抗瘤坏死因子治疗对炎症性肠病手术的影响:一项基于人口的研究
A Barney Hawthorne1,2, Bradley Arms-Williams3, Rebecca Cannings-John4
1Department of Gastroenterology, Cardiff and Vale University Health Board, Cardiff, UK abhawth@aol.com.
BMJ open gastroenterology
|May 22, 2024
概括
早期的抗瘤缩因子 (TNF) 治疗减少了克罗恩病 (CD) 的手术,但矛盾的是,在性结肠炎 (UC) 中增加了切除风险. 这影响了IBD治疗策略.
科学领域:
- 胃肠病学 胃肠病学
- 免疫学 免疫学 免疫学
- 临床医学 临床医学
背景情况:
- 在炎症性肠病 (IBD) 中广泛使用生物制剂需要评估它们对外科切除率的影响.
- 早期抗瘤坏死因子 (TNF) 治疗对IBD长期手术结果的影响尚不清楚.
研究的目的:
- 评估早期,持续的抗TNF治疗对IBD患者在诊断后五年内外科切除率的影响.
- 为了比较早期接受抗TNF治疗的患者和没有接受治疗的患者之间的外科切除率.
主要方法:
- 在威尔士 (2005-2016) 诊断出1250名IBD患者的基于人口的研究.
- 倾向性得分匹配和治疗权重的逆概率 (IPTW) 用于平衡基线特征和减轻偏差.
- 分析重点是克罗恩病 (CD) 和性结肠炎 (UC),包括IBD未分类 (IBD-U),不包括直肠炎.
主要成果:
- 早期持续的抗TNF治疗与显著降低CD切除的可能性有关 (IPTW HR 0.29,p=0.003).
- 相反,在UC (包括IBD-U) 中,早期持续的抗TNF治疗显示了显著增加的胆管切除风险 (IPTW HR 4.6,p=0.001).
结论:
- 早期持续的抗TNF疗法在降低克罗恩病手术切除率方面具有好处.
- 在性结肠炎早期使用抗TNF时,观察到结肠切除风险的悖论性增加,这表明基线临床因素的预测能力低于治疗.
- 这些发现支持在CD中早期引入抗TNF,但表明目前的方法可能无法充分评估其在UC中的益处.
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