Ann Rheum Dis:接受手术类风湿性关节炎患者的免疫抑制治疗以及再入院和死亡风险

2020-03-27 xiangting MedSci原创

与甲氨蝶呤相比,近期使用生物制剂或tsDMARD与髋部骨折、腹盆腔或心脏手术后的死亡或再入院风险升高无关。较高剂量的糖皮质激素与风险更高相关。

该研究主要在接受关节置换手术的患者中分析了免疫抑制剂对术后结局的影响。目的是评估生物制剂和糖皮质激素对其他重大手术后结局的影响。

这项回顾性队列研究使用2006-2015年医疗保险数据,查找接受髋部骨折修复、腹盆腔手术(胆囊切除术、子宫切除术、疝气、阑尾切除术、结肠切除术)或心脏手术(冠脉搭桥术、二尖瓣/主动脉瓣手术)的类风湿性关节炎成年患者。使用基于倾向得分的逆概率加权进行logistic回归比较术前8周使用甲氨蝶呤(不使用生物制剂或靶向合成疾病改善抗风湿药(tsDMARD))、肿瘤坏死因子抑制剂(TNFi)或非TNFi生物制剂/tsDMARD患者的90天死亡率和30天再入院率。使用类似分析评估了糖皮质激素与结局之间的关联。

共确定了10777例符合条件的手术:3585例髋部骨折、5025例腹盆腔手术和2167例心脏手术。与甲氨蝶呤治疗患者相比,TNFi治疗(死亡率调整OR(aOR)0.83(0.67-1.02),再入院aOR 0.86(0.75-0.993))或非TNFi生物制剂/tsDMARD治疗患者(死亡率aOR 0.78(0.49-1.22),再入院aOR 1.02(0.78-1.33))90天死亡或30天再入院的风险没有升高,按手术类别分层的分析结果类似。尽管按手术类别分层的结果有所不同,但是糖皮质激素5-10mg/天(死亡率aOR 1.41(1.08-1.82),再入院aOR 1.26(1.05-1.52))或>10mg/天(死亡率aOR 1.64(1.02-2.64),再入院aOR 1.60(1.15-2.24))的死亡和再入院风险高于不使用糖皮质激素。

与甲氨蝶呤相比,近期使用生物制剂或tsDMARD与髋部骨折、腹盆腔或心脏手术后的死亡或再入院风险升高无关。较高剂量的糖皮质激素与风险更高相关。

原始出处:

Michael D George. Immunosuppression and the risk of readmission and mortality in patients with rheumatoid arthritis undergoing hip fracture, abdominopelvic and cardiac surgery. Ann Rheum Dis. March 2020.

 

 

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    2020-03-29 lmm397
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