Iwańczak Barbara M, Kierkuś Jarosław, Ryżko Józef, Szczepanik Mariusz, Więcek Sabina, Czaja-Bulsa Grażyna, Kacperska Magdalena, Korczowski Bartosz, Maślana Jolanta, Iwańczak Franciszek
2nd Department of Paediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Poland.
Children's Memorial Health Institute, Warsaw, Poland.
Adv Clin Exp Med. 2017 Jan-Feb;26(1):57-61. doi: 10.17219/acem/42197.
Pediatric ulcerative colitis (UC) is a severe disease characterised by the presence of extensive inflammatory lesions in the colon. The administration of intravenous corticosteroids is recommended in patients with acute relapse of the disease, whereas early treatment with cyclosporine, tacrolimus or infliximab is recommended if there is no improvement.
The aim of this study was to retrospectively evaluate the efficacy and safety of infliximab therapy in the treatment of moderate-to-severe and severe relapse of pediatric UC.
The analysis included 42 children aged 4-18 years (23 girls, 19 boys) treated in 7 pediatric gastroenterology departments in Poland during the past 4 years. The disease duration ranged from 2 to 100 months. The clinical activity of UC ranged from 35 to 85 points according to the PUCAI scale. Twenty-one children were diagnosed with pancolitis, 10 children with extensive UC, and the remaining with the left-sided UC. In the induction therapy infliximab was administered at doses of 5 mg/kg in the 0.2 and 6 weeks, and after the clinical response every 8 weeks to 12 months. Treatment results were assessed in 10 and 54 weeks.
After the induction therapy the clinical response was achieved in 14 children (33.33%) and clinical remission in 11 children (26.19%). Two children required surgical treatment, and the remaining 2 suffered from anaphylactic shock. After the maintenance therapy clinical remission was maintained in 12 children (57.14%), whereas 3 children required surgery (colectomy).
Infliximab therapy in children with moderate-to-severe UC induces remission and, in some children, proves to be effective in preventing early colectomy.
小儿溃疡性结肠炎（UC）是一种严重疾病，其特征为结肠存在广泛炎症性病变。对于疾病急性复发的患者，建议静脉注射皮质类固醇，而如果没有改善，则建议早期使用环孢素、他克莫司或英夫利昔单抗进行治疗。
本研究的目的是回顾性评估英夫利昔单抗治疗小儿中重度和重度复发UC的疗效和安全性。
分析纳入了过去4年在波兰7个儿科胃肠病科接受治疗的42名4至18岁儿童（23名女孩，19名男孩）。病程为2至100个月。根据PUCAI量表，UC的临床活动度为35至85分。21名儿童被诊断为全结肠炎，10名儿童为广泛性UC，其余为左侧UC。在诱导治疗中，英夫利昔单抗在第0、2和6周以5mg/kg的剂量给药，临床缓解后每8周至12个月给药一次。在第10周和54周评估治疗结果。
诱导治疗后，14名儿童（33.33%）实现了临床缓解，11名儿童（26.19%）实现了临床缓解。2名儿童需要手术治疗，其余2名儿童发生过敏性休克。维持治疗后，12名儿童（57.14%）维持了临床缓解，而3名儿童需要手术（结肠切除术）。
英夫利昔单抗治疗小儿中重度UC可诱导缓解，并且在一些儿童中，被证明对预防早期结肠切除术有效。
