Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
J Clin Gastroenterol. 2014 Mar;48(3):248-52. doi: 10.1097/MCG.0b013e31829f2e06.
Infliximab (IFX) is an established treatment modality for moderate to severe pediatric ulcerative colitis (UC). The purpose of this study was to identify clinical and laboratory parameters, which predict response to IFX in pediatric UC defined by colectomy as the primary outcome measure. Postsurgical complications were examined as well.
A retrospective chart review was performed on children younger than 19 years who received IFX therapy at Texas Children's Hospital, Houston, Texas for the treatment of UC from January 2005 to April 2012. Demographics, laboratory data, clinical subtype, duration of disease, transfusion requirement, number of IFX infusions, concurrent medications, and postoperative complication with regard to IFX exposure were examined.
Forty-seven patients (22 male and 25 female; average age at diagnosis: 11.4 y) received IFX. Twenty-six (55.3%) required colectomy, 20 (42.6%) of which occurred within a year of therapy initiation. Disease duration <20 months before IFX initiation, increased the likelihood of a colectomy within a year [OR: 3.8 (95% CI, 1.6-13.3), P=0.044]. Blood transfusion requirement before IFX was associated with higher rates of colectomy within a year [OR: 9.78 (95% CI, 2.2-43.3), P=0.0028]. Preoperative exposure to IFX within 8 weeks did not significantly increase postoperative complications (P=0.26). Serum albumin levels at diagnosis did not predict colectomy.
Shorter disease duration and need for blood transfusion may be useful indicators of limited response to IFX in pediatric UC.
英夫利昔单抗（IFX）是中重度小儿溃疡性结肠炎（UC）的既定治疗方法。本研究旨在确定预测 IFX 治疗小儿 UC 反应的临床和实验室参数，主要结局指标为结肠切除术。还检查了手术后的并发症。
对 2005 年 1 月至 2012 年 4 月期间在德克萨斯州休斯顿德克萨斯儿童健康中心接受 IFX 治疗的年龄小于 19 岁的儿童进行了回顾性图表审查。检查了人口统计学、实验室数据、临床亚型、疾病持续时间、输血需求、IFX 输注次数、同时使用的药物以及 IFX 暴露后的术后并发症。
47 例患者（22 例男性和 25 例女性；平均诊断年龄：11.4 岁）接受了 IFX 治疗。26 例（55.3%）需要结肠切除术，其中 20 例（42.6%）在治疗开始后一年内发生。IFX 开始前疾病持续时间<20 个月，一年内发生结肠切除术的可能性增加[比值比（OR）：3.8（95%可信区间，1.6-13.3），P=0.044]。IFX 前输血需求与一年内结肠切除术发生率较高相关[OR：9.78（95%可信区间，2.2-43.3），P=0.0028]。IFX 术前 8 周内的暴露并未显著增加术后并发症（P=0.26）。诊断时的血清白蛋白水平不能预测结肠切除术。
较短的疾病持续时间和输血需求可能是小儿 UC 对 IFX 反应有限的有用指标。
