Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort.
Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort.
复制标题
DOI：
10.1371/journal.pone.0158017
复制
发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Higgins PD
中科院分区：
文献类型：
--
作者：
Waljee AK;Wiitala WL;Govani S;Stidham R;Saini S;Hou J;Feagins LA;Khan N;Good CB;Vijan S;Higgins PD
皮质类固醇对炎症性肠病（IBD）的短期治疗有效。然而，长期使用与显著的不良反应有关。要定义：（1）皮质类固醇使用的频率和持续时间，（2）升级为皮质类固醇保留治疗的频率，（3）与皮质类固醇使用相关的并发症发生率，（4）适当骨密度测量（双能X线吸收测定法[DEXA]扫描）的发生率，以及（5）与升级和DEXA扫描相关的因素。回顾性审查退伍军人健康管理局（VHA）2002-2010年的数据。在30，456名患有IBD的退伍军人中，32%在研究期间需要至少一个疗程的皮质类固醇，17%的类固醇使用者的疗程延长。在这些患者中，只有26.2%的患者接受了治疗升级。去看胃肠病（GI）医生的患者更有可能接受保留皮质类固醇的药物。与糖皮质激素保留药物相关的因素包括年龄较小（OR = 0.96/年，95%CI：0.95，0.97）、男性（OR = 2.00，95%CI：1.16，3.46）、糖皮质激素评估期间的GI访视（OR = 8.01，95%CI：5.85，10.95）和连续使用糖皮质激素与间歇使用糖皮质激素（OR = 2.28，95%CI：1.33，3.90）。IBD诊断后，皮质类固醇使用者（静脉血栓栓塞[VTE] 9.0%;脆性骨折2.6%;感染54.3）的每1000人-年并发症发生率高于非皮质类固醇使用者（VTE 4.9%;脆性骨折1.9%;感染26.9）。皮质类固醇使用者的DEXA扫描使用率仅为7.8%。用于治疗IBD的长期皮质类固醇治疗是常见的，并且与对患者的显著伤害相关。长期使用糖皮质激素治疗IBD的患者应尽早转诊至胃肠病学，并应普遍努力改善高质量护理的提供。
Corticosteroids are effective for the short-term treatment of inflammatory bowel disease (IBD). Long-term use, however, is associated with significant adverse effects. To define the: (1) frequency and duration of corticosteroid use, (2) frequency of escalation to corticosteroid-sparing therapy, (3) rate of complications related to corticosteroid use, (4) rate of appropriate bone density measurements (dual energy X-ray absorptiometry [DEXA] scans), and (5) factors associated with escalation and DEXA scans. Retrospective review of Veterans Health Administration (VHA) data from 2002–2010. Of the 30,456 Veterans with IBD, 32% required at least one course of corticosteroids during the study time period, and 17% of the steroid users had a prolonged course. Among these patients, only 26.2% underwent escalation of therapy. Patients visiting a gastroenterology (GI) physician were significantly more likely to receive corticosteroid-sparing medications. Factors associated with corticosteroid-sparing medications included younger age (OR = 0.96 per year,95%CI:0.95, 0.97), male gender (OR = 2.00,95%CI:1.16,3.46), GI visit during the corticosteroid evaluation period (OR = 8.01,95%CI:5.85,10.95) and the use of continuous corticosteroids vs. intermittent corticosteroids (OR = 2.28,95%CI:1.33,3.90). Rates of complications per 1000 person-years after IBD diagnosis were higher among corticosteroid users (venous thromboembolism [VTE] 9.0%; fragility fracture 2.6%; Infections 54.3) than non-corticosteroid users (VTE 4.9%; fragility fracture 1.9%; Infections 26.9). DEXA scan utilization rates among corticosteroid users were only 7.8%. Prolonged corticosteroid therapy for the treatment of IBD is common and is associated with significant harm to patients. Patients with prolonged use of corticosteroids for IBD should be referred to gastroenterology early and universal efforts to improve the delivery of high quality care should be undertaken.