临床儿科杂志 ›› 2025, Vol. 43 ›› Issue (10): 742-748.doi: 10.12372/jcp.2025.24e1284

• 论著 • 上一篇    下一篇

TNF-α拮抗剂治疗儿童慢性复发性多灶性骨髓炎6例疗效观察

刘欣, 张子博, 李赫, 周宇辉, 张冰, 刘力()   

  1. 天津市儿童医院(天津大学儿童医院)综合内科(免疫方向) 天津市儿童出生缺陷防治重点实验室(天津 300074)
  • 收稿日期:2024-11-29 录用日期:2025-07-23 出版日期:2025-10-15 发布日期:2025-09-29
  • 通讯作者: 刘力 E-mail:may13_cn@126.com
  • 基金资助:
    天津市医学重点学科建设资助(TJYXZDXK-3-016B);天津市第二批卫生健康行业高层次人才选拔培养工程天津市津门英才(TJSJMYXYC-D2-031)

Efficacy of TNF-α antagonist in treating 6 cases of chronic recurrent multifocal osteomyelitis in children

LIU Xin, ZHANG Zibo, LI He, ZHOU Yuhui, ZHANG Bing, LIU Li()   

  1. Department of General Internal Medicine/Immunity Direction, Tianjin Children's Hospital/Children's Hospital, Tianjin University, Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin 300074, China
  • Received:2024-11-29 Accepted:2025-07-23 Published:2025-10-15 Online:2025-09-29
  • Contact: LIU Li E-mail:may13_cn@126.com

摘要:

目的 评价TNF-α拮抗剂治疗儿童慢性复发性多灶性骨髓炎(CRMO)的疗效与安全性。方法 回顾性分析2021年6月至2023年5月医院收治的CRMO患儿的临床资料。结果 共纳入6例CRMO患儿,男4例、女2例,均以骨痛起病,中位起病年龄9.5(8~10)岁,中位确诊年龄为11(10~12)岁。4例C-反应蛋白、白细胞介素-6及红细胞沉降率升高,3例抗核抗体阳性,1例人类白细胞抗原B27阳性。自发病至最后1次随访,6例患儿共发现92处骨骼受累病灶,以跗骨(32处,34.8%)、跖骨(14处,15.2%)、股骨(9处,9.8%)和胫骨(9处,9.8%)为主。6例患儿于确诊后均接受了双氯芬酸钠、甲氨蝶呤及阿达木单抗治疗,例1、2、4、6接受阿达木单抗40 mg/次(2周1次),例3、5接受阿达木单抗20 mg/次(2周1次);例1入院前有阿达木单抗用药史,病情复发后再次应用阿达木单抗疗效欠佳,调整用药为英夫利昔单抗200 mg/次(每次4 mg/kg,1个月1次),经治疗病情明显缓解。6例患儿经规律治疗3个月后,4例骨痛症状消失;而例1在接受英夫利昔单抗治疗8个月后骨痛消失,例4在接受阿达木单抗治疗4个月后骨痛消失。在随访过程中,所有患儿炎性指标恢复正常,影像学提示病灶较治疗前明显吸收或消失,未见TNF-α拮抗剂相关的药物不良反应。结论 TNF-α拮抗剂治疗儿童CRMO可控制炎症、改善症状和影像学变化,在随访中未发现药物不良反应。

关键词: TNF-α拮抗剂, 慢性复发性多灶性骨髓炎, 临床疗效, 儿童

Abstract:

Objective To evaluate the efficacy and safety of TNF-α antagonists in the treatment of chronic recurrent multifocal osteomyelitis (CRMO) in children. Methods The clinical data of 6 children with CRMO admitted to the hospital from June 2021 to May 2023 were retrospectively analyzed. Results A total of 6 children (4 boys and 2 girls) with CRMO were included. All of them had the onset of bone pain. The median age of onset was 9.5 (8-10) years, and the median age of diagnosis was 11 (10-12) years. The levels of C-reactive protein, interleukin-6 and erythrocyte sedimentation rate increased in 4 cases, antinuclear antibody was positive in 3 cases, and human leukocyte antigen B27 was positive in 1 case. From the onset of the disease to the last follow-up visit, a total of 92 lesions of skeletal involvement were found in the 6 children, predominantly in the tarsus (32, 34.8%), metatarsus (14, 15.2%), femur (9, 9.8%), and tibia (9, 9.8%). All 6 children received treatment with diclofenac sodium, methotrexate and adalimumab after diagnosis. Cases 1, 2, 4 and 6 received adalimumab at a dose of 40mg each time (once every 2 weeks), while cases 3 and 5 received adalimumab at a dose of 20mg each time (once every 2 weeks). Before admission, case 1 had a history of using adalimumab. After the recurrence of the disease, the efficacy of adalimumab was poor. The medication was then adjusted to infliximab at a dose of 200mg per administration (4mg/kg each time, once a month). After treatment, the condition was significantly relieved. After regular treatment for 3 months, the bone pain symptoms disappeared in 4 of the 6 children. For case 1, the bone pain disappeared after 8 months of treatment with infliximab, and for case 4, the bone pain disappeared after 4 months of treatment with adalimumab. During the follow-up process, all the children's inflammatory indexes returned to normal, and the imaging suggested that the lesions were significantly absorbed or disappeared compared with before treatment, and no TNF-α antagonist-related adverse drug reactions were seen. Conclusions TNF-α antagonists can control inflammation and improve symptoms and imaging changes in children with CRMO. No adverse drug reactions were observed during the follow-up period.

Key words: TNF-α antagonist, chronic recurrent multifocal osteomyelitis, clinical efficacy, child

中图分类号: 

  • R72