IBD: 早期启动抗肿瘤坏死因子治疗可减少回盲部切除术后克罗恩病的术后复发

2022-08-26 xuyihan MedSci原创

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。本病和慢性非特异性溃疡性结肠炎两者统称为炎症性肠病(IBD)。

克罗恩病 (CD) 是一种慢性进行性免疫介导的炎症性肠病 (IBD), 尽管目前CD治疗在医学方面取得了重大进展,但CD手术仍然很常见,特别是对于存在难治性疾病和并发症的患者,如瘘管、脓肿、或狭窄。虽然手术切除可以使CD病情得到缓解,但大多数患者会出现疾病复发。研究表明,高达90%的CD个体一年内会发生内镜下复发(POR),5年内临床复发率为 60%至78%,并且高达50%的患者可能需要在5年内重复切除肠段。内窥镜检查被认为是诊断POR的金标准,Rutgeerts评分是一种广泛接受的内窥镜评估工具,用于评估回盲部切除 (ICR) 和回结肠吻合术后患者的术后CD活动。本项研究旨在探究我们旨在比较成人CD患者回盲部切除 (ICR) 后预防 POR 的生物学类型和时机。

 

 

研究人员对在医疗中心接受ICR手术的CD患者进行了回顾性队列研究。复发通过内窥镜检查(≥i2b Rutgeerts 评分)或放射成像(新末端回肠的活动性炎症)来定义,并根据 ICR 后 12 周内的术后预防性生物制剂的类型和时间进行危险分层(无、肿瘤坏死因子拮抗剂 [抗 TNF]、维多珠单抗和乌司奴单抗)。

 

 

本项研究最后总共纳入了1037名接受ICR的CD患者。在接受术后预防治疗的278人 (26%) 中,80%接受抗TNF药物治疗 ( n=223),然后是乌思奴单抗治疗 ( n=28, 10%) 和维多珠单抗治疗 ( n=27, 10%)。35%的患者在ICR后4周内开始预防,65%的患者在术后4至12周内开始预防治疗。在调整与POR相关的因素后,与不进行生物预防相比,ICR后4周内开始使用抗TNF药物与POR降低相关(调整后的风险比,0.61;95% CI,0.40-0.93) . 与未接受预防的患者相比,ICR 或维多珠单抗或乌思奴单抗 4 周后的预防与 POR 降低无关。

 

 

本项研究证实ICR后4周内早期开始使用抗TNF药物与POR降低有关,但在手术后的任何时间点,维多珠单抗或乌思奴单抗均与 POR 降低无关。

 

 

 

原始出处:

Jordan E Axelrad. et al. Early Initiation of Antitumor Necrosis Factor Therapy Reduces Postoperative Recurrence of Crohn’s Disease Following Ileocecal Resection. Inflammatory Bowel Diseases.2022.

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    2022-08-24 bnurmamat
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    2022-08-24 millore
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