Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents

AIM:To evaluate the incidence and risk factors of Korean tuberculosis(TB) infection in patients with inflammatory bowel disease(IBD) undergoing anti-TNF treatment.METHODS:The data of IBD patients treated with anti-TNFs in 13 tertiary referral hospitals located in the southeastern region of Korea were collected retrospectively.They failed to show response or were intolerant to conventional treatments,including steroids or immunomodulators.Screening measures for latent TB infection(LTBI)and the incidence and risk factors ofactive TB infection after treatment with anti-TNFs were identified.RESULTS:Overall,376 IBD patients treated with antiTNF agents were recruited(male 255,mean age of anti-TNF therapy 32.5±13.0 years);277 had Crohn’s disease,99 had ulcerative colitis,294 used infliximab,and 82 used adalimumab.Before anti-TNF treatment,screening tests for LTBI including an interferon gamma release assay or a tuberculin skin test were performed in 82.2%of patients.Thirty patients(8%)had LTBI.Sixteen cases of active TB infection including one TB-related mortality occurred during 801 personyears(PY)follow-up(1997.4 cases per 100000 PY)after anti-TNF treatment.LTBI(OR=5.76,95%CI:1.57-21.20,P=0.008)and WBC count<5000 mm3(OR=4.5,95%CI:1.51-13.44,P=0.007)during follow-up were identified as independently associated risk factors.CONCLUSION:Anti-TNFs significantly increase the risk of TB infection in Korean patients with IBD.The considerable burden of TB and marked immunosuppression might be attributed to this risk.

Association of miR-146 rs2910164,miR-196a rs11614913,miR-221 rs113054794 and miR-224 rs188519172 polymorphisms with anti-TNF treatment response in a Greek population with Crohn's disease

AIM To investigate the correlation between rs2910164, rs11 614913, rs113054794, and rs188519172 polymorphisms and response to anti-TNF treatment in patients with Crohn's disease(CD). METHODS One hundred seven patients with CD based on standardclinical, endoscopic, radiological, and pathological criteria were included in the study. They all received infliximab or adalimumab intravenously or subcutaneously at standard induction doses as per international guidelines. Clinical and biochemical response was assessed using the HarveyBradshaw index and CRP levels respectively. Endoscopic response was evaluated by ileocolonoscopy at week 12-20 of therapy. The changes in endoscopic appearance compared to baseline were classified into four categories, and patients were classified as responders and nonresponders. Whole peripheral blood was extracted and genotyping was performed by PCR.RESULTS One hundred and seven patients were included in the study. Seventy two(67.3%) patients were classified as complete responders, 22(20.5%) as partial while 13(12.1%) were primary non-responders. No correlation was detected between response to anti-TNF agents and patients' characteristics such as gender, age and disease duration while clinical and biochemical indexes used were associated with endoscopic response. Concerning prevalence of rs2910164, rs11614913, and rs188519172 polymorphisms of miR-146, miR-196a and miR-224 respectively no statistically important difference was found between complete, partial, and non-responders to antiTNF treatment. Actually CC genotype of rs2910164 was not detected in any patient. Regarding rs113054794 of miR-221, normal CC genotype was the only one detected in all studied patients, suggesting this polymorphism is highly rare in the studied population.CONCLUSION No correlation is detected between studied polymorphisms and patients' response to anti-TNF treatment. Polymorphism rs113054794 is not detected in our population.

