Toruner Murat, Loftus Edward V, Harmsen W Scott, Zinsmeister Alan R, Orenstein Robert, Sandborn William J, Colombel Jean-Frederic, Egan Laurence J
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Gastroenterology. 2008 Apr;134(4):929-36. doi: 10.1053/j.gastro.2008.01.012. Epub 2008 Jan 11.
BACKGROUND & AIMS: We sought to identify and quantify the clinical factors that were associated with opportunistic infections in inflammatory bowel disease patients.
We identified 100 consecutive IBD patients with opportunistic infections. For each case, 2 matched IBD patients who did not have a history of opportunistic infection were selected as controls. Conditional logistic regression was used to assess associations between putative risk factors and opportunistic infections, presented as odds ratios (OR) and 95% confidence intervals (CIs).
In univariate analysis, use of corticosteroids (OR, 3.4; 95% CI, 1.8-6.2), azathioprine/6-mercaptopurine (OR, 3.1; 95% CI, 1.7-5.5), and infliximab (OR, 4.4; 95% CI, 1.2-17.1) were associated individually with significantly increased odds for opportunistic infection. Multivariate analysis indicated that use of any one of these drugs yielded an OR of 2.9 (95% CI, 1.5-5.3), whereas use of 2 or 3 of these drugs yielded an OR of 14.5 (95% CI, 4.9-43) for opportunistic infection. The relative risk of opportunistic infection was greatest in IBD patients seen at older than 50 years of age (OR, 3.0; 95% CI, 1.2-7.2, relative to those 24 years or younger). No patient died from opportunistic infection.
Immunosuppressive medications, especially when used in combination, and older age are associated with increased risk of opportunistic infections. The absolute risk of opportunistic infection in IBD patients remains to be determined, as does any potential benefit of any preventive strategy.
我们试图识别并量化与炎症性肠病患者机会性感染相关的临床因素。
我们确定了100例连续发生机会性感染的炎症性肠病患者。对于每例患者，选择2例匹配的无机会性感染病史的炎症性肠病患者作为对照。采用条件逻辑回归分析来评估假定危险因素与机会性感染之间的关联，结果以比值比（OR）和95%置信区间（CI）表示。
在单因素分析中，使用皮质类固醇（OR，3.4；95%CI，1.8 - 6.2）、硫唑嘌呤/6 - 巯基嘌呤（OR，3.1；95%CI，1.7 - 5.5）和英夫利昔单抗（OR，4.4；95%CI，1.2 - 17.1）分别与机会性感染的显著增加的几率相关。多因素分析表明，使用这些药物中的任何一种产生的机会性感染的OR为2.9（95%CI，1.5 - 5.3），而使用其中2种或3种药物产生的机会性感染的OR为14.5（95%CI，4.9 - 43）。50岁以上的炎症性肠病患者发生机会性感染的相对风险最高（OR，3.0；95%CI，1.2 - 7.2，相对于24岁及以下的患者）。没有患者死于机会性感染。
免疫抑制药物，尤其是联合使用时，以及年龄较大与机会性感染风险增加相关。炎症性肠病患者机会性感染的绝对风险以及任何预防策略的潜在益处仍有待确定。
