Diabetes and the risk of infections with immunomodulator therapy in inflammatory bowel diseases.
Diabetes and the risk of infections with immunomodulator therapy in inflammatory bowel diseases.
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DOI：
10.1111/apt.13195
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发表时间：
2015-06
影响因子：
7.6
通讯作者：
Liao KP
中科院分区：
文献类型：
--
作者：
Ananthakrishnan AN;Cagan A;Cai T;Gainer VS;Shaw SY;Churchill S;Karlson EW;Murphy SN;Kohane I;Liao KP
在使用免疫抑制治疗炎症性肠病(IBD)的患者中，感染是一个重要的问题。近10%的美国人患有糖尿病。它是否会给IBD带来免疫抑制的额外风险，以前还没有研究过。为了检验糖尿病与免疫调节剂在IBD中使用的感染之间的关系，我们使用了一个经过验证的、多机构的IBD队列，确定了所有至少接受一种免疫调节剂(硫嘌呤、甲氨蝶呤)处方的患者。我们的主要结果是免疫调节剂处方后1年内发生感染。对相关混杂因素进行多变量Logistic回归校正，以评估与糖尿病的独立关联。我们的研究包括2766名接受至少一种免疫调节剂处方的患者，其中210名(8%)在1年内发生感染。感染的患者可能年龄较大，有更多的合并症，更有可能接受过类固醇处方，但在该年内开始抗肿瘤坏死因子治疗的情况相似。在没有感染的人中，只有8%的人患有糖尿病，而在1年内发生感染的人中，这一比例为19%(优势比(OR)2.74，95%可信区间(CI)1.88-3.98，p<；0.001)。在多变量分析中，糖尿病独立地与感染风险增加近两倍相关(OR 1.80，95%CI 1.20-2.68)。加用抗肿瘤坏死因子治疗后，感染风险没有增加(OR1.14，95%CI 0.80~1.63)。糖尿病是使用免疫调节剂治疗的IBD患者感染的独立危险因素。
Infections are an important concern in patients using immunosuppressive therapy for their inflammatory bowel disease (IBD). Diabetes affects nearly 10% of Americans. Whether it confers an additional risk with immunosuppression in IBD has not been examined previously. To examine the association between diabetes and infections with immunomodulator use in IBD Using a validated, multi-institutional IBD cohort, we identified all patients who received at least one prescription for immunomodulators (thiopurines, methotrexate). Our primary outcome was infection within 1 year of the prescription of the immunomodulator. Multivariable logistic regression adjusting for relevant confounders was used to estimate the independent association with diabetes. Our study included 2,766 patients receiving at least one prescription for immunomodulators among whom 210(8%) developed an infection within 1 year. Patients who developed an infection were likely to be older, have more comorbidities, more likely to have received a prescription for steroids but similar in initiation of anti-TNF therapy within that year. Only 8% of those without an infection had diabetes compared to 19% of those who developed an infection within 1 year (Odds ratio (OR) 2.74, 95% confidence interval (CI) 1.88 – 3.98, p < 0.001). On multivariate analysis, diabetes was independently associated with a nearly two-fold increase in risk of infections (OR 1.80, 95% CI 1.20 – 2.68). There was no increase in risk of infections with addition of anti-TNF therapy (OR 1.14, 95% CI 0.80 – 1.63). Diabetes is an independent risk factor for infection in IBD patients using immunomodulator therapy.
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DOI：
10.1046/j.1365-2362.2000.00745.x
发表时间：
2000-11-01
影响因子：
5.5
作者：
Geerlings, SE;Brouwer, EC;Hoepelman, AIM
通讯作者：
Hoepelman, AIM
影响因子：
--
作者：
Geerlings, SE;Hoepelman, AIM
通讯作者：
Hoepelman, AIM
影响因子：
8
作者：
Rahier, J. F.;Magro, F.;Colombel, J. F.
通讯作者：
Colombel, J. F.
影响因子：
24.5
作者：
Fidder, H.;Schnitzler, F.;Rutgeerts, P.
通讯作者：
Rutgeerts, P.
影响因子：
39.2
作者：
PRESENT, DH;MELTZER, SJ;KORELITZ, BI
通讯作者：
KORELITZ, BI