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Strengthened monitoring and optimized management of Crohn's disease patients

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Author:: No author available

Journal Title:: World Chinese Journal of Digestology

Issue:: 15

DOI:: 10.11569/wcjd.v28.i15.660

Key Word:: 克罗恩病;炎症标志物治;疗性药物监测;术后监测;管理;优化治疗

Abstract：近年来,克罗恩病(Crohn's disease,CD)的治疗目标从临床缓解转向黏膜愈合.在这种情况下,CD的管理和监测格外重要.根据临床症状和炎症标志物及时调整治疗方案,有助于对患者进行监测,取得更好的临床和内镜治疗效果.然而目前还没有足够的证据来推荐仅考虑炎症标志物的治疗优化方案.治疗性药物监测(therapeutic drug monitoring,TDM)已被用于改善硫嘌呤和抗肿瘤坏死因子药物的治疗,被动性TDM适用于所有药物,为提高临床实用性,抗肿瘤坏死因子药物的监测应从被动性转变为主动性.主动的TDM对于优化非抗肿瘤坏死因子生物制剂的效用仍有待描述.此外,炎症标志物可以预测术后CD的复发,术后6-12 mo以及之后定期行结肠镜复查亦为重要.高危CD患者应考虑尽早在术后进行抗肿瘤坏死因子治疗,但抗肿瘤坏死因子预防性给药的最佳时间尚无统一意见,非抗肿瘤坏死因子生物制剂在术后预防性给药中的作用还需研究.本文主要综述了炎症标志物的监测、药物监测及术后患者的监测,进而优化CD患者管理,使更多的患者达到治疗目标,指出了CD患者密切监测的重要性.

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