乌司奴单抗治疗狭窄型克罗恩病1例报道及文献回顾

邵晓晓; 史睿昕; 方晔; 王伟中; 蒋益

doi:10.16766/j.cnki.issn.1674-4152.003315

乌司奴单抗治疗狭窄型克罗恩病1例报道及文献回顾

doi: 10.16766/j.cnki.issn.1674-4152.003315

1.
温州医科大学附属第二医院育英儿童医院消化内科，浙江温州 325000
2.
温州医科大学第二临床医学院，浙江温州 325000

基金项目:

浙江省温州市科技计划项目 Y2020285

贺林院士工作站科研基金项目 19331101

详细信息

通讯作者:
蒋益，E-mail：wzjiangyi@yeah.net

中图分类号: R574
计量
- 文章访问数: 238
- HTML全文浏览量: 91
- PDF下载量: 21
- 被引次数: 0
出版历程
- 收稿日期: 2023-03-28
- 网络出版日期: 2024-01-29

Ustekinumab in the treatment of stenosis Crohn's disease: A case report and literature review

1.
Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 克罗恩病(Crohn's disease, CD)是一种病因不明的慢性肉芽肿性疾病，可累及从口腔至肛门消化道的任何部位。CD常伴有多种并发症，如肠腔狭窄、肠瘘、脓肿、穿孔等，其中肠腔狭窄是最常见的并发症，但目前临床上尚缺乏根治CD肠腔狭窄的有效方法。近期研究发现乌司奴单抗(ustekinumab, UST)可以通过抑制IL-12和IL-23介导的细胞信号传导、激活和下游炎性细胞因子产生，从而减轻CD患者肠道慢性炎症相关性狭窄。本文对温州医科大学附属第二医院收治的1例CD合并肠腔狭窄的患者采用UST治疗并取得了良好的治疗效果，现报道如下并作相关文献回顾。
- 克罗恩病 /
- 肠狭窄 /
- 炎症性肠病 /
- 乌司奴单抗
Abstract: Crohn's disease (CD) is a chronic granulomatous disease of unknown etiology that can affect any part of the alimentary tract from the mouth to the anus. CD is often accompanied by a variety of complications, such as intestinal lumen stenosis, intestinal fistula, abscess and perforation. Intestinal lumen stenosis is the most common complication, and there is still a lack of effective methods for the radical treatment of CD intestinal lumen stenosis. Recent studies have found that ustekinumab (UST) attenuates chronic inflammation-associated stenosis in the intestinal tract of CD patients by inhibiting IL-12 and IL-23-mediated cell signaling, activation, and downstream inflammatory cytokine production. In this paper, a case of CD complicated with intestinal stenosis admitted to the Second Affiliated Hospital of Wenzhou Medical University was treated with UST and achieved good therapeutic effect. The case is reported as follows and relevant literature is reviewed.
- Crohn's disease /
- Intestinal stenosis /
- Inflammatory bowel disease /
- Ustekinumab

HTML全文

图 1 患者肠镜检查结果

注：A为2021年7月19日外院肠镜提示升结肠多发不规则溃疡，伴肠腔狭窄，见大量炎性息肉；B为2021年7月29日本院肠镜提示插镜至距肛缘60 cm，约升结肠、横结肠，肠腔布满息肉样隆起，狭窄，内镜无法通过；C为2022年1月17日本院肠镜治疗后复查，肠镜可顺利通过升结肠、回盲瓣，进入回肠末段，肠腔狭窄较前明显好转。

Figure 1. Colonoscopy findings patients

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图 2 患者CTE检查结果(2021年7月28日)

注：A为冠状面，B为矢状面，C为横断面。图像均提示升结肠、回盲部、末端回肠肠壁增厚，克罗恩病首先考虑，请结合内镜；回盲部周围淋巴结肿大。

Figure 2. CTE test results for patient (July 28, 2021)

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图 3 患者CTE检查结果(2022年1月17日)

注：A为冠状面，B为矢状面，C为横断面。图像均提示末端回肠肠壁稍增厚，回盲部-升结肠内壁可见多发息肉样突起。右下腹腔可见数枚淋巴结显示，肠腔狭窄较前好转。

Figure 3. CTE test results for patient (January 17, 2022)

下载: 全尺寸图片幻灯片

参考文献(17)

