双靶向生物制剂治疗儿童难治性炎症性肠病十例分析  

Analysis of ten cases of refractory inflammatory bowel disease in children treated with dual targeted therapy

作　　者：梅天璐 郭姝[1] 李婧 官德秀[1] 叶晓琳 吴捷 Mei Tianlu;Guo Shu;Li Jing;Guan Dexiu;Ye Xiaolin;Wu Jie(Department of Gastroenterology,Beijing Children's Hospital Affiliated to Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院消化科,100045

出　　处：《中国小儿急救医学》2024年第8期602-607,共6页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨双靶向生物制剂疗法(DTT)治疗儿童难治性炎症性肠病(IBD)的疗效及安全性。方法回顾性分析2022年4月至2024年5月于首都医科大学附属北京儿童医院消化科使用DTT治疗的难治性IBD患儿的诊治过程,总结其临床特点。结果共纳入10例难治性IBD患儿,男5例、女5例,中位发病年龄12.58(5.25,13.33)岁,克罗恩病(CD)7例、溃疡性结肠炎(UC)3例,中位病程1.25(0.91,4.00)年,使用DTT治疗中位时间6.08(6.00,13.40)个月。CD患儿中2例(2/7)使用英夫利西单克隆抗体(IFX)治疗部分有效,5例(5/7)使用IFX及硫唑嘌呤联合治疗部分有效,后均采用在IFX基础上加用乌司奴单克隆抗体(UST)的DTT治疗。7例CD患儿在DTT治疗4周、12周、24周时,临床缓解率分别为42.9%(3/7)、71.4%(5/7)、100.0%(7/7);儿童CD疾病活动指数评分逐渐下降,均显著低于治疗前(P<0.05);粪便钙卫蛋白、C-反应蛋白、红细胞沉降率、血白细胞计数均逐渐下降,低于治疗前,血红蛋白、血清白蛋白均高于治疗前。3例UC患儿均为糖皮质激素抵抗,1例使用阿达木单克隆抗体治疗部分有效,1例IFX联合免疫抑制剂部分有效,1例使用维多珠单克隆抗体部分有效,后均采用在原有生物制剂基础上加用UST的DTT治疗。3例UC患儿DTT治疗4周、12周时,1例临床缓解,1例临床应答,1例临床无应答;DTT治疗24周时,2例获得临床缓解,1例临床无应答;复查结肠镜显示,临床缓解患儿1例镜下黏膜愈合、1例疾病轻度活动,临床无应答患儿镜下疾病活动度较DTT治疗前略有改善。DTT治疗期间10例患儿均未发生不良事件。结论DTT对儿童难治性IBD有良好的疗效,且相对安全,可作为IBD患儿对一种生物制剂部分有效时的尝试之一。ObjectiveTo explore the efficacy and safety of dual targeted therapy(DTT)in the treatment of refractory inflammatory bowel disease(IBD)in children.MethodsThe diagnosis and treatment processes of refractory IBD children treated with DTT in the Department of Gastroenterology,Beijing Children's Hospital Affiliated to Capital Medical University from April 2022 to May 2024 were analyzed retrospectively,and their clinical characteristics were summarized.ResultsA total of ten children with refractory IBD were included,including five males and five females,with a median onset age of 12.58(5.25,13.33)years old,and seven cases of Crohn's disease(CD)and three cases of ulcerative colitis(UC),with a median disease course of 1.25(0.91,4.00)years,were treated with DTT for a median time of 6.08(6.00,13.40)months.Two(2/7)cases of CD patients were partially effective with infliximab(IFX)treatment,while five(5/7)cases were partially effective with a combination of IFX and azathioprine treatment.These patients received DTT with UST in addition to continuous using of IFX.When the seven CD patients were treated with DTT for four weeks,12 weeks and 24 weeks,and the clinical remission rates were 42.9%(3/7),71.4%(5/7)and 100%(7/7),respectively.The pediatric Crohn's disease activity index gradually decreased,which were significantly lower than those before treatment(P<0.05).Fecal calprotectin,C-reactive protein,erythrocyte sedimentation rate,and blood white blood cells all gradually decreased,which were lower than those before treatment,while hemoglobin and serum albumin were higher than those before treatment.Three children with UC were all resistant to glucocorticoids.One case was partially effective with adalimumab treatment,one case was partially effective with IFX combined with immunosuppressive agents,and one case was partially effective with vedolizumab.All the three UC patients received DTT treatment with UST in addition to continuous using of the original biological preparation.When the three UC patients were treated with DTT for

关 键 词：儿童 难治性炎症性肠病 双靶向生物制剂 英夫利西单克隆抗体 乌司奴单克隆抗体 维多珠单克隆抗体 阿达木单克隆抗体 

分 类 号：R725.7[医药卫生—儿科]