英夫利昔单抗诱导治疗儿童溃疡性结肠炎后的组织学愈合情况。
Histological healing after infliximab induction therapy in children with ulcerative colitis.
作者信息
Wiernicka Anna, Szymanska Sylwia, Cielecka-Kuszyk Joanna, Dadalski Maciej, Kierkus Jaroslaw
机构信息
Anna Wiernicka, Maciej Dadalski, Jaroslaw Kierkus, Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
出版信息
World J Gastroenterol. 2015 Oct 7;21(37):10654-61. doi: 10.3748/wjg.v21.i37.10654.
AIM
To verify the impact of induction therapy with infliximab (IFX) on mucosal healing in children with ulcerative colitis (UC).
METHODS
The study included all UC pediatric patients treated with IFX at our center over the last 10 years. The data were collected from patients' medical charts and analyzed retrospectively. A total of 16 patients with UC underwent colonoscopy with sample collection before and after three IFX injections. Pediatric Ulcerative Colitis Activity Index (PUCAI) was used to assess the clinical condition; endoscopic features were classified according to the Baron scale; and histological changes were evaluated according to the protocol of The British Society of Gastroenterology and Geboes Index. Clinical response was defined as a ≥ 20-point reduction in PUCAI index, and clinical remission as PUCAI index < 10 points. Endoscopic mucosal remission was defined as completely normal (score 0) on the Baron scale. Histological remission was defined as grade 0 in the Geboes Index. To assess correlation between variables, Spearman's rank correlation coefficient was used.
RESULTS
Clinical remission (PUCAI < 10) at week 8 was achieved in 68.75% of investigated subjects. Endoscopic mucosal remission at week 8 (Baron 0) was observed in 12.5% of patients. Histological remission (Geboes 0) after induction therapy with IFX was noticed in 18.75% cases. A general histological improvement, expressed by normal surface and crypt architecture, number of crypts, and lamina propria cellularity, was observed in six (37.5%) patients; there was no improvement in nine (56.25%) individuals, and worsening was observed in one (3.75%) case. Changes were not related to UC location. A reduction of inflammatory process was observed in 10 (62.5%) patients; there were no changes in four (25%) individuals, and the inflammation became more severe in two (12.5 %) cases. Simultaneous clinical, endoscopic and histological improvement of parameters assessing disease activity at week 8 was noticed in six (37.5%) patients. 55.5% of investigated patients with normal mucosa seen on endoscopy showed no inflammation on histology. A Baron score of 2 and 3 showed a good correlation with histology results (78.2% of patients with a Geboes Index ≥ 3).
CONCLUSION
IFX has a positive histological effect in more than one-third of UC patients. IFX reduces intestinal inflammation and improves clinical condition.
目的
验证英夫利昔单抗（IFX）诱导治疗对溃疡性结肠炎（UC）患儿黏膜愈合的影响。
方法
本研究纳入了过去10年在我们中心接受IFX治疗的所有UC儿科患者。数据从患者病历中收集并进行回顾性分析。共有16例UC患者在接受3次IFX注射前后接受了结肠镜检查并采集样本。采用儿童溃疡性结肠炎活动指数（PUCAI）评估临床状况；内镜特征根据Baron量表分类；组织学变化根据英国胃肠病学会的方案和Geboes指数进行评估。临床缓解定义为PUCAI指数降低≥20分，临床缓解为PUCAI指数<10分。内镜黏膜缓解定义为Baron量表上完全正常（0分）。组织学缓解定义为Geboes指数为0级。为评估变量之间的相关性，使用Spearman等级相关系数。
结果
8周时68.75%的研究对象实现了临床缓解（PUCAI<10）。8周时12.5%的患者观察到内镜黏膜缓解（Baron 0）。IFX诱导治疗后18.75%的病例出现组织学缓解（Geboes 0）。6例（37.5%）患者观察到一般组织学改善，表现为表面和隐窝结构正常、隐窝数量和固有层细胞增多；9例（56.25%）个体无改善，1例（3.75%）病例病情恶化。变化与UC部位无关。10例（62.5%）患者观察到炎症过程减轻；4例（25%）个体无变化，2例（12.5%）病例炎症加重。6例（37.5%）患者在8周时同时出现评估疾病活动的临床、内镜和组织学参数改善。内镜检查显示黏膜正常的研究患者中，55.5%的组织学检查无炎症。Baron评分为2和3与组织学结果具有良好相关性（78.2%的患者Geboes指数≥3）。
结论
IFX对超过三分之一的UC患者具有积极的组织学作用。IFX可减轻肠道炎症并改善临床状况。
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