静脉注射免疫球蛋白在有禁忌证或对传统治疗无反应的炎症性肠病患者中的应用。

Use of Intravenous Immunoglobulin for Patients with Inflammatory Bowel Disease with Contraindications or Who Are Unresponsive to Conventional Treatments.

作者信息

Merkley Scott A, Beaulieu Dawn B, Horst Sara, Duley Caroline, Annis Kim, Nohl Anne, Schwartz David A

机构信息

IBD Center, Division of Gastroenterology, Hepatology, & Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.

出版信息

Inflamm Bowel Dis. 2015 Aug;21(8):1854-9. doi: 10.1097/MIB.0000000000000456.

DOI:10.1097/MIB.0000000000000456

PMID:25993689

Abstract

BACKGROUND

Managing patients with IBD who are refractory or have contraindications to standard therapies is challenging. Many will lose response, become intolerant to treatment, or develop infections with contraindication for immunosuppression. Therefore, alternative therapies, such as the use of intravenous immunoglobulin (IVIg), could be used to manage patients in these difficult cases.

METHODS

Data were extracted retrospectively from the electronic medical records at Vanderbilt University on patients with IBD who received IVIg (February 2011-June 2013). Patients were treated with IVIg 0.4 g·kg·d for 3 consecutive days and then 0.4 g/kg once monthly. The dose was increased to 0.4 g/kg biweekly for loss of response or partial response. Clinical response was defined as decreasing the Harvey-Bradshaw Index ≥3 points or improvement in C-reactive protein >25%. Clinical remission was defined as Harvey-Bradshaw Index score <5, no hospitalizations or surgeries after IVIg, or symptom resolution. Statistical analysis was performed using Wilcoxon signed-rank test.

RESULTS

Twenty-four patients with IBD received IVIg. Seventeen patients received IVIg for failure of standard treatment. Six patients received IVIg during active infection. Two patients had histoplasmosis, 1 patient had tuberculosis, and 2 patients had pulmonary fungal infections. One patient with ulcerative colitis was given IVIg for recurrent Clostridium difficile. Nine patients required dose escalation after median 153 days (30-360). Ninteen patients (79%) had a response or remission. Sixteen (67%) had a response and 3 (12.5%) obtained remission with IVIg. C-reactive protein decreased significantly after treatment (19 mg/dL [0.1-77] to 7.5 [0.2-20]), P < 0.05. Harvey-Bradshaw Index scores improved (8 [0-19] to 6 [0-17]), P = not significant. Of note, 62.5% had endoscopic improvement after treatment.

CONCLUSIONS

IVIg is safe and effective in the short-term management of patients with IBD when standard therapies are contraindicated.

摘要

背景

对标准治疗无效或有禁忌证的炎症性肠病（IBD）患者进行管理具有挑战性。许多患者会失去反应、对治疗不耐受或发生感染且有免疫抑制禁忌证。因此，替代疗法，如使用静脉注射免疫球蛋白（IVIg），可用于处理这些困难病例中的患者。

方法

回顾性提取范德比尔特大学电子病历中2011年2月至2013年6月接受IVIg治疗的IBD患者的数据。患者连续3天接受0.4 g·kg·d的IVIg治疗，然后每月一次0.4 g/kg。对于反应丧失或部分反应，剂量增加至每两周0.4 g/kg。临床反应定义为哈维-布拉德肖指数降低≥3分或C反应蛋白改善>25%。临床缓解定义为哈维-布拉德肖指数评分<5分、IVIg治疗后无住院或手术或症状缓解。使用Wilcoxon符号秩检验进行统计分析。

结果

24例IBD患者接受了IVIg治疗。17例患者因标准治疗失败接受IVIg治疗。6例患者在活动性感染期间接受IVIg治疗。2例患者患有组织胞浆菌病，1例患者患有结核病，2例患者患有肺部真菌感染。1例溃疡性结肠炎患者因复发性艰难梭菌感染接受IVIg治疗。9例患者在中位153天（30 - 360天）后需要增加剂量。19例（79%）患者有反应或缓解。16例（67%）有反应，3例（12.5%）通过IVIg获得缓解。治疗后C反应蛋白显著降低（从19 mg/dL [0.1 - 77]降至7.5 [0.2 - 20]），P < 0.05。哈维-布拉德肖指数评分有所改善（从8 [0 - 19]降至6 [0 - 17]），P = 无显著性差异。值得注意的是，62.5%的患者治疗后内镜检查有改善。