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在性结肠炎中对生物药物的初级无反应的预测因素:一项前性多中心研究
Atsushi Yoshida1, Tomohisa Takagi2, Kousaku Kawashima3
1Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan. atsushi-yoshida@ofunachuohp.net.
蛋白酶-3 (PR3) 抗中性粒细胞质抗体 (ANCA) 预测了性结肠炎 (UC) 患者对抗TNF治疗的初级无反应. 在其他标志物更相关的情况下,PR3-ANCA并不能预测对抗整合素治疗的不反应.
科学领域:
- 胃肠病学 胃肠病学
- 免疫学 免疫学 免疫学
- 临床医学 临床医学
背景情况:
- 性结肠炎 (UC) 的治疗包括生物药物.
- 预测治疗反应对于个性化治疗至关重要.
- 对生物药物的初级不反应 (PNR) 影响患者的治疗结果.
研究的目的:
- 评估蛋白质酶-3 (PR3) - 抗中性粒细胞质抗体 (ANCA) 和髓氧化酶 (MPO) - ANCA,以预测UC中的生物药物的PNR.
- 确定PNR对抗TNF和抗整蛋白疗法的预测因子.
主要方法:
- 对以前没有使用过生物药物的UC患者进行的前性多中心队列研究.
- 患者接受了抗TNF,抗整合素或抗IL12/23药物作为第一线治疗.
- 由于症状改善或治疗修改不足而定义的PNR;用于分析的后勤回归.
主要成果:
- 在抗TNF接受者中,PR3-ANCA阳性是常见的 (47.4%).
- 接受抗TNF治疗的PR3-ANCA阳性患者的PNR率明显更高 (66.7%与25.0%,P=0.02).
- PR3-ANCA独立地预测了PNR对抗TNF治疗的结果 (OR 5.61). 血小板与淋巴细胞的比率 (PLR) 和全身免疫-炎症指数 (SII) 预测了PNR与抗整体素治疗.
结论:
- 在UC中,PR3-ANCA预测了PNR对抗TNF治疗的作用.
- PR3-ANCA不预测PNR对抗整合素治疗;PLR和SII是潜在的预测因素.
- PR3-ANCA可以为个性化的UC治疗提供生物选择信息.
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