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炎症性腸疾患のためにチオプリンを投与している患者のリンパ増殖性疾患:前向きの観察コホート研究
Laurent Beaugerie1, Nicole Brousse, Anne Marie Bouvier
1Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Université Pierre et Marie Curie Paris-VI, Paris, France. laurent.beaugerie@sat.aphp.fr
Lancet (London, England)
|October 20, 2009
まとめ
ティオプリン療法を受けている炎症性腸疾患の患者は,リンパ増殖性疾患を発症するリスクが著しく高まります. このリスクは,これらの免疫抑制薬を使用したことがない人と比較して顕著に上昇しています.
科学分野:
- 免疫学 免疫学とは
- 胃腸内科 胃腸内科
- 腫瘍学 腫瘍学
背景:
- ティオプリンを使用する炎症性腸疾患 (IBD) 患者のリンパ増殖性疾患のリスクの増加に関する論争があります.
- このリスクを評価するために,前向きな観察コホート研究が行われました.
研究 の 目的:
- ティオプリン治療に曝された炎症性腸疾患 (IBD) の患者のリンパ増殖性疾患のリスクを評価する.
- ティオプリンを投与する,投与を中止する,または決して使用しない患者の間でこれらの疾患の発生率を比較する.
主な方法:
- フランスの全国的なコホートには,IBD患者の19486人が含まれ,そのデータは680人の胃腸科医によって収集されました.
- 追跡期間は平均35ヶ月で,免疫抑制療法,がん,死亡を記録した.
- リンパ増殖障害のリスクは,チオプリン暴露状態に基づいて分析されました.
主要な成果:
- リンパ増殖性疾患の新たな23例が診断されました (ホジキン病1例,ノンホジキン病22例).
- 1000患者年あたりの発生率は,0.90 (チオプリン投与),0.20 (投与中断),0.26 (投与中断) であった.
- 多変量分析により,チオプリン受容者および非受容者におけるリンパ増殖性疾患の危険比率は5.28であった (p=0.0007).
結論:
- 炎症性腸疾患のためにチオプリンを投与している患者は,リンパ増殖性疾患を発症するリスクが高くなります.
- チオプリンに関連した多くの症例の病理学的プロファイルは,移植後のリンパ増殖性疾患に似ている.
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