英夫利西单抗在儿童克罗恩病中的应用  

Application of Infliximab in children with Crohn′s disease

作　　者：王姣 钟雪梅[1] 宫幼喆[1] 金萌[1] 张姌 陈燕飞[1] Wang Jiao;Zhong Xuemei;Gong Youzhe;Jin Meng;Zhang Ran;Chen Yanfei(Department of Gastroenterology,Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院消化内科,北京100020

出　　处：《中华实用儿科临床杂志》2024年第5期342-345,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：首都儿科研究所附属儿童医院临床培育专项(LCYG-2023-21)。

摘　　要：目的:分析英夫利西单抗(IFX)对儿童克罗恩病(CD)诱导阶段治疗疗效,探讨其治疗前后儿童CD活动指数(PCDAI)和简化内镜评分(SES-CD)在评估疾病活动程度方面的一致性。方法:病例总结。回顾性分析2015年1月至2022年8月于首都儿科研究所附属儿童医院住院并接受IFX治疗的53例CD患儿的临床资料。治疗前后比较采用独立样本t检验或Mann-Whitney检验,采用Kappa检验进行一致性评估。结果:共纳入病例53例,其中男33例,女20例;年龄11.0(0.6,16.2)岁。53例患儿中,学龄前儿童(<6岁)9例,占比16.98%。25例(47.17%)患儿存在不同程度的营养不良。53例CD患儿经IFX治疗14周后PCDAI及SES-CD评分中位值分别从35.00分、17.00分降至5.00分、3.00分;C反应蛋白和红细胞沉降率中位值分别从28.10 mg/L、32.00 mm/1 h降至0.84 mg/L、7.00 mm/1 h。治疗后红细胞比容从(0.34±0.05)mg/L升至(0.37±0.04)mg/L、血红蛋白从(106.98±15.39)g/L升至(122.22±15.08)g/L、白蛋白从(37.62±6.50)g/L升至(42.31±4.87)g/L,差异均有统计学意义(均P<0.01)。临床缓解率和临床应答率分别为73.58%和84.91%,内镜缓解率和内镜应答率分别为64.15%和77.36%。治疗前PCDAI与SES-CD评分对于CD活动度分级划分一致性较差(Kappa值为0.092);治疗后PCDAI与SES-CD评分对于CD活动度分级划分一致性中等(Kappa值为0.431)。结论:IFX在儿童CD诱导缓解治疗中疗效确切,PCDAI和SES-CD评分在儿童CD活动度评估中一致性较差,部分PCDAI评估临床缓解的CD患儿仍然存在内镜下黏膜炎症,临床中应综合PCDAI评分及SES-CD结果对患儿进行综合的疗效评估。Objective To analyze the efficacy of Infliximab(IFX)in the induction stage of Crohn′s disease(CD)in children and to explore the consistency between the pediatric Crohn′s disease activity index(PCDAI)and simple endoscopic scale for Crohn′s disease(SES-CD)in assessing disease activity before and after treatment.Methods Case summary.The clinical data of 53 CD patients treated with IFX at Children′s Hospital,Capital Institute of Pediatrics from January 2015 to August 2022 was retrospectively analyzed and compared using the t-test or Mann-Whitney test before and after treatment.The Kappa test was conducted for consistency evaluation.Results A total of 53 patients,including 33 males and 20 females,were included,with an age of 11.0(0.6,16.2)years.Among the 53 patients,there were 9 preschool children(<6 years old),accounting for 16.98%,and 25 patients(47.17%)had varying degrees of malnutrition.After 14 weeks of IFX treatment,the medians of PCDAI and SES-CD scores decreased from 35.00 and 17.00 points to 5.00 and 3.00 points,respectively.The medians of C-reactive protein and erythrocyte sedimentation rate decreased from 28.10 mg/L and 32.00 mm/1 h to 0.84 mg/L and 7.00 mm/1 h,respectively.After treatment,the levels of hematocrit,hemoglobin,and albumin increased from(0.34±0.05)mg/L,(106.98±15.39)g/L,and(37.62±6.50)g/L to(0.37±0.04)mg/L,(122.22±15.08)g/L,and(42.31±4.87)g/L,respectively(all P<0.01).The clinical remission and response rates were 73.58%and 84.91%,respectively.The endoscopic remission and response rates were 64.15%and 77.36%,respectively.The consistency between PCDAI and SES-CD scores for CD activity grading before treatment was poor(Kappa value:0.092),while after treatment,the consistency was moderate(Kappa value:0.431).Conclusions IFX has a definite therapeutic effect in CD-induced remission treatment in children.The consistency between PCDAI and SES-CD scores in assessing CD activity is poor.Some CD patients who have clinical remission evaluated by PCDAI still have endoscopic mucosal inflammati

关 键 词：儿童 克罗恩病 儿童克罗恩病活动指数 克罗恩病简化内镜评分 

分 类 号：R725.7[医药卫生—儿科]