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炎症性肠病患者的活性结核病:一个病例对照研究
Matheus Freitas Cardoso de Azevedo1, Luísa Leite Barros2, Filipe Fernandes Justus2
1Department of Gastroenterology, University of São Paulo School of Medicine, Av. Dr. Eneas de Carvalho Aguiar, 255, São Paulo, SP 05400-000, Brazil.
Therapeutic advances in gastroenterology
|July 12, 2023
概括
抗瘤坏死因子 (TNF) 药物对炎症性肠病 (IBD) 至关重要,但会增加结核病 (TB) 风险. 在IBD诊断时的年龄较大和抗TNF治疗是流行地区活跃结核病的关键风险因素.
科学领域:
- 免疫学 免疫学 免疫学
- 胃肠病学 胃肠病学
- 传染性疾病 传染性疾病
背景情况:
- 抗瘤坏死因子 (TNF) 疗法是适度至严重的炎症性肠病 (IBD) 的标准.
- 抗TNF药物与机会性感染有关,包括结核病 (TB),这是巴西等特有地区的重大问题.
- 在接受抗TNF治疗的IBD患者中确定结核病的风险因素对于患者的安全至关重要.
研究的目的:
- 确定IBD患者发展活跃结核病的危险因素.
- 描述在巴西第三级转诊中心治疗的IBD患者结核病的临床特征和结果.
主要方法:
- 从2010年1月到2021年12月进行了一项回顾性病例控制研究.
- 根据性别,年龄和IBD类型,IBD患者的活跃结核病病例与对照组 (没有活跃结核病史的IBD患者) 匹配1:3.
- 使用多变量分析来确定结核病发展的显著风险因素.
主要成果:
- 在1760名IBD患者中发现了38例 (2.2%) 活跃结核病病例.
- 在17岁以上的IBD诊断和抗TNF治疗与结核病发展有显著的相关性 (p <0.05).
- 大多数结核病例 (94.7%) 发生在接受免疫抑制药物治疗的患者中,主要是抗TNF药物 (86.1%),在开始抗TNF治疗后的32个月中位数诊断.
结论:
- 结核病仍然是结核病流行地区IBD患者的重大威胁,特别是那些接受抗TNF治疗的人.
- 在IBD诊断时的年龄较大 (>17岁) 是活性结核病的额外危险因素.
- 在结核病治疗后重新引入抗TNF疗法似乎是安全的,这强调了在易患IBD的人群中需要警的结核病查和监测.
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