核周型抗中性粒细胞胞浆抗体对维得利珠单抗治疗溃疡性结肠炎的疗效预测研究

Prediction of Therapeutic Effect of Perinuclear Antineutrophil Cytoplasmic Antibody on Vederizumab in the Treatment of Ulcerative Colitis

摘要: 目的：探讨核周型抗中性粒细胞胞浆抗体(perinuclear antineutrophil cytoplasmic antibody, p-ANCA)阳性对应用维得利珠单抗(vedolizumab, VDZ)治疗的溃疡性结肠炎(ulcerative colitis, UC)患者的长期治疗临床疗效的预测价值。方法：回顾性收集2019年1月至2024年7月在青岛大学附属医院接受VDZ治疗的中重度活动性UC患者共55例，根据p-ANCA检测结果分为阳性组及阴性组，于用药52 ± 8周时进行疗效评价，主要包括临床有效率、临床缓解率、内镜好转率及内镜愈合率，同时比较两组患者药物继发性失应答率及不良反应发生率。结果：本研究共纳入55例UC患者，其中p-ANCA阴性组患者33 (60%)例，阳性组患者22 (40%)例；与阴性组相比，阳性组临床缓解率(50.00% vs 21.21%)更高，其余临床有效率、内镜好转率和内镜愈合率差异均无统计学意义(P > 0.05)；治疗期间，9 (16.36%)例患者出现继发性失应答，阴性组患者7 (21.21%)例，阳性组患者2 (9.09%)例，差异不具有统计学意义(P > 0.05)；18 (32.73%)例患者出现不良反应，其中p-ANCA阴性组12 (36.36%)例，阳性组患者6 (27.27%)例，两组患者对比不具有统计学意义(P > 0.05)。结论：p-ANCA阳性组的患者在52 ± 8周时临床缓解率显著高于阴性组，提示p-ANCA对VDZ长期疗效具有一定的预测价值；两组继发性失应答率及不良反应发生率大致相似。

Abstract: Objective: To explore the predictive value of perinuclear antineutrophil cytoplasmic antibody (p-ANCA) positivity in the long-term clinical efficacy of ulcerative colitis (UC) patients treated with vedolizumab (VDZ). Methods: A total of 55 patients with moderately to severely active UC who received VDZ treatment at the Affiliated Hospital of Qingdao University from January 2019 to July 2024 were retrospectively collected and divided into positive and negative groups according to the p-ANCA test results. The efficacy evaluation was carried out at 52 ± 8 weeks, mainly including clinical effective rate, clinical remission rate, endoscopic improvement rate, and endoscopic healing rate. At the same time, the secondary drug non-response rate and the incidence of adverse reactions were compared between the two groups of patients. Results: A total of 55 UC patients were included in this study, including 33 (60%) patients in the p-ANCA negative group and 22 (40%) patients in the positive group; Compared with the negative group, the clinical remission rate of the positive group was higher (50.00% vs 21.21%). There was no statistical significance in the other clinical effective rates, endoscopic improvement rates and endoscopic mucosal healing rates (P > 0.05); during treatment, 9 (16.36%) patients had secondary unresponsiveness, 7 (21.21%) patients in the negative group and 2 patients in the positive group (9.09%) cases, the difference was not statistically significant (P > 0.05); 18 (32.73%) patients had adverse reactions, including 12 (36.36%) patients in the p-ANCA negative group and 6 (27.27%) patients in the positive group. For example, the comparison between the two groups of patients was not statistically significant (P > 0.05). Conclusion: The clinical remission rate of patients in the p-ANCA positive group at 52 ± 8 weeks was significantly higher than that in the negative group, suggesting that p-ANCA has certain predictive value for the long-term efficacy of VDZ; The rates of secondary non response and adverse reactions were roughly similar between the two groups.