肿瘤坏死因子-α 阻断在慢性肉芽肿病相关性结肠炎中的并发症。
Complications of tumor necrosis factor-α blockade in chronic granulomatous disease-related colitis.
机构信息
Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
出版信息
Clin Infect Dis. 2010 Dec 15;51(12):1429-34. doi: 10.1086/657308. Epub 2010 Nov 8.
BACKGROUND
Chronic granulomatous disease (CGD) is a genetic disorder of the phagocyte NADPH oxidase, which predisposes patients to infections and inflammatory complications, including severe colitis. Management of CGD colitis is a challenge because standard immunosuppressive therapy increases the risk of infection in already immunocompromised hosts.
METHODS
We report the use of infliximab in 5 patients with CGD.
RESULTS
Infliximab administration predisposed patients to severe infections with typical CGD pathogens but not mycobacteria, as reported with infliximab in other conditions. In addition to infections, infliximab administration led to successful closure of fistulae, sometimes with other untoward consequences. Infliximab-associated complications were associated with 2 deaths.
CONCLUSIONS
Infliximab use in the treatment of CGD inflammatory bowel disease requires aggressive antimicrobial prophylaxis, assiduous surveillance for infection, and vigilance for untoward gastrointestinal complications. This experience suggests that infliximab therapy is effective but has untoward consequences in patients with CGD.
背景
慢性肉芽肿病（CGD）是吞噬细胞 NADPH 氧化酶的遗传性疾病，使患者易发生感染和炎症并发症，包括严重结肠炎。CGD 结肠炎的治疗具有挑战性，因为标准免疫抑制疗法会增加已经免疫功能低下宿主发生感染的风险。
方法
我们报告了使用英夫利昔单抗治疗 5 例 CGD 患者的情况。
结果
英夫利昔单抗给药使患者易发生典型 CGD 病原体的严重感染，但不会发生分枝杆菌感染，这与其他情况下使用英夫利昔单抗的情况一致。除感染外，英夫利昔单抗给药还成功地闭合了瘘管，但有时会产生其他不良后果。英夫利昔单抗相关并发症与 2 例死亡相关。
结论
英夫利昔单抗治疗 CGD 炎症性肠病需要积极的抗菌预防、密切监测感染以及警惕不良胃肠道并发症。这一经验表明，英夫利昔单抗治疗在 CGD 患者中有效，但具有不良后果。
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