Sands Bruce E, Kaplan Gilaad G
Gastrointestinal Unit, Center for the Study of Inflammatory Bowel Diseases, and MGH Crohn's and Colitis Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
J Clin Pharmacol. 2007 Aug;47(8):930-41. doi: 10.1177/0091270007301623. Epub 2007 Jun 13.
Standard of care for ulcerative colitis involves long-term pharmacotherapy or colectomy. Approximately 20% to 30% of patients eventually require a colectomy because patients either do not respond or cannot tolerate the currently available pharmacotherapies. Advances in our knowledge of the pathophysiology of ulcerative colitis have highlighted the importance of cytokines such as tumor necrosis factor alpha (TNFalpha) in the inflammatory process. TNFalpha is a proinflammatory mediator that plays an integral role in the pathogenesis of inflammatory bowel disease. In addition, mounting evidence indicates a genetic association between TNFalpha and ulcerative colitis. Furthermore, increased TNFalpha levels have been demonstrated in studies of patients with ulcerative colitis. TNFalpha is likely an important component in the pathophysiology of ulcerative colitis, and thus agents targeting TNFalpha in ulcerative colitis have been studied. Recent randomized controlled trials have confirmed that biologic anti-TNFalpha therapy is effective in ulcerative colitis. Soluble TNFalpha receptors or biologic agents that suppress or inhibit TNFalpha production may also show therapeutic promise.
溃疡性结肠炎的标准治疗方案包括长期药物治疗或结肠切除术。约20%至30%的患者最终需要进行结肠切除术，因为患者要么对现有药物治疗无反应，要么无法耐受。我们对溃疡性结肠炎病理生理学认识的进展突出了细胞因子如肿瘤坏死因子α（TNFα）在炎症过程中的重要性。TNFα是一种促炎介质，在炎症性肠病的发病机制中起不可或缺的作用。此外，越来越多的证据表明TNFα与溃疡性结肠炎之间存在遗传关联。此外，在溃疡性结肠炎患者的研究中已证实TNFα水平升高。TNFα可能是溃疡性结肠炎病理生理学中的一个重要组成部分，因此针对溃疡性结肠炎中TNFα的药物已得到研究。最近的随机对照试验证实，生物抗TNFα治疗对溃疡性结肠炎有效。可溶性TNFα受体或抑制或阻止TNFα产生的生物制剂也可能具有治疗前景。
