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。

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.