Rinat Grabovski, Stav Regev, Manar Matar, Yael Weintraub, Raanan Shamir, Dror S Shouval, Noa Tal
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引用次数: 0
摘要
目的：粘膜愈合（MH）是克罗恩病（CD）的一个关键治疗目标，与改善预后有关。虽然成人研究表明血清抗肿瘤坏死因子（TNF）水平与黏膜愈合呈正相关，但儿科患者的数据却很有限。我们旨在明确CD儿科患者在维持治疗期间血清抗肿瘤坏死因子水平与MH的关系：我们收集了接受英夫利昔单抗或阿达木单抗治疗的儿童 CD 患者的回顾性数据（2014-2023 年），这些患者在开始治疗至少 26 周后接受了回肠结肠镜检查。内镜检查时间前后的血清抗肿瘤坏死因子水平与内镜检查结果进行了比较。MH的定义是胃肠道各段完全没有炎症或溃疡性病变。进行了单变量和多变量逻辑回归分析，以确定与MH相关的因素：107名患者（41名英夫利昔单抗患者和66名阿达木单抗患者）的数据，诊断时的中位年龄为12.6（9.9-14.0）岁。开始使用抗肿瘤坏死因子后，到回肠结肠镜检查的中位时间为89.0（56.3-152.3）周。31例（29.0%）患者被确诊为MH。MH组和非MH组的抗TNF血清水平相当（9.5 [4.9-13.9] vs. 9.3 [6.4-15.7] µg/mL；p = 0.73），接受英夫利昔单抗或阿达木单抗治疗的患者之间没有差异。在多变量分析中，诊断体重 Z 评分（几率比 [OR] = 2.860，95% 置信区间 [CI] = 1.005-8.138；P = 0.049）以及 C 反应蛋白（OR = 0.037，95% CI = 0.002-0.687; p = 0.027）和回肠结肠镜检查时的粪便钙蛋白（OR = 0.995，95% CI = 0.990-1.000; p = 0.037）与MH显著相关：结论：在我们的队列中，维持治疗期间的抗肿瘤坏死因子水平与小儿 CD 的 MH 无关。
Maintenance-phase serum anti-TNF levels are not associated with mucosal healing in pediatric Crohn's disease.
Objectives: Mucosal healing (MH) is a key therapeutic target in Crohn's disease (CD) and is associated with improved outcomes. While adult studies indicate a positive correlation between serum anti-tumor necrosis factor (TNF) levels and MH, data in pediatric patients is limited. We aimed to define the association of serum anti-TNF levels with MH in pediatric patients with CD during maintenance therapy.
Methods: Retrospective data (2014-2023) was collected from pediatric CD patients treated with infliximab or adalimumab who performed an ileocolonoscopy at least 26 weeks after initiating therapy. Serum anti-TNF levels around endoscopic time were compared with endoscopic findings. MH was defined as complete absence of inflammatory or ulcerative lesions across all segments of the gastrointestinal tract. Univariable and multivariable logistic regression analysis was conducted to identify factors associated with MH.
Results: Data were obtained from 107 patients (41 infliximab and 66 adalimumab), with a median age at diagnosis of 12.6 (9.9-14.0) years. Median time until ileocolonoscopy following anti-TNF initiation was 89.0 (56.3-152.3) weeks. MH was identified in 31 (29.0%) patients. Anti-TNF serum levels were comparable in the MH and non-MH groups (9.5 [4.9-13.9] vs. 9.3 [6.4-15.7] µg/mL; p = 0.73), without differences in patients treated with infliximab or adalimumab. In multivariable analysis, diagnosis weight Z-score (odds ratio [OR] = 2.860, 95% confidence interval [CI] = 1.005-8.138; p = 0.049), along with C-reactive protein (OR = 0.037, 95% CI = 0.002-0.687; p = 0.027) and fecal calprotectin (OR = 0.995, 95% CI = 0.990-1.000; p = 0.037) at time of ileocolonoscopy were significantly associated with MH.
Conclusions: In our cohort, anti-TNF levels during maintenance were not associated with MH in pediatric CD.
期刊介绍：
The Journal of Pediatric Gastroenterology and Nutrition (JPGN) provides a forum for original papers and reviews dealing with pediatric gastroenterology and nutrition, including normal and abnormal functions of the alimentary tract and its associated organs, including the salivary glands, pancreas, gallbladder, and liver. Particular emphasis is on development and its relation to infant and childhood nutrition.
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