Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease.
Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease.
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DOI：
10.1097/mcg.0000000000000421
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发表时间：
2016-02
影响因子：
2.9
通讯作者：
Sandler RS
中科院分区：
文献类型：
--
作者：
Long MD;Kappelman MD;Martin CF;Chen W;Anton K;Sandler RS
确定NSAID在IBD激活中的作用。非甾体类抗炎药（NSAID）可激活炎症性肠病（IBD）的炎症通路。美国克罗恩病和结肠炎基金会（CCFA）合作伙伴是一项正在进行的IBD患者队列研究。所有数据均通过互联网自行报告。我们确定了一个子队列的参与者，其疾病活动，基于短克罗恩病活动指数（sCDAI）和简单的临床结肠炎活动指数（SCCAI），表明缓解。在基线时测量NSAID的使用模式，并在6个月后进行疾病活动评估。我们使用多变量二项回归来确定NSAID对疾病活动性的影响。共有791名缓解期患者有基线和随访数据可供分析。其中，247例克罗恩病（CD）患者（43.2%）和89例溃疡性结肠炎（UC）患者（40.6%）报告使用NSAID。NSAID使用≥ 5次/月的CD患者在随访时活动性疾病的风险更高（23% v. 15%，p=0.04）;（校正风险比（RR）1.65; 95%置信区间（CI）1.12-2.44）。在UC患者中未观察到影响（22% vs 21%，p=0.98;校正后RR 1.25; 95% CI，0.81-1.92）。对乙酰氨基酚的使用与CD患者随访时的活动性疾病相关（调整后的RR 1.72，95% CI 1.11-2.68）。定期（≥ 5次/月）使用NSAID和对乙酰氨基酚与活动性CD相关，但与UC无关。NSAID使用频率较低与活动性CD或UC无关。这些结果表明，定期使用NSAID可能会增加CD活动，或NSAID的使用可能是一个不太稳健的缓解标志物，从而反映亚临床疾病的活动。
To determine the role of NSAIDs in activation of IBD. Non-steroidal anti-inflammatory drugs (NSAIDs) may activate inflammatory pathways in inflammatory bowel disease (IBD). Crohn’s and Colitis Foundation of American (CCFA) Partners is an ongoing cohort study of patients living with IBD. All data are self-reported via the internet. We identified a sub-cohort of participants whose disease activity, based on short Crohn’s Disease Activity Index (sCDAI) and simple clinical colitis activity index (SCCAI), indicated remission. Pattern of use of NSAIDs was measured at baseline, and disease activity assessment was performed 6 months later. We used multivariate binomial regression to determine effects of NSAIDs on disease activity. A total of 791 individuals in remission had baseline and follow data available for analysis. Of these, 247 Crohn’s disease (CD) patients (43.2%) and 89 ulcerative colitis (UC) patients (40.6%) reported NSAID use. CD patients with NSAID use ≥ 5 times/monthly had greater risk of active disease at follow-up (23% v. 15%, p=0.04); (adjusted risk ratio (RR) 1.65; 95% confidence interval (CI) 1.12–2.44). No effect was observed in patients with UC (22% vs 21%, p=0.98; adjusted RR 1.25; 95% CI, 0.81–1.92). Acetaminophen use was associated with active disease at follow-up in CD (adjusted RR 1.72, 95% CI 1.11–2.68). Regular (≥ 5 times/monthly) NSAID and acetaminophen use were associated with active CD, but not UC. Less frequent NSAID use was not associated with active CD or UC. These findings indicate that regular NSAID use may increase CD activity, or that NSAID use may be a marker of a less robust remission; thus reflecting subclinical disease activity.