Steiner Steven J, Pfefferkorn Marian D, Fitzgerald Joseph F, Denne Scott C
Division of Pediatric Gastroenterology, Hepatology, Nutrition, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana 46202-5225, USA.
Pediatr Res. 2008 Dec;64(6):673-6. doi: 10.1203/PDR.0b013e318186dde2.
Improvements in insulin resistance after anti-TNF-alpha therapy have been reported in inflammatory conditions, although no changes were noted in adult patients with Crohn's disease. There is no information concerning insulin resistance and substrate metabolism in children with Crohn's disease after anti-TNF-alpha therapy. Our aim was to describe changes in carbohydrate and lipid metabolism in children with active Crohn's disease after their initial dose of infliximab. Children with active Crohn's disease underwent measurement of plasma insulin and glucose just before and 2 wk after their initial infusion of infliximab, an anti-TNF-alpha antibody. In addition, resting energy expenditure, with determination of both carbohydrate and lipid oxidation rates, was determined. Measurements were conducted in both fasting and parenterally fed states. Despite no changes in resting energy expenditure, a significant reduction (p < 0.05) in RQ (5%) and carbohydrate oxidation rate (24%), with a corresponding increase in lipid oxidation rate (42%) was found during parenteral nutrition infusion. No differences in plasma insulin, glucose, and insulin resistance were noted when comparing pre- and postinfliximab measurements.
在炎症性疾病中，抗TNF-α治疗后胰岛素抵抗有所改善，尽管成年克罗恩病患者未观察到变化。目前尚无关于抗TNF-α治疗后儿童克罗恩病患者胰岛素抵抗和底物代谢的相关信息。我们的目的是描述初治剂量英夫利昔单抗治疗后，活动期克罗恩病患儿碳水化合物和脂质代谢的变化。活动期克罗恩病患儿在首次输注英夫利昔单抗（一种抗TNF-α抗体）前及输注后2周测量血浆胰岛素和葡萄糖。此外，测定静息能量消耗以及碳水化合物和脂质氧化率。在禁食和肠外营养状态下均进行测量。尽管静息能量消耗无变化，但在肠外营养输注期间发现呼吸商（RQ）显著降低（p < 0.05）（5%），碳水化合物氧化率降低（24%），脂质氧化率相应增加（42%）。比较英夫利昔单抗治疗前后的测量结果时，血浆胰岛素、葡萄糖和胰岛素抵抗无差异。
