克罗恩病免疫抑制治疗的长期安全管理 研究进展

Research Progress on Long-Term Safety Management of Immunosuppressive Therapy in Crohn’s Disease

摘要: 克罗恩病(Crohn’s Disease, CD)是一种慢性、进展性肠道炎症性疾病，需长期管理。过去二十年间，CD治疗目标已从症状控制提升至黏膜愈合，治疗手段从传统药物转向生物制剂及小分子药物。然而，上述免疫抑制方案(包括传统免疫抑制剂、生物制剂及小分子药物)在取得较好疗效的同时，其长期使用所伴随的安全性风险——尤其是机会性感染与恶性肿瘤——正日益成为临床管理的核心挑战。不同药物类别的风险谱各异，且长期用药可放大累积毒性。本文系统梳理并整合现有文献，深入分析CD免疫抑制治疗的长期安全性证据，重点解析各类药物的风险特征，进而构建从治疗前风险评估、药物选择到治疗中监测的全周期管理框架，旨在为临床个体化治疗提供循证参考。

Abstract: Crohn’s disease (CD) is a chronic, progressive inflammatory bowel disease requiring long-term management. Over the past two decades, the therapeutic goal for CD has shifted from symptom control to mucosal healing, and treatment modalities have evolved from conventional drugs to biologics and small molecules. However, while these immunosuppressive regimens (including conventional immunosuppressants, biologics, and small molecules) achieve favorable efficacy, the safety risks associated with their long-term use—particularly opportunistic infections and malignancies—are increasingly becoming a core challenge in clinical management. The risk profiles vary across drug classes, and long-term therapy may amplify cumulative toxicity. This article systematically reviews and synthesizes the available literature, provides an in-depth analysis of the long-term safety evidence for immunosuppressive therapy in CD, focuses on the risk characteristics of each drug class, and further constructs a full-cycle management framework that spans pre-treatment risk assessment, drug selection, and on-treatment monitoring, aiming to provide evidence‑based references for individualized clinical practice.