生物制剂对炎症性肠病肠外表现作用的研究进展

Research progress on the effect of biologic agents for the treatment of inflammatory bowel disease on extraintestinal manifestations

炎症性肠病(IBD)临床表现包括腹痛、腹泻、黏液脓血便,不容忽视的是炎症性肠病病人中肠外表现(EIMs)同样影响着疾病的预后与转归。EIMs可以被定义为在各因素驱动肠道炎症过程中,可同时引起的一系列其他器官的炎症,其发病部位位于肠外。EIMs的发生较为少见,目前尚未确定EIMs是肠道炎症延伸的直接结果,还是机体由于遗传因素对环境因素产生的独立的免疫失调反应。一般来说,这两种机制可同时存在,其在不同EIMs中发挥不同程度的作用。目前尚未得出EIMs的明确诊断标准,关于EIMs的管理及治疗也缺少前瞻性研究,仅国外发表了相关的案例分析,国内关于肠外表现的资料尚缺。有研究显示生物制剂使EIMs的治疗成为可能,目前常用生物制剂包括英夫利西单抗、阿达木单抗、维得利珠单抗、戈利木单抗及乌司奴单抗。阅读分析国内外相关的文献,就治疗炎症性肠病的生物制剂对肠外表现的作用作一综述。

The clinical manifestations of inflammatory bowel disease(IBD)include abdominal pain,diarrhea and mucopurulent bloody stool.It cannot be ignored that the extraintestinal manifestations(EIMs)of patients with inflammatory bowel disease also affect the prognosis and prognosis of the disease.EIMs can be defined as a series of inflammation of other organs that can be caused at the same time in the process of intestinal inflammation driven by various factors,and its pathogenesis is located outside the intestine.The occurrence of EIMs is relatively rare.At present,it has not been determined whether EIMs are the direct result of the extension of intestinal inflammation or the independent immune maladjustment reaction of the body to environmental factors due to genetic factors.Generally speaking,these two mechanisms can exist at the same time and play different roles in different EIMs.At present,there is no clear diagnostic criteria for EIMs,and there is also a lack of prospective research on the management and treatment of EIMs.Only relevant case studies have been published abroad,while domestic data on extraintestinal manifestations are still lacking.Some studies have shown that biological agents make the treatment of EIMs possible.At present,commonly used biological agents include infliximab,adalimumab,vidrizumab,golimumab and ulinumab.Through reading and analyzing the relevant literature at home and abroad,this paper summarizes the effects of biological agents for the treatment of inflammatory bowel disease on extraintestinal manifestations.