克罗恩病的管理:一篇综述
Kelly Cushing1, Peter D R Higgins1
1Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor.
JAMA
|January 5, 2021
概括
有效的克罗恩病管理需要个性化治疗计划,平衡类固醇,生物制剂和手术等疗法的风险和益处, 以控制炎症和预防并发症. 患者的偏好和风险分层是最佳结果的关键.
科学领域:
- 胃肠病学
- 免疫学
- 药理学
背景情况:
- 克罗恩病 (CD) 是一种慢性胃肠炎症,全球发病率正在上升.
- 在CD中不受控制的炎症可能导致严重的并发症,如狭窄,和瘤.
- 早期和有效的炎症控制对于治疗克罗恩病和预防长期后果至关重要.
研究的目的:
- 概述克罗恩病的最佳治疗方法.
- 强调个性化治疗决策在克罗恩病的重要性.
- 审查当前的治疗方式及其相关风险和益处.
主要方法:
- 管理包括患者的风险分层,偏好和临床因素.
- 第一线治疗通常包括用皮质类固醇和抗瘤死因α药物缓解症状.
- 治疗方案包括单克隆抗体 (抗IL-12/23,抗整蛋白α4β7),免疫调节剂,组合疗法和手术.
主要成果:
- 有效的炎症控制降低了需要手术的透并发症的风险.
- 治疗不良反应包括抗体形成,输液反应,感染和潜在的癌症.
- 皮质类固醇使用和克罗恩病本身与骨质疏松症有关;活体疫苗在免疫抑制患者中是禁忌的.
结论:
- 克罗恩病的治疗是根据疾病的严重程度,风险分层,患者的偏好和临床因素进行的.
- 治疗方案包括类固醇,单克隆抗体,免疫调节剂和手术.
- 医生必须了解每种治疗方法的优缺点,
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