摘要
背景:治疗药物监测(TDM)已成为监测英夫利西单抗(IFX)治疗失应答的重要方法,主动TDM和被动TDM对于炎症性肠病(IBD)患者临床结局的影响尚无明确定论。目的:评价IFX主动TDM和被动TDM对IBD患者预后的影响。方法:回顾性分析2017年1月—2021年10月于空军军医大学第一附属医院接受IFX治疗且进行TDM的99例IBD患者的临床资料,其中主动TDM组34例,被动TDM组65例。比较两组治疗失败率、IBD相关手术率和IBD相关住院率。采用Logistic回归分析明确IFX治疗失败的危险因素。结果:本研究中位随访时间为21(13,32)个月。主动TDM组治疗失败率、IBD相关住院率明显低于被动TDM组(P<0.05),而两组IBD相关手术率无明显差异(P=0.081)。单因素分析结果显示TDM前回结肠手术史、抗英夫利西单抗抗体(ATI)和被动TDM可能与治疗失败相关,多因素Logistic回归分析显示被动TDM是治疗失败的危险因素(OR=5.829,95%CI:1.070~31.754,P=0.042),TDM前有回结肠手术史与治疗失败呈负相关(OR=0.119,95%CI:0.019~0.736,P=0.022)。结论:与被动TDM相比,主动TDM可以减少治疗失败率和IBD相关住院率。被动TDM是IFX治疗失败的危险因素,TDM前有回结肠手术史与治疗失败呈负相关。
Background:Therapeutic drug monitoring(TDM)has emerged as the important method for managing loss of response to infliximab(IFX).The effect of proactive and reactive TDM on clinical outcomes in inflammatory bowel disease(IBD)is uncertain.Aims:To evaluate the effect of proactive and reactive TDM of IFX on the prognosis of patients with IBD.Methods:Clinical data of 99 IBD patients treated with IFX from January 2017 to October 2021 at the First Affiliated Hospital of Air Force Medical University were retrospectively analyzed,including 34 patients with proactive TDM and 65 patients with reactive TDM.The rates of treatment failure,IBD⁃related surgery or hospitalization were compared between the two groups.Logistic regression analysis was used to determine the independent risk factors of treatment failure.Results:The median follow⁃up of the patients was 21(13,32)months.The rates of treatment failure,IBD⁃related hospitalization of proactive TDM group were significantly lower than those of reactive TDM group(P<0.05),however,no significant difference in IBD⁃related surgery rate was found between the two groups(P=0.081).Univariate analysis showed that ileocolonic resection before TDM,antibodies to infliximab(ATI)and reactive TDM might be correlated with treatment failure(P<0.05).Multivariate Logistic regression analysis showed that reactive TDM was the risk factor of treatment failure(OR=5.829,95%CI:1.070⁃31.754,P=0.042),and ileocolonic resection before TDM was negatively related with treatment failure(OR=0.119,95%CI:0.019⁃0.736,P=0.022).Conclusions:Compared with reactive TDM group,proactive TDM can significantly decrease the rates of treatment failure and IBD⁃related hospitalization.Reactive TDM is the risk factor of treatment failure,and ileocolonic resection before TDM is negatively related with treatment failure.
作者
刘欢
吕宁
吴开春
时永全
陈敏
LIU Huan;LÜNing;WU Kaichun;SHI Yongquan;CHEN Min(Department of Gastroenterology,the First Affiliated Hospital of Air Force Medical University,Xi′an,710032;Department of Gastroenterology,the Jiang Yaojian Integrated Traditional Chinese and Western Medicine Hospital of Weinan,Weinan,Shaanxi Province)
出处
《胃肠病学》
北大核心
2023年第10期584-588,共5页
Chinese Journal of Gastroenterology
基金
国家自然科学基金(81600443)。
