克罗恩病:当前的治疗选择。
Crohn's disease: current treatment options.
作者信息
Akobeng A K
机构信息
Department of Paediatric Gastroenterology, Central Manchester and Manchester Children's University Hospitals, Booth Hall Children's Hospital, Charlestown Road, Blackley, Manchester M9 7AA, UK.
出版信息
Arch Dis Child. 2008 Sep;93(9):787-92. doi: 10.1136/adc.2007.128751. Epub 2008 May 2.
There is no known cure for Crohn's disease (CD), but a better understanding of the evidence base of both established treatments (such as enteral nutrition, corticosteroids, 5-aminosalicylates and immunosuppressive agents) and emerging treatments (such as the anti-tumour necrosis factor-alpha (anti-TNF-alpha) agents, infliximab and adalimumab) provides opportunities to improve and maintain the quality of life for children with the disease. This article provides an overview of the evidence base of current medical treatments that are used to induce and maintain remission in CD. Exclusive enteral nutrition is recommended as the first line of treatment for the induction of remission in paediatric CD. Corticosteroids are also effective for inducing remission but may be associated with significant adverse events. Patients with chronically active CD may benefit from immunosuppressive agents such as azathioprine and methotrexate. Infliximab is effective for inducing remission in patients who continue to have significant active disease despite the use of conventional treatments. Adalimumab may be indicated for patients who develop a severe allergic reaction to infliximab or those who initially respond to infliximab but subsequently lose their response. Treatments that have been shown to be effective for the maintenance of remission include azathioprine, methotrexate, infliximab and adalimumab. Recent evidence also suggests that long-term enteral nutritional supplementation with patients taking about half of their daily calorie requirements as enteral nutrition may be an effective strategy for the maintenance of remission in CD. The available evidence does not support the use of corticosteroids or 5-aminosalicylates as maintenance therapy for CD.
目前尚无已知的克罗恩病(CD)治愈方法,但深入了解现有治疗方法(如肠内营养、皮质类固醇、5-氨基水杨酸酯和免疫抑制剂)以及新兴治疗方法(如抗肿瘤坏死因子-α(抗TNF-α)药物英夫利昔单抗和阿达木单抗)的证据基础,为改善和维持该病患儿的生活质量提供了机会。本文概述了目前用于诱导和维持CD缓解的药物治疗的证据基础。推荐采用全肠内营养作为小儿CD诱导缓解的一线治疗方法。皮质类固醇也可有效诱导缓解,但可能会伴有严重的不良事件。慢性活动性CD患者可能受益于硫唑嘌呤和甲氨蝶呤等免疫抑制剂。对于尽管使用了传统治疗方法但仍有明显活动性疾病的患者,英夫利昔单抗可有效诱导缓解。对于对英夫利昔单抗发生严重过敏反应的患者或最初对英夫利昔单抗有反应但随后失去反应的患者,可能需要使用阿达木单抗。已证明对维持缓解有效的治疗方法包括硫唑嘌呤、甲氨蝶呤、英夫利昔单抗和阿达木单抗。最近的证据还表明,对于以肠内营养形式摄入约一半每日热量需求的患者,长期进行肠内营养补充可能是维持CD缓解的有效策略。现有证据不支持将皮质类固醇或5-氨基水杨酸酯用作CD的维持治疗。