Esters N, Vermeire S, Joossens S, Noman M, Louis E, Belaiche J, De Vos M, Van Gossum A, Pescatore P, Fiasse R, Pelckmans P, Reynaert H, Poulain D, Bossuyt X, Rutgeerts P
Department of Gastroenterology, UZ Gasthuisberg Leuven, Belgium.
Am J Gastroenterol. 2002 Jun;97(6):1458-62. doi: 10.1111/j.1572-0241.2002.05689.x.
The use of monoclonal anti-tumor necrosis factor (TNF) antibodies (infliximab, Remicade) is a new therapeutic approach for severe refractory luminal or fistulizing, Crohn's disease (CD). However, up to 30% of patients do not respond to this treatment. So far, no parameters predictive of response to anti-TNF have been identified. Our aim was to determine whether serological markers ASCA (anti-Saccharomyces cerevisiae antibodies) or pANCA (perinuclear antineutrophil cytoplasmic antibodies) could identify Crohn's patients likely to benefit from anti-TNF therapy.
Serum samples of 279 CD patients were analyzed for ASCA and pANCA before anti-TNF therapy. A blinded physician determined clinical response at week 4 (refractory luminal CD) or week 10 (fistulizing CD) after the first infusion of infliximab (5 mg/kg).
Overall, there was no relationship between ASCA or pANCA and response to therapy. However, lower response rates were observed for patients with refractory intestinal disease carrying the pANCA+/ASCA- combination, although this lacked significance (p = 0.067).
In this cohort of infliximab-treated patients, neither ASCA nor pANCA could predict response to treatment. However, the combination pANCA+/ASCA- might warrant further investigation for its value in predicting nonresponse in patients with refractory luminal disease.
使用单克隆抗肿瘤坏死因子（TNF）抗体（英夫利昔单抗，类克）是治疗重度难治性管腔型或瘘管型克罗恩病（CD）的一种新方法。然而，高达30%的患者对这种治疗无反应。到目前为止，尚未发现预测抗TNF反应的参数。我们的目的是确定血清学标志物抗酿酒酵母抗体（ASCA）或核周抗中性粒细胞胞浆抗体（pANCA）是否能够识别可能从抗TNF治疗中获益的克罗恩病患者。
在抗TNF治疗前，对279例CD患者的血清样本进行ASCA和pANCA分析。一名不知情的医生在首次输注英夫利昔单抗（5mg/kg）后第4周（难治性管腔型CD）或第10周（瘘管型CD）确定临床反应。
总体而言，ASCA或pANCA与治疗反应之间无相关性。然而，携带pANCA+/ASCA-组合的难治性肠道疾病患者的反应率较低，尽管这一差异无统计学意义（p = 0.067）。
在这个接受英夫利昔单抗治疗的队列中，ASCA和pANCA均不能预测治疗反应。然而，pANCA+/ASCA-组合在预测难治性管腔疾病患者无反应方面的价值可能值得进一步研究。
