克罗恩病患儿英夫利西单抗维持治疗前血药浓度与疾病转归的关系

Association between drug trough concentration and disease outcome before infliximab maintenance treatment in children with Crohn's disease

目的探讨维持治疗前英夫利西单抗血药浓度(infliximab trough level,IFX-TL)与克罗恩病(Crohn's disease,CD)患儿疾病转归之间的关系。方法回顾性选取2018年8月—2021年11月首次规律接受英夫利西单抗(infliximab,IFX)诱导治疗并于维持治疗前测定IFX-TL的35例CD患儿为研究对象,收集基线及维持治疗前的临床资料及实验室指标,分析不同转归与IFX-TL之间的关系。结果临床缓解组、内镜缓解组和联合缓解组IFX-TL均高于相应未缓解组,差异有统计学意义(P<0.05),生物学缓解组与未缓解组IFX-TL比较差异无统计学意义(P>0.05)。受试者工作特征曲线结果显示,IFX-TL预测临床缓解的最佳截断值为2.3μg/mL,曲线下面积为0.959(95%CI:0.894~1,P<0.001),灵敏度为90%,特异度为100%。结论在接受IFX治疗的CD患儿中,维持治疗前得到临床和内镜缓解的患儿有更高的IFX-TL,IFX-TL对临床缓解有预测价值。

Objective To study the association between infliximab trough level(IFX-TL)prior to maintenance treatment and disease outcome in children with Crohn's disease(CD).Methods A retrospective analysis was performed on 35 children with CD who received induction therapy with infliximab(IFX)and the measurement of IFX-TL before maintenance treatment from August 2018 to November 2021.Clinical data and laboratory markers at baseline and before maintenance treatment were collected,and the association between outcome and IFX-TL was analyzed.Results The clinical remission group,endoscopic remission group,and combined remission group had a significantly higher IFX-TL level than the corresponding non-remission groups(P<0.05),and there was no significant difference in the IFX-TL level between the biological remission and non-biological remission groups(P>0.05).The receiver operating characteristic(ROC)curve showed that IFX-TL had an area under the ROC curve of 0.959(95%CI:0.894-1)in predicting clinical remission,with a sensitivity of 90%and a specificity of 100%at the optimal cutoff value of 2.3μg/mL(P<0.001).Conclusions Among children with CD receiving infliximab induction therapy,the children achieving clinical and endoscopic remission before maintenance treatment tend to have a higher level of IFX-TL.IFX-TL has a certain predictive value for clinical remission.