儿童炎症性肠病的精准治疗

doi:10.12372/jcp.2022.22e1048

摘要/Abstract

摘要：

我国儿童炎症性肠病（inflammatory bowel disease，IBD）的发病率不断上升，精准治疗可提高患儿的临床缓解及黏膜愈合率，提高儿童IBD的诊治水平。儿童IBD的精准治疗的发展主要基于对疾病发生发展认识的不断深入。生物制剂应用的不断优化可提高患儿的治疗效果，减轻经济负担。随着基因组学、转录组学、肠道微生态学及代谢组学等学科的发展及人工智能算法的协助，新的生物标志物不断被研究发现和应用。通过对儿童IBD精准化治疗的推动，IBD诊治策略将有新的改革和发展。

关键词: 精准治疗, 炎症性肠病, 生物制剂, 儿童

Abstract:

The incidence of pediatric inflammatory bowel disease (IBD) in China rose these years. Precision treatment can improve the treatment of IBD and increase the remission rate. The development of precision treatment is mainly based on the in-depth understanding of the pathogenesis of IBD. The continuous optimization of biologic applications can improve the treatment outcome of children and reduce the economic burden. New biomarkers are constantly discovered and applied with the development of genomics, transcriptomics, gut microbiome, metabolomics, and artificial intelligence algorithms. Precision treatment will innovate treatment strategies in the near future.

Key words: precision treatment, inflammatory bowel disease, biologics, child

王歆琼, 许春娣. 儿童炎症性肠病的精准治疗[J]. 临床儿科杂志, 2022, 40(11): 813-818.

WANG Xinqiong, XU Chundi. Precision treatment in pediatric inflammatory bowel disease[J]. Journal of Clinical Pediatrics, 2022, 40(11): 813-818.

图/表 1

参考文献 37

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风险分层	疾病表现	风险因素	建议诱导方案
低	炎症表现	无	全肠内营养，糖皮质激素
中	炎症表现	治疗12周临床或生物标志物未缓解	考虑升级至抗TNF单抗¹⁾
中	炎症表现	生长延迟	全肠内营养；优先抗TNF单抗
高	炎症表现	病变广泛或存在深大结肠溃疡	优先抗TNF单抗
高	炎症表现	肛周病变	优先抗TNF单抗联合肛周病变治疗
高	狭窄表现	无	优先抗TNF单抗
高	狭窄表现	梗阻表现	肠切除联合抗TNF单抗
高	穿孔表现（肠穿孔、腹腔瘘、炎性肿块、脓肿）		手术联合抗TNF单抗