预测克罗恩病预后的生物标志物

Pablo A Olivera, Mark S Silverberg
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摘要

摘要克罗恩病(Crohn 's disease, CD)是一种消化道慢性炎症性疾病,在疾病预后和治疗选择方面面临重大挑战。生物标志物具有预测CD结果和指导临床决策的潜力。本综述旨在总结与乳糜泻结局相关的生物标志物及其潜在临床意义的最新文献。鉴别可靠的CD预后生物标志物对于制定治疗策略、监测疾病活动和预测并发症风险至关重要。传统上用于评估疾病严重程度和并发症可能性的临床预后因素在准确性和预测价值方面存在局限性。因此,需要更精确的生物标志物,特别是在新诊断和治疗新手患者中。药物基因组学标记,如TPMT和NUDT15多态性,已被用于识别有硫嘌呤治疗不良事件风险的患者。一些生物标志物,包括HLA单倍型、肿瘤抑制素M表达和转录组谱,已经显示出与抗tnf治疗的反应相关。共聚焦激光内窥镜和单细胞分析有望预测对特定疗法的治疗反应。鉴别与CD术后复发相关的生物标志物是至关重要的,因为它可能导致管理算法的改变。已经确定了几个有希望的微生物组特征和蛋白质组谱。总之,通过提供有价值的预后信息和指导治疗决策,生物标志物有可能彻底改变CD的管理。然而,进一步的研究和验证是必要的,以建立其临床应用和融入日常实践。
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Biomarkers That Predict Crohn’s Disease Outcomes
Abstract Crohn’s disease (CD), a chronic inflammatory condition of the digestive tract, poses significant challenges in terms of disease prognosis and treatment selection. Biomarkers have the potential to predict CD outcomes and guide clinical decision-making. This review aims to summarize the current literature on promising biomarkers associated with CD outcomes and their potential clinical implications. The identification of reliable biomarkers for CD outcomes is of paramount importance in tailoring treatment strategies, monitoring disease activity, and predicting the risk of complications. Clinical prognostic factors traditionally used to assess disease severity, and the likelihood of complications have limitations in accuracy and predictive value. Thus, there is a need for more precise biomarkers, particularly in newly diagnosed and treatment-naive patients. Pharmacogenomic markers, such as TPMT and NUDT15 polymorphisms, have been utilized to identify patients at risk of adverse events with thiopurine therapy. Several biomarkers, including HLA haplotypes, oncostatin M expression, and transcriptomic profiles, have shown associations with response to anti-TNF therapy. Confocal laser endomicroscopy and single-cell analyses hold promise in predicting treatment response to specific therapies. The identification of biomarkers associated with post-operative recurrence in CD is crucial, as it could lead to changes in management algorithms. Several promising microbiome signatures and proteomic profiles have been identified. In conclusion, biomarkers have the potential to revolutionize the management of CD by providing valuable prognostic information and guiding treatment decisions. However, further research and validation are necessary to establish their clinical utility and integration into routine practice.
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