Anti-TNF-αMcAb对创伤失血性休克大鼠肾脏保护作用的实验研究

目的 :研究肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和抗肿瘤坏死因子-α单克隆抗体(anti-TNF-αmonoclonal antibody,anti-TNF-αMc Ab)在创伤失血性休克大鼠肾脏损害中的作用。方法:24只成年雄性SD大鼠随机均分为Ⅰ组(对照组)、Ⅱ组(休克用乳酸林格氏液治疗组)和Ⅲ组(休克用anti-TNF-αMc Ab治疗组)。Ⅱ组、Ⅲ组用电刀在大鼠腹正中切开约5 cm长的切口,股动脉放血,制作创伤失血性休克动物模型;Ⅱ组用乳酸林格氏液治疗,Ⅲ组用含anti-TNF-αMc Ab(3 mg/kg)的乳酸林格氏液治疗,而Ⅰ组在相同条件下不进行创伤和失血。测定所有SD大鼠血清肌酐(creatinine,Cr)、尿素氮(urea nitrogen,UN)、TNF-α、肾组织中丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)水平。在光镜、电镜下观察所有大鼠肾组织的病理学改变情况。结果 :Ⅱ、Ⅲ组大鼠血清Cr、UN、TNF-α、肾组织中MDA含量较Ⅰ组升高(P<0.05),SOD含量减低(P<0.05);Ⅲ组Cr(133.10±17.39)μmol/L、UN(23.78±5.49)mmol/L、TNF-α(106.85±14.65)pg/m L、肾组织中MDA(13.26±1.46)nmol/mgprot水平比Ⅱ组血清Cr、UN、TNF-α、肾组织中MDA水平降低(P<0.05),Ⅲ组SOD(79.26±11.21)U/mgprot水平比Ⅱ组增高(P<0.05)。Ⅲ组大鼠肾组织病理损伤比Ⅱ组轻。Ⅰ组无明显病理改变。结论:TNF-α可能是创伤失血性休克大鼠肾损害的重要介导因子,使用anti-TNF-αMc Ab治疗可以减轻创伤失血性休克时大鼠肾损害,为临床治疗提供新的策略。

Effects of anti-TNF biologic drugs on uveitis severity in Behcet patients: systematic review and Meta-analysis

AIM:To investigate effects of anti-TNF biologic drugs on uveitis severity(comparing visual acuity log MAR levels) in Behcet patients.METHODS:Three databases Pub Med, Scopus, and the Web of Science were searched for qualified papers focusing on the anti-TNF-α factors treatment in Behcet’s disease(BD)-associated uveitis. Studies that were designed pre and post anti-TNF drug treatment, were selected. After determining the search strategy for this study, the relevant data were extracted. RESULTS:The initial search was performed in the target databases and a total of about 1458 articles were found. Fifteen articles were selected for systematic review and only 12 of them had inclusion criteria for Meta-analysis(with visual acuity data). The mean dose of prednisolone before and after biological treatments was reported in 5 studies(28.56 and 7.56 mg/kg, respectively). Also, the preliminary results indicate a significant reduction in visual acuity log MAR levels(MD=-1.5 IU/L, 95%CI:-2.1,-0.01).CONCLUSION:Biological drugs significantly reduce the dose of prednisolone and affect visual acuity values.

Effect of Anti-TNF Therapy on Resistance to Insulin in Patients with Rheumatoid Arthritis

Objective: To evaluate the effect of anti-TNF therapy on resistance to insulin in patients with rheumatoid arthritis (RA) compared with patients with RA being treated with non-biological DMARDs. Methods: Inactive patients diagnosed with RA (ACR 1987 criteria) (DAS 28 2.6) were included, being treated with anti-tumor necrosis factor inhibitors (anti-TNF) (cases) and non-biological disease-modifying anti-rheumatic drugs (DMARD) (controls), without risk factors for insulin resistance (administration of steroids, body mass index > 25 kg/m2, diabetes mellitus or use of glucose lowering agents, systemic arterial hypertension or use of anti-hypertensive drugs, triglycerides > 150 mg/dl, hypercholesterolemia > 200 mg/dl, high-density lipoproteins 40 mg/dl in men and 50 mg/in women, or with lipids lowering agents, waist measurement > 88 cm in women and > 102 cm in men). We used HOMA (Homeostasis Model Assessment) to determine insulin resistance in both groups, HOMA being defined as >1 and sensitivity to insulin using QUICKI (Insulin Sensitivity Check Index), ≥0.38 being considered as normal. The Mann Whitney U was used for the statistical analysis. Results: A total of 28 patients, 15 being treated with non-biological DMARDs and 13 with anti-TNF therapy, were evaluated;89.7%, of which were women. Average age: 43.5 (range 21 - 62);the average HOMA index of the non-biological DMARD group was 1.58 (range 0.7 - 5.4), compared with patients treated with anti-TNF therapy, 1.18 (range 0.2 - 4.3) (P = 0.5). The average QUICKI index was 0.36 (range 0.30 - 0.42) in patients treated with non-biological DMARD, compared with0.37 inpatients treated with anti-TNF therapy (range 0.30 - 0.51) (P = 0.8). Conclusion: Resistance to insulin manifested itself in both groups, although there was a greater trend of less insulin resistance and greater sensitivity in the anti-TNF group;this was probably not statistically significant due to the sample size.

