克罗恩病英夫利昔单抗治疗失应答的影响因素分析  

Analysis of factors affecting loss of response to infliximab in the treatment of Crohn’s disease

作　　者：杨花花 周旭春[1] 黄怡[1] 袁雪 文友飞 YANG huahua;ZHOU Xuchun;HUANG Yi;YUAN Xue;WEN Youfei(Department of Gastroenterology,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;不详)

机构地区：[1]重庆医科大学附属第一医院消化内科,重庆400010 [2]贵州医科大学附属医院消化内科

出　　处：《山东医药》2022年第3期30-34,共5页Shandong Medical Journal

摘　　要：目的分析克罗恩病(CD)英夫利昔单抗(IFX)治疗失应答的影响因素。方法回顾性分析使用IFX治疗的63例CD患者的临床资料,包括年龄、性别、发病至治疗时间(病程)、蒙特利尔分型(包括诊断时年龄A、病变部位L和疾病行为B)、联用免疫制剂、联合肠内营养、合并瘘管、合并肛周病变、合并肠外表现、治疗前克罗恩病活动指数(CDAI)评分、BMI、CRP、CRP降低率[(第四次治疗前CRP-基线CRP)/基线CRP]、基线红细胞沉降率(ESR)、基线血红蛋白(Hb)、基线白蛋白(ALB)等。根据IFX诱导治疗3次后的CDAI评分分为原发失应答组和应答组,应答组的患者根据应答情况分为继发失应答组和持续应答组。比较原发失应答组和应答组以及继发失应答组和持续应答组的上述临床资料,采用Logistic回归分析CD患者IFX治疗失应答的影响因素。结果63例CD患者中,22例(34.9%)患者发生IFX治疗失应答,发生原发失应答的患者8例(12.7%),继发失应答的患者14例(22.2%),原发失应答组和应答组患者BMI、疾病行为和联合肠内营养比较,P均<0.05。未发现原发失应答的独立预测因素;继发失应答组和持续应答组患者性别、CDAI评分和Hb比较,P均<0.05,治疗前CDAI评分>220分是继发失应答的独立预测因素(P<0.05)。结论IFX治疗CD患者失应答不可避免。患者的疾病行为、BMI和联合肠内营养是IFX治疗原发失应答的可能影响因素。CDAI评分>220分为IFX治疗继发失应答的独立预测因素,性别、CDAI评分和Hb与IFX治疗继发失应答有关。ObjectiveTo investigate the factors affecting loss of response(LOR)to infliximab(IFX)in treatmentof Crohn’s disease(CD).MethodsA retrospective analysis on the clinical data of 63 CD patients treated with IFX wasconducted,including age,gender,disease duration,Montreal classification(age at diagnosis,CD location,and CD be-havior),concomitant immunosuppressant,concomitant enteral nutrition,combined fistula,combined perianal disease,combined extraintestinal manifestations,CDAI score,BMI,CRP,CRP reduction rate,erythrocyte sedimentation rate(ESR),Hb,and ALB. According to the CDAI score after three administrations,patients were divided into the primarynon-response(PNR)group and response group,and those in the response group were then divided into secondary LORand continuous response groups by assessment. We compared the above clinical data between the PNR and responsegroups,and between the LOR and continuous response groups. Logistic regression was used to analyze the factors affectingthe failure of IFX treatment for CD patients.ResultsA total of 22(34. 9%)of 63 CD patients experienced IFX treat-ment failure. PNR occurred in 8 patients(12. 7%)and LOR in 14 patients(22. 2%). We noted there were statisticallydifferences in BMI,disease behavior,and concomitant enteral nutrition between the PNR group and response group(all P<0. 05). No independent predictors of PNR were found. Univariate analysis revealed the gender,CDAI score,and Hb wererelated to LOR(all P<0. 05). Multivariate analysis showed that CDAI score > 220 was an independent predictor for LOR(P<0. 05).ConclusionsLOR to IFX treatment in CD patients is inevitable. Disease behavior,BMI,and concomitant enteral nutrition of CD patients possibly influence PNR. CDAI score >220 is an independent predictor for LOR,and gen-der,CDAI score and Hb are associated with LOR.

关 键 词：英夫利昔单抗 英夫利昔单抗失应答 克罗恩病 影响因素 

分 类 号：R574.62[医药卫生—消化系统]