[1]	CHAN W P W, MOURAD F, LEONG R W. Crohn's disease associated strictures[J]. J Gastroenterol Hepatol, 2018, 33(5): 998-1008. doi: 10.1111/jgh.14119
[2]	宋彩霞, 马强. 小肠疾病的临床特点及研究现状[J]. 中国临床研究, 2018, 31(3): 424-426. SONG C R, MA Q. The clinical features and research status of small intestinal diseases[J]. Chinese Journal of Clinical Research, 2018, 31(3): 424-426.
[3]	刁磊, 洪汝涛, 韩玮, 等. CT小肠成像与双气囊小肠镜在疑似小肠出血诊断中的临床应用[J]. 中华全科医学, 2021, 19(8): 1347-1350. doi: 10.16766/j.cnki.issn.1674-4152.002057 DIAO L, HONG R T, HAN W, et al. Clinical application of CT enterography and double-balloon enteroscopy in the diagnosis of suspected small intestinal bleeding[J]. Chinese Journal of General Practice, 2021, 19(8): 1347-1350. doi: 10.16766/j.cnki.issn.1674-4152.002057
[4]	VEAUTHIER B, HORNECKER J R. Crohn's disease: diagnosis and management[J]. Am Fam Physician, 2018, 98(11): 661-669.
[5]	LI J, MAO R, KURADA S, et al. Pathogenesis of fibrostenosing Crohn's disease[J]. Transl Res, 2019, 209(7): 39-54.
[6]	LIN X X, QIU Y, ZHUANG X J, et al. Intestinal stricture in Crohn's disease: a 2020 update[J]. J Dig Dis, 2021, 22(7): 390-398. doi: 10.1111/1751-2980.13022
[7]	WANG J, LIN S, BROWN JM, et al. Novel mechanisms and clinical trial endpoints in intestinal fibrosis[J]. Immunol Rev, 2021, 302(1): 211-227. doi: 10.1111/imr.12974
[8]	MA C, JAIRATH V, CLICK B, et al. Targeting anti-fibrotic pathways in Crohn's disease: the final frontier?[J]. Best Pract Res Clin Gastroenterol, 2019, 38-39(1): 101603. DOI: 10.1016/j.bpg.2019.02.005.
[9]	ALFREDSSON J, WICK M J. Mechanism of fibrosis and stricture formation in Crohn's disease[J]. Scand J Immunol, 2020, 92(6): e12990. DOI: 10.1111/sji.12990
[10]	YOO J H, HOLUBAR S, RIEDER F. Fibrostenotic strictures in Crohn's disease[J]. Intest Res, 2020, 18(4): 379-401. doi: 10.5217/ir.2019.09148
[11]	王革非. 克罗恩病并发肠梗阻的诊断与治疗[J]. 肠外与肠内营养, 2019, 26(1): 1-5. WANG G F. Diagnosis and treatment of Crohn's disease complicated with intestinal obstruction[J]. Parenteral & Enteral Nutrition, 2019, 26(1): 1-5.
[12]	时雯琳, 金世柱, 王丽霞, 等. 内镜下克罗恩病合并肠道狭窄治疗研究[J]. 胃肠病学和肝病学杂志, 2019, 28(8): 853-856. SHI W L, JIN S Z, WANG L X, et al. Study of endoscopic treatment of Crohn's disease with intestinal stenosis[J]. Chinese Journal of Gastroenterology and Hepatology, 2019, 28(8): 853-856.
[13]	HONAP S, MEADE S, IBRAHEIM H, et al. Effectiveness and safety of ustekinumab in inflammatory bowel disease: a systematic review and meta-analysis[J]. Dig Dis Sci, 2022, 67(3): 1018-1035. doi: 10.1007/s10620-021-06932-4
[14]	AGGELETOPOULOU I, ASSIMAKOPOULOS S F, KONSTANTAKIS C, et al. Interleukin 12/interleukin 23 pathway: biological basis and therapeutic effect in patients with Crohn's disease[J]. World J Gastroenterol, 2018, 24(36): 4093-4103. doi: 10.3748/wjg.v24.i36.4093
[15]	PETAGNA L, ANTONELLI A, GANINI C, et al. Pathophysiology of Crohn's disease inflammation and recurrence[J]. Biol Direct, 2020, 15(1): 23. doi: 10.1186/s13062-020-00280-5
[16]	WEISSHOF R, EL JURDI K, ZMETER N, et al. Emerging therapies for inflammatory bowel disease[J]. Adv Ther, 2018, 35(11): 1746-1762. doi: 10.1007/s12325-018-0795-9
[17]	MURATE K, NAKAMURA M, YAMAMURA T, et al. Ustekinumab is effective against small bowel lesions in Crohn's disease: two case reports[J]. Clin J Gastroenterol, 2021, 14(1): 129-135. doi: 10.1007/s12328-020-01242-0