儿童溃疡性结肠炎药物治疗研究进展

Progress of drug therapy for children with ulcerative colitis

溃疡性结肠炎(ulcerative colitis,UC)是一种影响肠道的慢性非特异性炎症性疾病。药物治疗包括5-氨基水杨酸药物(5-ASA)、糖皮质激素、免疫调节剂和生物制剂,可以有效诱导和维持缓解,预防疾病并发症。5-ASA是轻中度UC患儿诱导及维持缓解的一线药物;而糖皮质激素用于中重度UC的一线治疗及轻中度UC对5-ASA无效者的二线诱导缓解治疗。免疫调节剂嘌呤类制剂适用于激素依赖、5-ASA不耐受、频繁复发及急性重度UC激素诱导治疗有效后的维持缓解治疗。钙调神经磷酸酶抑制剂和生物制剂英夫利西单抗可作为急性重度UC激素治疗无效的二线治疗。维得利珠单抗和乌司奴单抗可用于抗肿瘤坏死因子-α失败后的二线生物治疗,但尚缺乏在儿童UC中的研究数据。该文旨在对儿童UC的药物治疗进展进行综述,为临床实践提供参考。

Ulcerative colitis(UC)is a chronic,nonspecific inflammatory disease that affects the intestines.Drug therapy includes 5-aminosalicylic acid(5-ASA)drugs,glucocorticoids,immunomodulators,and biological agents,which can effectively induce and maintain remission and prevent complications.5-ASA is the first-line drug for inducing and maintaining remission in children with mild to moderate UC.Glucocorticoids are the first-line therapy for moderate to severe UC and the second-line remission inducing therapy for patients with mild to moderate UC who do not respond to 5-ASA.Immunomodulators(purine preparations)are suitable for maintenance remission therapy after steroid dependence,5-ASA intolerance,frequent recurrence,and acute severe UC response to hormone-induced therapy.Calcineurin inhibitors and the biological agent infliximab can be used as second-line treatment for patients with acute severe UC who do not respond to glucocorticoids therapy.Vedolizumab and ustekinumab can be used as second-line biotherapy after failure of anti-tumor necrosis factor-α,but data are lacking in studies of pediatric UC.The purpose of this article is to review the progress of drug therapy for children with UC,and provide reference for clinical practice.