Rutgeerts P
Department of Medicine, University of Leuven, Leuven, Belgium.
Eur J Surg Suppl. 2002(587):58-61.
Considerable advances have been made in the treatment of inflammatory bowel disease (IBD) mainly in that of Crohn's disease, but many questions still remain. We need to develop treatments that modify the disease. The use of immunomodulation using cytokines and anti-cytokines is an important step to achieve this goal. The standard is now the chimeric monoclonal antibody against tumour necrosis factor (TNF) in Crohn's disease. These treatments, however, are associated with problems of immunogenicity and autoimmunity. Moreover a proportion of patients do not respond to treatment and we do not have measurements that predict response. The optimal use and the combined treatment with immunosuppression are under investigation. The safety of this treatment in the long-term is also not established. These costly drugs are not suitable for the management of mild to moderate Crohn's disease and ulcerative colitis (UC). If it turns out that the antigenic drive of the inappropriate immune reaction is in the lumen of the gut changing the gut flora by using probiotics may be the way to go.
炎症性肠病（IBD）的治疗，主要是克罗恩病的治疗，已经取得了相当大的进展，但仍有许多问题存在。我们需要开发能够改变疾病的治疗方法。使用细胞因子和抗细胞因子进行免疫调节是实现这一目标的重要一步。目前，针对克罗恩病的标准治疗是使用抗肿瘤坏死因子（TNF）的嵌合单克隆抗体。然而，这些治疗方法存在免疫原性和自身免疫性问题。此外，一部分患者对治疗无反应，且我们没有能够预测反应的指标。免疫抑制的最佳使用方法以及联合治疗正在研究中。这种治疗的长期安全性也尚未确定。这些昂贵的药物并不适用于轻度至中度克罗恩病和溃疡性结肠炎（UC）的治疗。如果事实证明不适当免疫反应的抗原驱动因素存在于肠道腔内，那么使用益生菌改变肠道菌群可能是解决之道。
