IBD: 炎症性肠病患者接受抗TNF治疗前后严重感染的风险变化

2022-07-10 xuyihan MedSci原创

炎症性肠病是一种可以累及回肠、结肠、直肠的特发性肠道的炎症性疾病,发病原因目前并不明确,可能与先天因素、后天生活习惯、感染性因素以及免疫因素有关。

炎症性肠病 (IBD) 由克罗恩病 (CD)、溃疡性结肠炎 (UC) 和未分类的炎症性肠病 (IBD-U) 组成的一类影响胃肠道的慢性炎症性疾病。与一般人群相比,IBD 患者发生严重感染的风险明显增加,抗肿瘤坏死因子 (anti-TNF) 治疗已成为常规治疗失败的 IBD 患者中重度发作和维持缓解的标准治疗方案,但是抗 TNF 治疗会干扰免疫系统,患者和医生都可能担心严重感染风险的增加。为了描述在IBD患者使用抗TNF治疗前后严重感染率的变化情况,从而阐明抗TNF(相对于疾病活动性)在感染风险中的作用。研究人员进行了一项队列研究,比较了抗TNF启动前后严重感染的发生率的差异。

研究人员收集了在瑞典IBD质量中心登记的5个中心未接受抗TNF治疗的炎症性肠病患者的临床数据,并详细检查了他们的医疗病历。然后对严重感染(定义为需要住院治疗的感染)在开始抗 TNF 治疗之前和之后的一年进行了评估。

研究结果显示在1999年至2016年期间开始首次抗TNF治疗的980名患者中,严重感染的发生率为前一年每100人年 2.19(95% CI,1.43-3.36),治疗开始后 1 年每 100 人年为 2.11(95% CI,1.33-3.34)。这对应于抗TNF治疗后1年的发病率比为0.97(95% CI,0.51-1.84)。与抗TNF治疗前相比,治疗1年后严重感染发生率明显下降(发生率比0.56;95% CI,0.33-0.95;P =0.03)。

本项研发现IBD 患者的严重感染率在开始抗 TNF 治疗的前一年和后一年同样高,但在治疗第一年之后显着降低。抗TNF治疗对治愈黏膜可能超过对感染风险的不利免疫抑制作用。

原始出处:

Johanna Holmgren. Et al. The Risk of Serious Infections Before and After Anti-TNF Therapy in Inflammatory Bowel Disease: A Retrospective Cohort Study. Inflammatory Bowel Diseases.2022.

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    2023-01-28 mfx808
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    2022-07-11 bnurmamat
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    2022-07-11 snowpeakxu
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