Gastric Neoplasia during Anti-TNF Therapy for Crohn’s Disease: Casual Event?

The increase risk of cancer development in patients with inflammatory intestinal disease (IBD) has already studied for decades. The anti-TNF therapy has changed the treatment strategy of IBD. By using on a larger scale and for a longer time, the anti-TNF raised concern over its potential adverse events. A male Crohn’s disease (CD) patient, 55 years old, diagnosed for nine years, treated with infliximab for 6 years. In 2011, he underwent a nupper endoscopy (UE) which showed flat erosive gastritis with moderate intensity in antrum, gastric polyps and gastric erosion. Pathological examination revealed a chronic gastritis in erosive activity and search for Helicobacter pylori resulted positive. In May 2014, the patient was asymptomatic, when it held UE, which showed suggestive lesion of early gastric cancer, measuring 1.5 cm and search for Helicobacter pylori negative. Histopathological exams confirmed the adenocarcinoma. The patient underwent to a laparoscopic surgery (total gastrectomy with lymphadenectomy and reconstruction Roux-en-Y). Risk factors for the development of gastric cancer in general population are already well defined. However studying a possible association among CD and the different therapeutic modalities used in the treatment of this disease with gastric cancer appearance is important to set specific assessment strategies, prevention and follow-up. While there is no consensus on a proper monitoring for gastric cancer prevention in these patients, individualized conduct, taking into account individual characteristics, family record and other risk factors, should be adopted to avoid unfavorable outcomes in CD patients.

Reactivation of Hepatitis B after Administration of Anti-TNF<i>α</i>in a Patient with Psoriasis

In patients with severe psoriasis that at the same time have multiple comorbidities and chronic infections, is difficult to establish safer and more effective therapy. There are contradictions between the indications of the international protocols of systemic treatments, and the most recent publications which show that anti-TNFα agents could be safe therapeutic options in patients with chronic hepatitis. In the case of chronic viral infections, specifically hepatitis B, there are several conflicts in reference to the biological treatments that can block tumoral necrosis factor-α (TNFα) because there is evidence of a risk of reactivation of hepatitis. Most viral reactivations with the administration of an anti-TNFα agent have been reported in patients with inflammatory diseases. However, there are a few cases described in psoriasis. We’ll present the first case reported in literature of hepatisis B viral (HBV) reactivation in a patient with severe psoriasis secondary to the administration of adalimumab.

Tenosynovitis and Sporotrichoid Disease Due to <i>M. marinum</i>on a Patient under Anti-TNF<i>α</i>Therapy

There have been several reports of tuberculosis (TB) and, less frequently, of nontuberculous mycobacterial (NTM) infections in association with tumor necrosis factor α inhibitor (anti-TNFα) therapy. Mycobacterium marinum is a NTM with a distinct epidemiology and is infrequently responsible for disease in humans. Most commonly, it causes localized skin infections, but in 20% to 40% of cases, it involves deeper structures. Disseminated disease is exceptional and has been reported to occur only in immunocompromised patients. The authors report a clinical case of tenosynovitis and sporotrichoid disease due to M. marinum in a 45-year-old male patient under anti-TNFα therapies for spondyloarthropathy. Along antimicrobial therapy, the patient underwent surgical debridement and after two years he is still on treatment but substantially improved. A few cases of M. marinum infection occurring in patients treated with anti-TNFα drugs have been reported. The diagnosis of infection due to M. marinum requires a high index of suspicion from a properly obtained exposure history and is important so that efficient diagnostic approach and treatment are ensured.

