Gastroenterology:接受腹部手术的炎症性肠病患者术前肿瘤坏死因子抑制剂的治疗的安全性分析

2022-06-26 xuyihan MedSci原创

克罗恩病在疾病早期对患者的影响并不大,但如果不及时进行治疗,发展到后期则会对患者造成巨大的伤害。一旦发现有相关症状,建议患者尽早到医院进行治疗。

目前炎症性肠病 (IBD) 的治疗靶点主要集中在免疫抑制上,研究表明,使用肿瘤坏死因子抑制剂 (TNFi) 和硫嘌呤的联合治疗是治疗中度至重度溃疡性结肠炎 (UC) 和克罗恩病的最有效方法。尽管使用了更有效的疗法,但在生物时代IBD患者需要手术的风险仍然很高。有人担心术前使用包括 TNFi 在内的免疫抑制药物治疗会增加潜在的术后感染并发症的风险。虽然文献一致表明手术前使用皮质类固醇会增加术后感染并发症的风险,但有关 TNFi 的证据仍然不一致。在过去的二十年中,许多回顾性研究表明术前 TNFi暴露与术后并发症或感染的风险增加相关。因此,用肿瘤坏死因子抑制剂 (TNFis) 术前治疗炎症性肠病 (IBD) 是否会增加术后感染并发症的风险仍存在争议。本研究的主要目的是确定术前暴露于 TNFis 是否是术后 30 天内术后感染并发症的独立危险因素。

 

 

研究人员对17个IBD中心的患者进行了一项多中心前瞻性观察研究。感染性并发症分为手术部位感染 (SSI) 或非 SSI。当前的 TNFi 暴露定义为在手术后12周内使用,并收集血清用于药物水平分析。主要观察结果为任何感染或 SSI 发生,多变量模型用于判断影响术后并发症的危险因素,探索性模型使用基于血清药物浓度的 TNFi暴露与术后感染并发症的相关性。

 

 

从2014年9月到2017年6月,共有947名患者入组。382名患者报告存在当前 TNFi 暴露。目前暴露于TNFis 的患者和未暴露于TNFis 的患者的术后任何感染情况(18.1% VS 20.2%,P= .469)和 SSI(12.0% VS 12.6%,P = .889)的概率相似。在多变量分析中,当前的 TNFi 暴露与任何感染(OR,1.050;95%CI,0.716–1.535)或 SSI(OR,1.249;95%CI,0.793–1.960)无关。同时研究人员还发现TNFi药物浓度与任何感染或SSI无关。

 

 

在这个接受腹腔内手术的 IBD 患者的前瞻性队列中研究人员证实手术前12周内使用 TNFi与术后30天发生任何感染或 SSI 无关。二次分析也没有发现血清TNFi药物浓度与术后任何感染或SSI有任何关联。同时研究人员发现与感染或 SSI 独立相关的危险因素包括术前使用皮质类固醇、当前吸烟、既往肠切除术和糖尿病

 

 

 

原始出处:

Benjamin L. Cohen. Et al. Prospective Cohort Study to Investigate the Safety of Preoperative Tumor Necrosis Factor Inhibitor Exposure in Patients With Inflammatory Bowel Disease Undergoing Intra-abdominal Surgery. Gastroenterology.2022.

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    2022-10-24 jklm09
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[GetPortalCommentsPageByObjectIdResponse(id=1756499, encodeId=f47c1e5649946, content=<a href='/topic/show?id=3bf48568e5e' target=_blank style='color:#2F92EE;'>#腹部手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85687, encryptionId=3bf48568e5e, topicName=腹部手术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=871937156800, createdName=ms622625817193301, createdTime=Fri May 12 23:12:49 CST 2023, time=2023-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853003, encodeId=348b1853003cf, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Mon Oct 24 14:12:49 CST 2022, time=2022-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2065545, encodeId=d978206554515, content=<a href='/topic/show?id=94ffe853a7' target=_blank style='color:#2F92EE;'>#Gastroenterol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7853, encryptionId=94ffe853a7, topicName=Gastroenterol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bed488, createdName=jktdtl, createdTime=Sat Oct 15 04:12:49 CST 2022, time=2022-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2073568, encodeId=ff9b20e356805, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82876, encryptionId=1b6b828e6a6, topicName=肿瘤坏死因子抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=58df296, createdName=shock_melon, createdTime=Mon Jun 27 08:12:49 CST 2022, time=2022-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1363038, encodeId=c18b136303841, content=<a href='/topic/show?id=b723414321c' target=_blank style='color:#2F92EE;'>#坏死#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41432, encryptionId=b723414321c, topicName=坏死)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Mon Jun 27 08:12:49 CST 2022, time=2022-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485515, encodeId=04d414855154a, content=<a href='/topic/show?id=3879828e19d' target=_blank style='color:#2F92EE;'>#肿瘤坏死因子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82871, encryptionId=3879828e19d, topicName=肿瘤坏死因子)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=43077999209, createdName=ms7524819409032184, createdTime=Mon Jun 27 08:12:49 CST 2022, time=2022-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1505414, encodeId=30b6150541421, content=<a href='/topic/show?id=7730e85412' target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Mon Jun 27 08:12:49 CST 2022, time=2022-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1547561, encodeId=c382154e56104, content=<a href='/topic/show?id=4ef26e01766' target=_blank style='color:#2F92EE;'>#炎症性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, 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 Jun 27 08:12:49 CST 2022, time=2022-06-27, status=1, ipAttribution=)]
    2023-02-11 许安
  5. 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  6. 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  7. 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createdName=chaojitidian, createdTime=Mon Jun 27 08:12:49 CST 2022, time=2022-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1547561, encodeId=c382154e56104, content=<a href='/topic/show?id=4ef26e01766' target=_blank style='color:#2F92EE;'>#炎症性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, 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 Jun 27 08:12:49 CST 2022, time=2022-06-27, status=1, ipAttribution=)]
    2022-06-27 millore
  8. 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  9. 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中华炎性肠病杂志,2022年第6卷第2期

IBD: 乌司奴单抗在伴有和不伴有自身免疫性皮肤病的克罗恩病中的疗效差异

克罗恩病是一种原因不明的肠道炎症性疾病,在胃肠道的任何部位均可发生,但多发于末端回肠和右半结肠。

AP&T: 超声愈合与克罗恩病患者的长期预后改善有关

克罗恩病是一种无法治愈的终生性疾病,在人体受到环境和遗传易感因素的作用下,影响到肠黏膜免疫,造成非特异性的炎症性疾病。

European Radiology:克罗恩病中口服造影剂的类型和体积对MRE肠腔扩张程度的影响

肠道磁共振成像(MRE)无辐射,其依赖于良好的小肠扩张和多参数序列的结合以准确识别疾病和分型。