Department of Pediatric Gastroenterology, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin St, MW1010, Houston, TX, 77030.
Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, One Baylor Plaza, MS BCM385, Houston, TX 77030; Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.
J Pediatr Surg. 2020 Sep;55(9):1815-1823. doi: 10.1016/j.jpedsurg.2020.01.054. Epub 2020 Feb 3.
BACKGROUND/PURPOSE: Clinical outcomes in pediatric ulcerative colitis (UC) in the era of biologic agents are poorly defined. We aimed to describe risk factors for colectomy in pediatric UC in the era of infliximab therapy.
We reviewed 217 pediatric patients at Texas Children's Hospital with newly diagnosed UC between 2003 and 2015; 117 had a minimum of 5 years of follow-up. Extent of disease at diagnosis, medication exposure, the presence of extraintestinal manifestations (EIMs), and need for surgery were noted.
Average length of follow up was 5.02 ± 2.27 years. Forty-two percent presented with pancolitis. Infliximab was used in 39%, immunomodulators in 65%, and steroids in 89% of patients. EIMs occurred in 24.9% of patients. The cumulative rate of colectomy was 12.9% at 5 years. Children presenting as E2 (Paris Classification) and children prescribed oral steroid monotherapy at diagnosis progressed to surgery faster than any other group. Of the children who received infliximab, females and children less than 5 years old were less likely to respond to therapy.
The natural course of pediatric UC remains aggressive despite the addition of infliximab to the standard of care and suggests a need for early aggressive clinical intervention.
LEVEL-OF-EVIDENCE RATING: Level IV.
背景/目的：生物制剂时代儿童溃疡性结肠炎（UC）的临床结果定义不明确。我们旨在描述英夫利昔单抗治疗时代儿童 UC 中结肠切除术的风险因素。
我们回顾了 2003 年至 2015 年间在德克萨斯儿童医院新诊断为 UC 的 217 名儿科患者；其中 117 名患者的随访时间至少为 5 年。记录疾病的严重程度、药物暴露、是否存在肠外表现（EIMs）以及是否需要手术。
平均随访时间为 5.02±2.27 年。42%的患者表现为全结肠炎。39%的患者使用英夫利昔单抗，65%的患者使用免疫调节剂，89%的患者使用皮质类固醇。24.9%的患者出现 EIMs。5 年时结肠切除术的累积率为 12.9%。以巴黎分类（E2）为表现和以口服皮质类固醇单药治疗为表现的患儿比任何其他组更快进展为手术。在接受英夫利昔单抗治疗的儿童中，女性和 5 岁以下儿童不太可能对治疗有反应。
尽管英夫利昔单抗已加入标准治疗方案，但儿童 UC 的自然病程仍然很严重，这表明需要早期积极的临床干预。
IV 级。