对炎症性肠病患者开展抗TNF-α制剂TDM的国内外指南/共识的质量评价

目的评价对炎症性肠病(IBD)患者开展抗肿瘤坏死因子α(TNF-α)制剂治疗药物监测(TDM)的指南/共识的质量。方法检索PubMed、Embase、中国知网、万方数据和维普网以及国内外指南/共识发布网站,收集针对IBD患者开展抗TNF-α制剂TDM的指南/专家共识。检索时限均为建库至2023年6月。由2名研究者独立筛选文献、提取资料后,采用指南研究与评价工具Ⅱ对纳入指南/共识的方法学质量进行评价,并汇总纳入指南/共识的主要推荐意见。结果共纳入9篇文献,3篇为指南,6篇为共识。9篇指南/共识在范围和目的、参与人员、制定的严谨性、表达的清晰性、应用性和编辑独立性6个维度的标准化百分比分别为90.43%、41.98%、52.55%、85.49%、19.00%、76.85%。8篇指南/共识的推荐级别为B级,1篇共识的推荐级别为C级。主要推荐意见涉及TDM应用场景、阈值范围、策略调整、检测方法以及结果解读。大部分指南/共识均推荐对失应答患者应进行被动TDM;建议根据预期的治疗结果设定TDM浓度范围,并结合疾病状况和TDM结果进行策略调整,且建议同一患者采用相同的检测方法。部分指南/共识认为,生物类似药和原研药不存在结果解读差异。结论纳入的指南/共识总体质量一般,推荐意见较为统一。临床工作者需要了解该类药物TDM的特点和局限性,并结合具体的临床治疗目标去解读和运用监测结果。

黄柏抗痛风活性部位筛选及其对腹膜炎小鼠的保护作用

目的 研究黄柏不同萃取部位抗痛风作用,筛选有效部位并初步探究其作用机制。方法 采用单钠尿酸盐(MSU)诱导小鼠腹腔巨噬细胞及骨髓来源巨噬细胞(BMDM)建立细胞痛风模型,经黄柏不同极性部位给药后,ELISA法检测肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)分泌,从而筛选出活性部位,最后研究活性部位在小鼠体内抗痛风作用及相关机制。结果 黄柏醇提液各萃取部位中,正丁醇部位能降低细胞IL-1β水平和巨噬细胞的吞噬能力(P<0.01),但对TNF-α无明显影响(P>0.05)。与模型组比较,正丁醇部位各剂量组小鼠腹腔灌洗液IL-1β、IL-6水平和中性粒细胞募集程度均降低(P<0.05,P<0.01),其中高剂量组效果最明显,但各给药组TNF-α水平无明显变化(P>0.05)。结论 正丁醇部位为黄柏抗痛风活性部位,其抗痛风机制可能是通过降低细胞吞噬MSU晶体的能力,从而减少IL-1β、IL-6等细胞因子释放,进而减少中性粒细胞募集程度,改善痛风症状。

Codiaeum Variegatum Hydro Alcoholic Leaf Extracts and Their Fractions Inhibit Pro-Inflammatory Mediators in Vitro

Codiaeum variegatum has been widely investigated for its biological proprieties ranging from the antiamoebic potential to the phytochemical analysis. The aim of the present study was to evaluate the anti-inflammatory potential of C. variegatum leaf extracts and fractions. A primary macrophage culture activated by Saccharomyces cereviseae (SC) was used to evaluate cell cytotoxicity and anti-inflammatory potential of the plant extracts and fractions. Macrophages were treated with different concentrations (0.1;1;10 and 100 μg/mL) of the extracts/fractions for the inhibition of 5-lipoxygenase activity, nitric oxide (NO) and Tumor Necrosis Factor Alpha (TNF-α) production. No significant difference was observed on cell viability in the presence of extracts and fractions at tested concentration during the incubation period. Extracts and fractions of C. variegatum inhibited the 5-lipoxygenase activity, NO and TNF-α production by viable primary mouse macrophages in a concentration-dependent manner. The fractionation process increased anti-inflammatory activity. Among fractions, HEF2, HEF3, HEF5, EEF1, EEF3 and EEF5 exhibited the best anti-inflammatory potential. C. variegatum extracts and fractions exhibited a greater anti-inflammatory potential throughout the inhibition of pro-inflammatory mediators such as NO, 5-Lox and TNF-α.

