英夫利昔单抗早期治疗对儿童克罗恩病的疗效。
Efficacy of early treatment with infliximab in pediatric Crohn's disease.
机构信息
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam, Seoul 135-710, South Korea.
出版信息
World J Gastroenterol. 2010 Apr 14;16(14):1776-81. doi: 10.3748/wjg.v16.i14.1776.
AIM
To investigate the effectiveness of early infliximab use for induction and maintenance therapy in pediatric Crohn's disease.
METHODS
We performed a retrospective chart review of 36 patients with Crohn's disease. Ten patients (group A) were treated with mesalamine after induction therapy with oral prednisolone, and 13 patients (group B) were treated with azathioprine after induction therapy with oral prednisolone. Thirteen patients (group C) received infliximab and azathioprine for induction and maintenance therapy for the first year, and were treated with azathioprine after 1 year. All patients were followed for at least 24 mo. Efficacy was determined by the relapse rate using the pediatric Crohn's disease activity index score in each group at 12 and 24 mo.
RESULTS
At the 1 year follow-up, the relapse rate (23.1%, 3 of 13 patients) in group C was lower than that (61.5%, 8 of 13 patients) in group B (P = 0.047). At the 2 years follow-up, the relapse rate (38.5%, 5 of 13 patients) in group C was lower than that (76.9%, 10 of 13 patients) in group B (P = 0.047). Adverse events in group C were fewer than in groups A and B.
CONCLUSION
Early induction with infliximab at diagnosis, known as "top-down" therapy, was effective for reducing the relapse rate compared to conventional therapies for at least 2 years.
目的
探讨英夫利昔单抗早期诱导和维持治疗在儿童克罗恩病中的疗效。
方法
我们对 36 例克罗恩病患者进行了回顾性图表分析。10 例患者（A 组）在口服泼尼松诱导治疗后用美沙拉嗪治疗，13 例患者（B 组）在口服泼尼松诱导治疗后用硫唑嘌呤治疗。13 例患者（C 组）在第一年接受英夫利昔单抗和硫唑嘌呤诱导和维持治疗，第 1 年后用硫唑嘌呤治疗。所有患者的随访时间均至少 24 个月。通过各组在 12 个月和 24 个月时的小儿克罗恩病活动指数评分来确定疗效。
结果
在 1 年随访时，C 组的复发率（23.1%，13 例中的 3 例）低于 B 组（61.5%，13 例中的 8 例）（P = 0.047）。在 2 年随访时，C 组的复发率（38.5%，13 例中的 5 例）低于 B 组（76.9%，13 例中的 10 例）（P = 0.047）。C 组的不良反应少于 A 组和 B 组。
结论
与传统疗法相比，早期诊断时使用英夫利昔单抗（称为“自上而下”疗法）进行诱导治疗至少 2 年可有效降低复发率。
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