Meta-analysis: peri-operative anti-TNF treatment and post-operative complications in patients with inflammatory bowel disease
Meta-analysis: peri-operative anti-TNF treatment and post-operative complications in patients with inflammatory bowel disease
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DOI：
10.1111/apt.12313
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发表时间：
2013-06-01
影响因子：
7.6
通讯作者：
Marshall, J. K.
中科院分区：
文献类型：
--
作者：
Narula, N.;Charleton, D.;Marshall, J. K.
背景 围手术期使用 TNF 拮抗剂对感染和伤口愈合等术后并发症的影响存在争议。目的 进行系统评价和荟萃分析，以评估围手术期使用 TNF 拮抗剂对炎症性肠病 (IBD) 患者感染和伤口愈合等术后并发症的影响。方法 通过文献检索找到了调查使用 TNF 拮抗剂治疗 IBD 患者术后结果的研究。主要结局是术后感染并发症的发生率。次要结局包括非感染性并发症和总并发症的发生率。报告优势比 (OR) 和 95% 置信区间 (CI)。结果 总体而言，涉及 4659 名参与者的 18 项研究符合纳入条件。术前接受抗 TNF 治疗的 IBD 患者术后感染性 [OR 1.56 (95% CI, 1.092.24)]、非感染性 [OR 1.57 (95% CI, 1.142.17)] 和总并发症 [OR 1.73 (95% CI, 1.232.43)] 显着增加。仅限于克罗恩病患者的研究表明，感染性并发症（OR 1.93，95% CI 1.282.89）和总并发症（OR 2.19，95% CI 1.692.84）显着增加，并且非感染性并发症有增加的趋势（OR 1.73，95% CI 0.943.17）。对溃疡性结肠炎患者的研究并未表明感染性（OR 1.39，95% CI 0.563.45）、非感染性（OR 1.40，95% CI 0.682.85）或总并发症（OR 1.10，95% CI 0.811.47）的显着增加。结论 抗 TNF 疗法似乎会增加术后并发症的风险。风险的增加很小，很可能反映了残留的混杂因素，而不是真正的生物效应。尽管如此，医生在围手术期继续进行生物治疗时应谨慎行事。
Background The impact of peri-operative use of TNF antagonists on post-operative complications such as infection and wound healing is controversial. Aim To conduct a systematic review and meta-analysis to assess the impact of peri-operative use of TNF antagonists on post-operative complications such as infection and wound healing in patients with inflammatory bowel disease (IBD). Methods A literature search identified studies that investigated post-operative outcomes in patients with IBD using TNF antagonists. The primary outcome was the rate of post-operative infectious complications. Secondary outcomes included the rates of non-infectious complications and total complications. Odds ratios (OR) with 95% confidence intervals (CI) are reported. Results Overall, 18 studies with 4659 participants were eligible for inclusion. Patients with IBD using preoperative anti-TNF therapies had significant increases in post-operative infectious [OR 1.56 (95% CI, 1.092.24)], non-infectious [OR 1.57 (95% CI, 1.142.17)] and total complications [OR 1.73 (95% CI, 1.232.43)]. Studies limited to patients with Crohn's disease demonstrated a statistically significant increase in infectious (OR 1.93, 95% CI 1.282.89) and total (OR 2.19, 95% CI 1.692.84) complications, and a trend towards increase in non-infectious complications (OR 1.73, 95% CI 0.943.17). Studies of patients with ulcerative colitis did not demonstrate significant increases in infectious (OR 1.39, 95% CI 0.563.45), non-infectious (OR 1.40, 95% CI 0.682.85), or total complications (OR 1.10, 95% CI 0.811.47). Conclusion Anti-TNF therapies appear to increase the risk of post-operative complications. The increase in risk is small, and may well reflect residual confounding rather than a true biological effect. Nevertheless, physicians should exercise caution when continuing biological therapies during the peri-operative period.