The impact of preoperative serum anti-TNFα therapy levels on early postoperative outcomes in inflammatory bowel disease surgery.
The impact of preoperative serum anti-TNFα therapy levels on early postoperative outcomes in inflammatory bowel disease surgery.
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DOI：
10.1097/sla.0000000000000757
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发表时间：
2015-03
影响因子：
9
通讯作者：
Fleshner P
中科院分区：
文献类型：
--
作者：
Lau C;Dubinsky M;Melmed G;Vasiliauskas E;Berel D;McGovern D;Ippoliti A;Shih D;Targan S;Fleshner P
评估术前血清抗 TNFα 药物水平对炎症性肠病患者术后 30 天发病率的影响。由于抗 TNFα 药物的药代动力学各不相同，关于抗 TNFα 药物与 IBD 术后结果之间关系的研究是相互矛盾的。术前血清抗 TNFα 药物水平是否与术后发病率相关还有待观察。研究了术前 7 天内抽取血清的连续 IBD 手术患者的术后 30 天结果。测定3种抗TNF-α药物（英夫利昔单抗、阿达木单抗、赛妥珠单抗）的血清总浓度，≥0.98μg/ml视为检出。数据还根据 3 µg/ml 的临床临界值进行了审查。对 217 名患者（123 名克罗恩病 (CD) 和 94 名溃疡性结肠炎 (UC)）进行了分析。接受抗 TNFα 治疗的 150 名患者中，有 75 名 (50%) 在手术时未检测到 TNFα 水平。在 UC 队列中，根据 UC 手术类型分层时，不可检测组和可检测组之间的不良术后结果发生率相似。在 CD 队列中，可检测组与不可检测组的不良结果发生率较高，但在统计学上不显着。使用 3 µg/ml 的截止水平，≥ 3 µg/ml 组的术后发病率（OR=2.5，p=0.03）和感染并发症（OR=3.0，p=0.03）显着较高。与 < 3 µg/ml 组相比，≥ 8 µg/ml 组术后发病率 (p=0.047) 和再入院率 (p=0.04) 较高。术前血清抗 TNFα 药物水平升高与 CD 患者术后不良结局相关，但与 UC 患者无关。
Assess the impact of preoperative serum anti-TNFα drug levels on 30-day postoperative morbidity in inflammatory bowel disease patients. Studies on the association of anti-TNFα drugs and postoperative outcomes in IBD are conflicting due to variable pharmacokinetics of anti-TNFα drugs.. It remains to be seen whether preoperative serum anti-TNFα drug levels correlate with postoperative morbidity. 30 days postoperative outcomes of consecutive IBD surgical patients with serum drawn within 7 days pre-operatively, were studied. The total serum level of 3 anti-TNF-α drugs (infliximab, adalimumab, certolizumab) was measured, with ≥0.98 µg/ml considered as detected. Data was also reviewed according to a clinical cut off value of 3 µg/ml. 217 patients (123 Crohn’s disease (CD) and 94 ulcerative colitis (UC)) were analyzed. 75 of 150 (50%) treated with anti-TNFα therapy did not have detected levels at the time of surgery. In the UC cohort, adverse postoperative outcomes rates between the undetectable and detectable groups were similar when stratified according to type of UC surgery. In the CD cohort, there was a higher but statistically insignificant rate of adverse outcomes in the detectable vs undetectable groups. Using acut-off level of 3 µg/ml, postoperative morbidity (OR=2.5, p=0.03) and infectious complications (OR=3.0, p=0.03) were significantly higher in the ≥ 3 µg/ml group. There were higher rates of postoperative morbidity (p=0.047) and hospital readmissions (p=0.04) in the ≥ 8 µg/ml compared to < 3 µg/ml group. Increasing preoperative serum anti-TNFα drug levels are associated with adverse postoperative outcomes in CD but not UC patients.