;Shengjing Hospital of China Medical University,Shenyang 110004,China;Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Xi'an Children's Hospital,Xi'an 710003,China;Children's Hospital,Capital Institute of Pediatrics,Beijing 100020,China;He'nan Children's Hospital,Zhengzhou 450018,China;Children's Hospital of Fudan University Xiamen Branch,Xiamen 361006,China;Peking University Third Hospital,Beijing 100191,China;Beijing Jing Du Children's Hospital,Beijing 102208,China;Children's Hospital of Nanjing Medical University,Nanjing 210000,China;Chengdu Women's&Children's Central Hospital,Chengdu 610073,China;Wuhan Children's Hospital,Wuhan 430015,China;Clinical Medical School of Maternal and Child Affiliated to Guizhou Medical University,Guiyang 550003,China)

机构地区：[1]复旦大学附属儿科医院,上海201102 [2]浙江大学医学院附属儿童医院,杭州310003 [3]广州市妇女儿童医疗中心,广州510623 [4]湖南省儿童医院,长沙410007 [5]首都医科大学附属北京儿童医院,北京100045 [6]重庆医科大学附属儿童医院,重庆401122 [7]深圳市儿童医院,深圳518038 [8]中国医科大学附属盛京医院,沈阳110004 [9]上海交通大学医学院附属瑞金医院,上海200025 [10]西安交通大学附属儿童医院,西安710003 [11]首都儿科研究所附属儿童医院,北京100020 [12]河南省儿童医院,郑州450018 [13]复旦大学附属儿科医院厦门分院,厦门361006 [14]北京大学第三医院,北京100191 [15]北京京都儿童医院,北京102208 [16]南京医科大学附属儿童医院,南京210000 [17]成都市妇女儿童中心医院,成都610073 [18]华中科技大学同济医学院附属武汉儿童医院,武汉430015 [19]贵州省妇幼保健院,贵阳550003

出　　处：《中国循证儿科杂志》2020年第3期224-228,共5页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的评估新型冠状病毒(SARS-CoV-2)流行期间,因为不可抗力因素导致延迟使用英夫利昔单抗(IFX)对炎症性肠病(IBD)患儿疾病活动指数的影响。方法多中心横断面调查。纳入2020年1月20日至2020年3月20日(疫情中)国内19家医院使用IFX的IBD连续病例,疫情中较疫情前(2020年1月20日前)儿童克罗恩病疾病活动指数(PCDAI)或儿童溃疡性结肠炎疾病活动指数(PUCAI)评分疾病分期加重为病例组,未加重为对照组。考察年龄、性别、延期治疗时间、WBC、Hb、PLT和CRP对疾病分期加重的影响。结果 19家医院参加了本次调查,232例应该接受IFX治疗的IBD患儿中,67例(28.9%)因疫情因素未按时使用IFX。暂停使用2例,疫情中失访;延迟使用65例,其中9例疫情中失访。56例延迟使用IFX[(17.9±9.9) d]并采集到疫情前和中数据的IBD患儿进入本文分析。男27例,女29例,平均年龄(11.3±4.1)岁。病例组11例(诱导阶段3例,维持阶段8例),对照组45例(诱导阶段2例,维持阶段43例)。疫情中与疫情前相比,延迟使用IFX的患儿WBC、Hb、PLT、CRP和疾病活动指数差异均无统计学意义(P分别为0.44、0.60、0.80、0.34和0.33)。11例疾病分期加重,其中6例需要住院,无因为延迟治疗而需要外科手术或死亡的病例。结论维持治疗阶段延迟3周使用IFX未改变IBD患儿疾病活动指数。Objective To investigate the effect of delayed infliximab infusion on the disease activity index among children with inflammatory bowel disease during the SARS⁃CoV⁃2 epidemic.Methods This is a multicenter cross⁃sectional study.Children from 19 hospitals in China who received infliximab infusion for inflammatory bowel disease between January 20th and March 20th were enrolled in the study.Patients whose disease stages were deteriorated according to PCDAI/PUCAI were categorized as case group.Others were in control group.The impact of age,sex,the average length of postpone infusion,WBC count,Hb level,PLT count and CRP level on disease stage were analyzed.Results Among 232 patients who should receive scheduled infliximab infusion,67 cases(28.9%)had their infusion delayed due to the epidemic including 2 patients of discontinuing the therapy and losing follow up and 65 patients of delaying the infusion with 9 lost cases.A total of 56 patients(27 males,29 females,with average age of 11.3±4.1 years)were finally included in the study.The average length of infusion postponement was 17.9±9.9 days.There were 11 patients(3 with induction therapy and 8 with maintenance therapy)in case group and 45 patients(2 with induction therapy and 43 with maintenance therapy)in control group.WBC count,Hb level,PLT count,CRP level and disease activity index were not significantly changed in patients who delayed the infusion(P was 0.44,0.60,0.80,0.34 and 0.33,respectively)compared with that before the epidemic.Disease stages of 11 patients were deteriorated,6 of which needed hospitalization.There was no case of surgery or death.Conclusion Postponing infliximab infusion for three weeks during maintenance therapy did not change the disease activity index among children with inflammatory bowel disease.

关 键 词：新型冠状病毒 炎症性肠病 儿童 英夫利昔单抗 

分 类 号：R725.7[医药卫生—儿科]