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慢性阿片类药物使用在炎症性肠病患者中的预测因素:基于人口的队列研究
Bente Mertz Nørgård1,2, Caroline Thingholm Thorarinsson1,2, Jan Nielsen1,2
1Center for Clinical Epidemiology, Odense University Hospital, Odense C, Denmark.
The American journal of gastroenterology
|February 5, 2025
概括
相当数量的克罗恩氏病和性结肠炎患者出现慢性阿片类药物使用. 手术,老年和镇静剂使用是关键预测因素,需要有针对性的预防策略.
科学领域:
- 胃肠病学 胃肠病学
- 疼痛管理 疼痛管理
- 药理学 药理学是指药理学的学科.
背景情况:
- 炎症性肠病 (IBD),包括克罗恩病 (CD) 和性结肠炎 (UC),经常与阿片类药物使用有关.
- 在IBD患者中慢性阿片类药物使用的预测因素仍未得到充分研究,这突出了关键的知识差距.
研究的目的:
- 确定诊断为克罗恩病和性结肠炎的患者慢性阿片类药物使用的关键预测因素.
- 在IBD人群中为慢性阿片类药物使用的风险分层和预防策略提供信息.
主要方法:
- 采用1996-2021年丹麦登记处的全国性队列研究,包括18岁以上的CD/UC患者.
- 慢性阿片类药物使用定义为 ≥1处方至少在3个连续季度中的2个.
- 考克斯回归模型分析了预测因素,包括时间变化的协变量,如IBD手术和精神药物使用.
主要成果:
- 在克罗恩氏病 (n=15,092) 中,27.4%成为慢性阿片类药物使用者. 最重要的预测因素:手术 (HR 4.20),催眠药/镇静剂 (HR 2.02) 和年龄≥50 (HR 1.92).
- 在性结肠炎 (n=30,416) 中,22.3%成为慢性阿片类药物使用者. 最重要的预测因素:手术 (HR 4.81),年龄≥50 (HR 2.62) 和催眠药/镇静药 (HR 2.11).
结论:
- 令人担忧的IBD患者比例过渡到慢性阿片类药物使用.
- 识别有手术史的患者,使用催眠药/镇静剂的患者和老年人对于有针对性的预防至关重要.
- 对IBD患者的非阿片类药物疼痛管理和阿片类药物戒断策略需要进一步的研究.
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