小肠克罗恩病诊断与治疗杨森讲稿.pptVIP

* * 虽然越来越多的人应用免疫抑制剂，但并没有真正改变疾病的病程，手术率和以前无多大变化， * * 随着病程的增长,手术后复发率也逐年增加 * * * * 英夫利西除了前一张幻灯片提到的阻止TNF-a的作用外，还可以通过激活补体和ADCC（抗体依赖性的细胞毒性）作用，特异性溶解产生TNF?的活性细胞（如单核细胞、巨嗜细胞和T细胞），从而从根本上抑制TNF-a的生成。 1.激活补体的作用：英夫利西单抗与TNF-a结合后可以激活补体，补体可以在产生TNF-a的T细胞上打孔，从而溶解T细胞； 2.ADCC作用：英夫利西单抗与TNF-a结合后，抗体的Fc段可与吞噬细胞上的Fc段受体结合，从而激活吞噬细胞，吞噬细胞进而吞噬产生TNF-a的T细胞。 * * Notes: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ * * The proportion of patients achieving clinical response at Week 10 in pediatric patients (REACH) was 88%. The proportion of patients in clinical response in adult patients (ACCENT I) at Week 10 was 67%. The confidence interval for the proportion of patients in clinical response at Week 10 for the pediatric population in the REACH study lies completely above the confidence interval for the adult population in the ACCENT I study, and on this basis, REACH met its primary endpoint. The study definition of clinical response in REACH was based on the PCDAI score, whereas CDAI was used in ACCENT I. * * The proportion of patients in clinical remission without corticosteroids at Week 30 was 46% for the infliximab q 8 weeks maintenance group and 33% for the q 12 weeks maintenance group. The proportion of patients in clinical remission without corticosteroids at Week 54 was 46% for the infliximab q 8 weeks maintenance group and 17% for the q 12 weeks maintenance group. * * Eighty-one percent of patients treated with a single dose of 类克 5 mg/kg achieved clinical response (decrease in 克罗恩病AI