英夫利昔治疗炎症性肠病最佳效果的临床观察

Optimizing effect of infliximab upon inflammatory bowel disease

目的探讨获取英夫利昔（IFX）治疗难治性溃疡性结肠炎（UC）和克罗恩病（CD）良好疗效的方法。方法应用IFX治疗7例难治性、1例初治炎症性肠病患者（5例CD、3例uc）；药物每次5mg／kg，分别于0、2、6周及其后每8周1次缓慢静脉滴注。治疗后长期随访，8例患者中5例对皮质激素抵抗、2例激素依赖、1例为初治病例。结果所有患者均对5mg／kg程序性IFX治疗有较好应答，CD患者2例完全缓解，2例有效，1例不易判断疗效；3例UC患者中1例完全缓解，2例有效。随访6～12个月未见复发病例。随访中，没有发现严重不良反应。结论正确选择适应证；根据患者对药物的临床反应掌握用药剂量和疗程；适当搭配免疫抑制剂；以内镜下黏膜愈合作为IFX的治疗终点可有效地防止疾病复发，并减少不良反应发生。

Objective To explore the optimal therapeutic effect of infliximab （IFX） upon inflammatory bowel disease. Methods Eight patients with inflammatory bowel disease （IBD） , including 5 Crohn＇s disease （CD） and 3 ulcerative colitis （ UC）, were treated with IFX of 5 mg/kg body weight at 0, 2 and 6 weeks, followed by scheduled maintenance therapy every 8 weeks and followed up for a long-term period, Of these patients, 5 cases were resistant to corticosteroid, 2 cases corticosteroid dependency and one naive patient. Results All patients responded well to the scheduled program of 5 mg/kg infusion of IFX. Two CD cases achieved a complete remission. Two CD patients responded clinically; one was difficult to judge the result; of the UC patients, one achieved a complete remission and 2 responded. There were no serious side effects during the course of therapy. Conclusion Selecting the proper drug indications and therapeutic protocol, determining the doses and course of IFX on the basis of therapeutic response, combining IFX with other immunomodulators （ esp. budesonide ） and assessing the therapeutic efficacy of IFX by endoscopic mucosa healing rather than symptoms prevent disease recurrence and decrease side effects.