英夫利昔单抗诱导治疗儿童克罗恩病疗效的预测指标分析

doi:10.12372/jcp.2025.24e0615

Abstract

Abstract:

Objective To explore the predictive indexes for the efficacy of infliximab induction therapy in children with Crohn's disease. Methods The clinical data of children diagnosed with Crohn's disease and initially treated with infliximab in the Gastroenterology Department from January 1, 2018 to July 31, 2023 were retrospectively analyzed. The clinical features and laboratory tests before treatment were compared between children with mucosal healing and those without mucosal healing after 14 weeks of infliximab induction therapy. Results Fifty-three children with Crohn's disease (39 boys and 14 girls) were included, and the median age of diagnosis was 12.0 (11.0-13.0) years. The median duration from disease onset to the first infliximab treatment was 5.0(2.0-12.0) months. All the 53 patients had moderate to severe Crohn's disease, including 27 cases with anal fistula, 9 cases with anal fistula combined with intestinal stenosis, 8 cases with intestinal stenosis, 7 cases with extensive intestinal lesions, and 2 cases with growth retardation. Multivariate logistic regression analysis showed that simple endoscopic score for Crohn's disease (SES-CD), C-reactive protein (CRP) and procalcitonin (PCT) might be related to the outcome of mucosal non-healing under endoscopy after infliximab induction therapy (P<0.05). The area under the receiver operating characteristic (ROC) curve (AUC) of baseline SES-CD, CRP and PCT for predicting mucosal non-healing under endoscopy after infliximab induction therapy was 0.73, 0.77 and 0.77, respectively. The sensitivity, specificity and AUC of combined prediction of the three indicators were 0.96, 0.68 and 0.88, respectively. Conclusions The combination of SES-CD, CRP and PCT before infliximab treatment is more accurate in predicting the efficacy of infliximab induction therapy in children with Crohn's disease.

Key words: Crohn's disease, infliximab, prediction, mucosal healing, child

CLC Number:

YUE Yang, ZHANG Zhihua, LI Mei, LIU Zhifeng, GUO Hongmei. Predictors of efficacy of infliximab induction therapy in children with Crohn's disease[J].Journal of Clinical Pediatrics, 2025, 43(6): 426-431.

Figures/Tables 3

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Table 2

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References 26

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项目	黏膜愈合组(n=25)	黏膜未愈组(n=28)	统计量	P
男[n(%)]	18(72.0)	21(75.0)	χ²=0.06	0.805
病程[M(P₂₅~P₇₅)]/月	7.0(3.5~12.5)	4.5(1.3~9.8)	Z=1.73	0.084
诊断时年龄[M(P₂₅~P₇₅)]/岁	13.0(11.5~13.0)	12.0(11~13.8)	Z=0.00	1.000
疾病部位[n(%)]			－	0.584¹⁾
L1+L4	0(0)	2(7.1)
L2	3(12.0)	1(3.6)
L2+L4	3(12.0)	2(7.1)
L3	7(28.0)	10(35.7)
L3+L4	12(48.0)	12(42.9)
L4	0(0)	1(3.6)
疾病行为[n(%)]			χ²=0.00	0.983
B1(非狭窄非穿透)	16(64.0)	18(64.3)
B2(狭窄)	9(36.0)	10(35.7)
肛周瘘管[n(%)]	18(72.0)	18(64.3)	χ²=0.36	0.548
生长发育迟缓[n(%)]	1(4.0)	4(14.3)	－	0.355¹⁾
PCDAI($\bar{x}±s$)/分	30.3±13.7	37.5±12.0	t=2.04	0.047
BMI[M(P₂₅~P₇₅)]/kg·m^-2	16.2(14.6~18.4)	14.1(12.5~15.7)	Z=3.34	0.001
SES-CD($\bar{x}±s$)/分	16.2±8.4	24.6±9.6	t=3.36	0.001
钙卫蛋白[M(P₂₅~P₇₅)]/µg·g^-1	1 074.8(749.5~1 215.3)	1 074.8(901.8~1 298.4)	Z=0.61	0.544
CRP[M(P₂₅~P₇₅)]/mg·L^-1	14.0(0.0~29.9)	42.5(16.0~72.0)	Z=3.32	0.001
ESR[M(P₂₅~P₇₅)]/mm·h^-1	34.0(20.0~53.0)	41.0(23.5~56.0)	Z=0.13	0.894
Hb($\bar{x}±s$)/g·L^-1	107.4±20.1	104.1±17.9	t=0.64	0.525
血小板($\bar{x}±s$)×10⁹·L^-1	460.4±123.9	434.5±127.5	t=0.75	0.458
PCT[M(P₂₅~P₇₅)]/ng·mL^-1	0.05(0.04~0.08)	0.09(0.06~0.11)	Z=3.41	0.001
白蛋白($\bar{x}±s$)/g·L^-1	35.8±4.7	34.2±6.4	t=1.08	0.286
球蛋白($\bar{x}±s$)/g·L^-1	33.9±4.7	34.5±5.4	t=0.44	0.662
总胆红($\bar{x}±s$)/µmol·L^-1	5.3±2.4	5.5±2.0	t=0.29	0.773
N/L[M(P₂₅~P₇₅)]	2.4(1.9~3.8)	3.2(1.9~3.9)	Z=1.02	0.310
N/A[M(P₂₅~P₇₅)]	0.2(0.1~0.3)	0.2(0.1~0.3)	Z=0.43	0.669
N/B[M(P₂₅~P₇₅)]	1.6(0.7~2.2)	1.4(0.8~1.9)	Z=0.46	0.643
药物剂量($\bar{x}±s$)/mg·kg^-1	6.4±1.7	7.0±1.2	t=1.50	0.140

因素	偏回归系数	标准误	χ²值	P	OR(95%CI)
PCDAI	0.10	0.05	3.63	0.057	1.11(1.00~1.22)
SES-CD	0.11	0.05	3.95	0.047	1.11(1.00~1.24)
CRP	0.06	0.03	5.37	0.021	1.06(1.01~1.12)
PCT	0.03	0.01	4.97	0.026	1.03(1.00~1.06)
BMI	－0.36	0.19	3.66	0.056	0.70(0.49~1.01)
常量	3.00	3.38	0.79	0.376	－

Predictors of efficacy of infliximab induction therapy in children with Crohn's disease

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