TNF-α-308基因多态性与皖南地区克罗恩病患者英夫利昔单抗继发性失应答的关联性  

Association of TNF-α-308 Gene Polymorphism with Secondary Loss of Response to Infliximab in Patients with Crohn's Disease in Southern Anhui

作　　者：叶明琪 王培培 刘俊[1,2] 武元竹 袁梦[1] 李龙 栾家杰 YE Mingqi;WANG Peipei;LIU Jun;WU Yuanzhu;YUAN Meng;LI Long;LUAN Jiajie(School of Pharmacy,Wannan Medical College,Wuhu 241002,China;Department of Pharmacy,Yijishan Hospital of Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院药学院,芜湖241002 [2]皖南医学院弋矶山医院临床药学科,芜湖241001

出　　处：《医药导报》2023年第8期1211-1216,共6页Herald of Medicine

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2020-04-10);医学科研发展基金-临床与基础研究专项(YXKY-WS005E)。

摘　　要：目的探究皖南地区克罗恩病(CD)患者应用英夫利昔单抗(IFX)治疗继发性失应答(SLOR)的独立危险因素。方法对2018年1月—2021年4月皖南医学院弋矶山医院消化内科收治并应用IFX治疗的皖南地区CD患者进行分析。根据IFX临床应答情况分为持续性应答组和SLOR组,分析TNF-α-308基因多态性等临床资料组间差异,筛选IFX治疗SLOR独立危险因素并评估其诊断效能。结果70例CD患者SLOR发生率为28.6%。SLOR组患者既往肛周病变和肛周手术史占比、第4次IFX治疗前C反应蛋白(CRP)水平高于持续性应答组(P<0.05),TNF-α-308基因多态性组间无显著关联(P>0.05)。既往肛周病变[P=0.009,OR=15.633,95%CI=(1.959,123.740)]和第4次IFX治疗前CRP水平[P=0.010,OR=1.055,95%CI=(1.013,1.099)]是IFX治疗SLOR的独立危险因素,两个变量联合预测IFX治疗SLOR的诊断效能优于单个变量。结论临床应重视第4次IFX治疗前CRP≥3.89 mg·L^(-1)并有既往肛周病变的CD患者,密切监测其临床应答情况;TNF-α-308基因多态性不能作为皖南地区CD患者IFX治疗反应的预测因子。Objective To explore the independent risk factors for the application of infliximab(IFX)for secondary loss of response treated with infliximab in patients with Crohn's disease in southern Anhui.Methods Patients with Crohn's disease in southern Anhui who were admitted and treated with IFX in the Department of Gastroenterology of Yijishan Hospital of the first affiliated Hospital of Southern Anhui Medical College from January 2018 to April 2021 were analyzed.According to the clinical response of IFX,the patients were divided into a continuous response group and a secondary loss of response group.The differences in clinical data,such as TNF-α-308 gene polymorphism,were analyzed,the independent risk factors of secondary failure treated with IFX were screened,and its diagnostic efficacy was evaluated.Results The incidence of secondary loss of response in 70 patients with Crohn's disease was 28.6%.The proportion of patients with previous perianal lesions and the history of perianal surgery and the level of CRP before the fourth infliximab treatment in the secondary loss of response group were higher than those in the continuous response group(P<0.05).There was no significant correlation between the TNF-α-308 gene polymorphism groups(P>0.05).Previous perianal lesions[P=0.009,OR=15.633,95%CI=(1.959,123.740)]and CRP levels prior to 4th IFX treatment[P=0.010,OR=1.055,95%CI=(1.013,1.099)]as independent risk factors for secondary loss of response to infliximab treatment,the diagnostic efficacy of the combination of two variables in predicting a secondary loss of response of infliximab in the treatment of infliximab is better than that of a single variable.Conclusion More Clinical attention should be paid to the patients with Crohn's disease with CRP more than 3.89 mg·L^(-1) before the fourth IFX treatment and previous perianal lesions and their clinical response should be closely monitorede.TNF-α-308 gene polymorphism can not be used to predict therapeutic response to infliximab in patients with Crohn's disease in southe

关 键 词：英夫利昔单抗 克罗恩病 基因多态性 继发性失应答 危险因素 

分 类 号：R965[医药卫生—药理学] R574[医药卫生—药学]