艳山姜总黄酮改善无水乙醇致胃黏膜细胞损伤的作用及机制

目的探讨艳山姜总黄酮通过微RNA-146a-5p(miR-146a-5p)对无水乙醇诱导的胃黏膜细胞损伤的改善作用及潜在机制。方法以人胃黏膜细胞GES-1为对象,以无水乙醇诱导建立急性胃溃疡细胞模型,在考察不同质量浓度艳山姜总黄酮对细胞活力影响及筛选作用浓度的基础上,检测细胞中miR-146a-5p的相对表达量,细胞中肿瘤坏死因子受体关联因子6(TRAF6)、核因子κB p65(NF-κB p65)、肿瘤坏死因子α(TNF-α)蛋白的表达水平,以及细胞上清液中白细胞介素1β(IL-1β)、IL-6、前列腺素E2(PEG2)水平;验证miR-146a-5p与TRAF6的靶向关系,并观察过表达miR-146a-5p、敲减TRAF6对模型细胞上清液中IL-1β、IL-6、PEG2水平的影响,以及敲减miR-146a-5p对艳山姜总黄酮抗胃溃疡作用的影响。结果与空白组比较,模型组细胞中miR-146a-5p的相对表达量和上清液中PGE2水平均显著降低(P<0.01),细胞中TRAF6、NF-κB p65、TNF-α蛋白的表达水平和上清液中IL-1β、IL-6水平均显著升高(P<0.01)。与模型组比较,模型+艳山姜总黄酮(60 mg/L)组细胞中miR-146a-5p的相对表达量和上清液中PGE2水平均显著升高(P<0.01),细胞中TRAF6、NF-κB p65、TNF-α蛋白的表达水平和上清液中IL-1β、IL-6水平均显著降低(P<0.05或P<0.01)。miR-146a-5p与TRAF6存在靶向关系且呈负相关;过表达miR-146a-5p或敲减TRAF6后,细胞上清液中IL-1β、IL-6水平均显著降低,PGE2水平显著升高(P<0.05)。敲减miR-146a-5p后,艳山姜总黄酮作用下的细胞上清液中IL-1β、IL-6水平和细胞中TRAF6蛋白的表达水平均显著升高,PGE2水平显著降低(P<0.05)。结论艳山姜总黄酮对无水乙醇致胃黏膜细胞损伤有一定的改善作用,其机制可能与上调miR-146a-5p的表达、抑制TRAF6的表达,进而抑制相关炎症因子的分泌有关。

强直性脊柱炎患者益赛普减量经验——为期1年的开放式前瞻性临床研究结果

目的探索一种经济、有效、安全的强直性脊柱炎(AS)患者应用重组人肿瘤坏死因子Ⅱ型受体-抗体融合蛋白(益赛普)的减量方法。方法对入选的16例男性活动期AS患者进行1年的疗效观察。益赛普最初治疗量为25mg每周2次皮下注射,同时开始的治疗包括沙利度胺、帕夫林及双氯芬酸钠。当疾病得到缓解(Bath强直性脊柱炎活动指数<2.0,血沉<15mmH2O/1h及C-反应蛋白<0.8mg/dl),即将益赛普每隔2个月减半量。如果减量使患者症状加重或C反应蛋白水平反弹至异常水平,则将益赛普重新调整至前一个剂量,并于下次复查时评估以确定益赛普的剂量。结果经过1年的随访观察后,4名患者可将益赛普减量至25mg/3周,9名患者可减量至25mg/2周,1名患者可减量至25mg/周,2名患者由于疗效不满意于4个月时退出研究。结论沙利度胺、帕夫林及双氯芬酸钠联合低于推荐剂量的益赛普可以使大部分AS患者的病情维持在缓解状态。

茯苓多糖的抗肿瘤作用及其机理的研究

茯苓多糖对小鼠肉瘤１８０及艾氏腹水癌（ＥＡＣ）的抑制作用与口服５－Ｆｕ的抑制作用相同。以荷瘤的ＮＩＨ小鼠腹腔巨噬细胞（ＰＭ）和脾脏组织为材料，茯苓多糖（１００～２００ｍｇ／ｋｇ，ｐｏ，ｄ１～８）能提高荷瘤小鼠体内的肿瘤坏死因子（ＴＮＦ）水平和明显提高自然杀伤（ＮＫ）细胞活性。

