肠白塞病诊断与管理的共识意见（第 2 版）：抗 TNFα 单克隆抗体的适应证。
The 2nd edition of consensus statements for the diagnosis and management of intestinal Behçet's disease: indication of anti-TNFα monoclonal antibodies.
机构信息
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan,
出版信息
J Gastroenterol. 2014 Jan;49(1):156-62. doi: 10.1007/s00535-013-0872-4. Epub 2013 Aug 18.
BACKGROUND
Clinical evidence regarding intestinal Behçet's disease (BD) management is lacking and intestinal lesions are a poor prognostic factor. In 2007, the Japan consensus statement for diagnosis and management of intestinal BD was developed. Recently, the efficacy of anti-tumor necrosis factor (TNF)α monoclonal antibodies (mAbs), and infliximab (IFX) was reported and adalimumab (ADA) was approved for intestinal BD in Japan. This study renewed consensus-based practice guidelines for diagnosis and treatment of intestinal BD focusing on the indication of anti-TNFα mAbs.
METHODS
An expert panel of Japanese gastroenterology and rheumatology specialists was involved. Clinical statements for ratings were extracted from the literature, a professional group survey, and by an expert panel discussion, which rated clinical statements on a nine-point scale. After the first round of ratings, a panelist meeting discussed areas of disagreement and clarified areas of uncertainty. The list of clinical statements was revised after the panelist meeting and a second round of ratings was conducted.
RESULTS
Fifteen relevant articles were selected. Based on the first edition consensus statement, improved clinical statements regarding indications for anti-TNFα mAbs use were developed. After a two-round modified Delphi approach, the second edition of consensus statements was finalized.
CONCLUSIONS
In addition to standard therapies in the first edition, anti-TNFα mAbs (ADA and IFX) should be considered as a standard therapy for intestinal BD. Colchicines, thalidomide, other pharmacological therapy, endoscopic therapy, and leukocytapheresis were deemed experimental therapies.
背景
缺乏关于肠贝赫切特病（BD）管理的临床证据，且肠病变是预后不良的因素。2007 年，日本制定了肠贝赫切特病的诊断和治疗共识声明。最近，报道了抗肿瘤坏死因子（TNF）α 单克隆抗体（mAbs）和英夫利昔单抗（IFX）的疗效，阿达木单抗（ADA）在日本被批准用于肠 BD。本研究针对抗 TNFα mAbs 的适应证，更新了基于共识的肠 BD 诊断和治疗实践指南。
方法
日本消化科和风湿科专家组成了一个专家小组。从文献、专业组调查和专家小组讨论中提取了用于评分的临床陈述，并对临床陈述进行了九点制评分。在第一轮评分后，专家组会议讨论了存在分歧的领域，并澄清了不确定的领域。在专家组会议后修订了临床陈述清单，并进行了第二轮评分。
结果
选择了 15 篇相关文章。基于第一版共识声明，制定了关于抗 TNFα mAbs 使用适应证的改进临床陈述。经过两轮改良 Delphi 方法，最终确定了第二版共识声明。
结论
除了第一版的标准治疗外，抗 TNFα mAbs（ADA 和 IFX）应被视为肠 BD 的标准治疗。秋水仙碱、沙利度胺、其他药物治疗、内镜治疗和白细胞吸附术被认为是实验性治疗。
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