与成人患者相比,儿童克罗恩病患者在生物治疗前炎症标志物增加

GastroHep Pub Date : 2022-03-22 DOI:10.1155/2022/9550908
M. Bouazzi, N. Bak, J. Agnholt, V. Wewer, M. Malham, Mia Bendix
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引用次数: 0

摘要

背景。最近关于炎症性肠病(IBD)的流行病学研究表明,与成人发病的IBD (aIBD)相比,儿童发病的IBD (pIBD)更需要生物治疗。这是否由于更具侵袭性的疾病表型或较低的生物制剂处方阈值尚不清楚。为了在临床环境中扩展这些发现,我们比较了需要生物治疗的pIBD和aIBD患者的炎症负担。方法。我们回顾性地纳入了70名pIBD和83名开始生物治疗的aIBD患者。在开始生物治疗前、6周、14周、22周和52周后记录症状和生物标志物水平。结果。在克罗恩病(CD)中,与成人CD患者相比,儿科CD患者粪便钙保护蛋白和c反应蛋白(CRP)的基线水平升高(分别为p < 0.0001和p = 0.01)。溃疡性结肠炎(UC)无显著性差异。在CD患者中,基线维生素D水平≥75 nmol/L和基线CRP水平< 5 mg/L与随访结束时更高的缓解率相关(p = 0.02)。此外,与pIBD患者相比,aIBD患者对生物治疗失去反应和停止治疗的风险更高(HR = 4.7 [1.6-13.4], p = 0.004)。结论。与生物治疗前的aCD患者相比,pCD患者的炎症标志物增加。除此之外,维生素D < 75 nmol/L和高CRP水平预示着IBD患者对治疗的不良反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Paediatric Crohn’s Disease Patients Have Increased Inflammatory Markers Compared to Adult Patients prior to Biological Treatment
Background. Recent epidemiological studies in inflammatory bowel disease (IBD) indicate that paediatric onset of IBD (pIBD) more often requires biological therapy compared to adult onset of IBD (aIBD). Whether this is due to a more aggressive disease phenotype or lower threshold of prescribing biologicals is unknown. In order to expand these findings in a clinical setting, we compared the inflammatory burden in pIBD and aIBD patients requiring biological therapy. Methods. We retrospectively included 70 pIBD and 83 aIBD patients initiating biological therapy. Symptoms and biomarker levels were recorded prior to and 6, 14, 22, and 52 weeks after initiation of biological therapy. Results. In Crohn’s disease (CD), the baseline levels of faecal calprotectin and C-reactive protein (CRP) were increased in paediatric CD patients compared to adult CD patients ( p < 0.0001 and p = 0.01 , respectively). No significant differences were seen in ulcerative colitis (UC). In CD, baseline vitamin D levels ≥ 75  nmol/L and baseline CRP levels < 5  mg/L were associated with higher remission rate ( p = 0.02 ) at the end of follow-up. Moreover, aIBD patients had a higher risk of loss of response to biological therapy and treatment discontinuation compared to pIBD patients ( HR = 4.7 [1.6-13.4], p = 0.004 ). Conclusions. pCD patients had increased inflammation markers compared to aCD patients prior to biological treatment. In addition to this, vitamin   D < 75  nmol/L and high CRP levels predicted poor response to treatment in IBD patients.
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