抗TNF-α制剂对克罗恩病合并肛瘘患者术后免疫平衡和细胞因子水平及远期复发率的影响

目的研究抗TNF-α制剂对克罗恩病合并肛瘘患者术后免疫平衡及细胞因子水平和远期复发率的影响。方法对42例行手术治疗的克罗恩病合并肛瘘患者资料进行回顾,依据术后应用抗TNF-α制剂与否,分为对照组(n=20,单行挂线引流术治疗)和观察组(n=22,挂线引流术+抗TNF-α制剂治疗),比较2组近远期疗效。结果观察组肛瘘瘘口完全愈合率68.18%,对照组50%,2组差异无统计学意义(P<0.05);观察组瘘口愈合时间显著短于对照组(P<0.05);治疗后,2组CDEIS评分、CDAI评分和PDAI评分均显著降低,且观察组降低幅度大于对照组,差异具有统计学意义(P<0.05);治疗后,观察组CD_4^+CD_(25)^+Treg显著上升(P<0.05),IL-4/IFN-γ值和TGF-β/IL-17值显著下降(P<0.05),而对照组变化不显著(P>0.05),组间比较差异有统计学意义(P<0.05);观察组肛瘘复发率9.09%,肛瘘再发率4.55%,对照组分别为35%和30%,2组差异有统计学意义(P<0.05)。结论抗TNF-α制剂可明显改善克罗恩病合并肛瘘患者症状,维持免疫平衡,降低肛瘘复发和再发率,与外科手术联合治疗利于提高预后疗效。

强直性脊柱炎治疗新进展

强直脊柱炎的药物治疗一直为风湿病学家所关注。本文综述了近年来新的药物 ,包括皮质类固醇激素、COX 2特异性抑制剂、甲氨蝶呤、帕米膦酸盐、沙利度胺 (反应停 )、TNF单克隆抗体及阿米替林的治疗方案、疗效。

红毛五加总甙抗炎机制研究

目的 :研究红毛五加总甙 (TGA)的抗炎机制。方法 :sc角叉菜胶 (Car)复制大鼠背部气囊滑膜炎模型 ,测定TNF、NO及MDA等含量。结果 :TGA能明显降低灌洗液中TNF、NO、MDA含量 ,提高炎细胞内cAMP的含量。结论 :TGA抗炎机制与抑制灌洗液中炎性细胞因子TNF、NO水平而增加炎细胞内cAMP含量及消除自由基、抑制脂质过氧化有关。

细胞因子在炎症性肠病治疗中的研究进展

抗肿瘤坏死因子α抗体已被用于炎症性肠病(inflammatory bowel disease,IBD)的临床治疗。靶向其他细胞因子或细胞因子相关信号通路的新药物也正在进行临床试验。然而,某些抗细胞因子疗法和细胞因子信号阻断剂似乎只在特定亚组IBD患者中有效,提示细胞因子调节网络的复杂性,其功能可能受基因、免疫及微生物等多方面因素的影响。本文就细胞因子及细胞因子调节途径(Th17细胞、激酶抑制剂、基因治疗、粪菌移植)治疗IBD的研究进展作一概述。

腹腔感染伴多器官功能障碍综合征时抗TNF抗体代谢调理作用的实验研究

目的 :观察抗TNF抗体对腹腔感染 (IAI)伴多器官功能障碍综合征 (MODS)时的代谢调理作用。 方法 :将 2 0只采用盲肠结扎加穿孔 (CLP)方法诱发的IAI伴MODS的兔随机分成两组 ,即①抗TNF血清组 :在CLP后0 .5h给予抗TNF血清 (每微升能中和TNF活性 10 0 0u) 2 .5ml/kg ;②对照组 :给予非免疫血清 2 .5ml/kg ,动态观察血清细胞因子 (TNF ,IL 6 )、激素 (皮质醇、胰岛素、胰高血糖素 )、血清生化 (葡萄糖、胆固醇、甘油三酯、白蛋白 )和每天尿中尿素氮、肌酐、3 甲基组氨酸排出的变化。两组观察时间均为 1周 ,并记录动物生存时间。 结果 :与对照组比较 ,应用抗TNF血清组血清TNF和IL 6水平下降 ,血清皮质醇升高幅度降低 ,胰岛素和胰高血糖素水平处于正常 ,血糖无显著下降 ,胆固醇和甘油三酯升高幅度减小 ,血清白蛋白水平下降减低 ,尿中尿素氮、肌酐、3 甲基组氨酸的排出量减少 ,生存率显著提高。 结论 :抗TNF抗体能够明显纠正IAI伴MODS时的代谢紊乱 ,对高分解代谢具有显著的代谢调理作用。