JCC: 抗肿瘤坏死因子治疗不影响炎症性肠病患者关节置换术后的严重感染发生率

2019-02-09 MedSci MedSci原创

目前有关炎症性肠病[IBD]患者关节置换手术并发症发生率的相关数据很少,其中使用肿瘤坏死因子-α抑制剂的影响还没有人进行过研究。因此,本项研究旨在探讨了这一人群中严重感染的风险。

背景和目的
目前有关炎症性肠病[IBD]患者关节置换手术并发症发生率的相关数据很少,其中使用肿瘤坏死因子-α抑制剂的影响还没有人进行过研究。因此,本项研究旨在探讨了这一人群中严重感染的风险。

方法
研究人员使用MarketScan数据库进行了一项回顾性病例对照研究。纳入的标准为所有年龄在18-64岁之间的IBD患者,在髋关节,膝关节或肩关节置换手术前≥6个月。同时对照在每个病例的入学时间,年份和联合替换频率上进行1:10匹配非IBD患者。主要观察结果是在手术后90天内出现严重感染[关节感染,手术部位感染,肺炎,败血症的复合物]。Cox比例风险模型用于评估IBD和IBD药物与严重感染的关联。

结果
研究结果表明IBD患者有着更高的感染发生率[3.2%vs 2.3%,p = 0.04],但调整变量后合并症后风险不高(风险比[HR],1.3; 95%置信区间[CI],0.95 -1.76)。在IBD患者中,皮质类固醇与严重感染风险增加有关[HR,4.6; 95%CI,2.2-9.8; p <0.01]而抗TNFα制剂则没有影响。阿片类药物也与感染风险增加有关[HR,1.5; 95%CI,1.2-1.8; p <0.01]。

结论
抗肿瘤坏死因子并不增加IBD患者在关节置换后发生严重感染的风险。皮质类固醇与IBD患者严重感染的风险增加有关。

原始出处:

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    2019-12-15 yxch48
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channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67017, encryptionId=4ef26e01766, topicName=炎症性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=09e813968720, createdName=12498dd9m15暂无昵称, createdTime=Mon Feb 11 07:47:00 CST 2019, time=2019-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1559807, encodeId=ca0f155980e2a, content=<a href='/topic/show?id=61785564089' target=_blank style='color:#2F92EE;'>#抗肿瘤坏死因子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55640, encryptionId=61785564089, topicName=抗肿瘤坏死因子)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1e7415021136, createdName=zblhy, createdTime=Mon Feb 11 07:47:00 CST 2019, time=2019-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1565816, encodeId=993715658168e, content=<a href='/topic/show?id=61785564089' target=_blank style='color:#2F92EE;'>#抗肿瘤坏死因子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55640, encryptionId=61785564089, topicName=抗肿瘤坏死因子)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1e7415021136, createdName=zblhy, createdTime=Mon Feb 11 07:47:00 CST 2019, time=2019-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576685, encodeId=653315e66852e, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, createdTime=Mon Feb 11 07:47:00 CST 2019, time=2019-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1594238, encodeId=a0cc159423870, content=<a href='/topic/show?id=c5c9211855f' target=_blank style='color:#2F92EE;'>#严重感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21185, encryptionId=c5c9211855f, topicName=严重感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Mon Feb 11 07:47:00 CST 2019, time=2019-02-11, status=1, ipAttribution=)]
    2019-02-11 millore
  5. 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  6. 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  7. 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Blood:炎症信号通过TNF直接上调HSCs的PU.1

中心点:在HSCs中,TNF整合炎症信号直接调控谱系指示转录因子PU.1。摘要:调控造血干细胞(HSCs)转化成谱系定向祖细胞的分子机制尚未十分明确。转录因子(TFs)是分化和谱系保证的强大的细胞内在的调节因子,而细胞因子信号已被证实可导向祖细胞的发展。但是,来源细胞外信号的诱导分化的造血转录因子的直接调控作用目前仍有很大的空白。PU.1是造血作用和促进髓系分化的主要调控因子。Martin Etz

JCC: 炎症性肠病的抗肿瘤坏死因子治疗不增加关节置换术后的严重感染几率

目前关于炎症性肠病(IBD)患者行关节置换手术的安全性的数据很少,因此研究人员探讨了这一人群中严重感染的风险。

GUT:炎症性肠病患者抗TNF治疗无应答预测方法研究

研究认为炎症活检或血基因检测均是有效的炎症性肠病患者抗TNF治疗应答效果预测的有效方法

Sci Signal:肿瘤坏死因子超级家族信号传递的结构基础

肿瘤坏死因子(tumor necrosis factor, TNF) 配体和受体超级家族在细胞增殖、存活和死亡方面起到重要作用。

JAMA Neurol:炎症性肠病患者接受抗TNF治疗可大幅降低后续帕金森病风险

研究证实炎症性肠病患者帕金森风险增加,接受抗肿瘤坏死因子抑制剂治疗可降低这一风险