硫嘌呤可预防炎症性肠病患者的结直肠高级别瘤变。
Thiopurines prevent advanced colorectal neoplasia in patients with inflammatory bowel disease.
机构信息
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
出版信息
Gut. 2012 Feb;61(2):235-40. doi: 10.1136/gut.2011.237412. Epub 2011 May 20.
BACKGROUND AND AIMS
Previous studies have suggested a chemopreventive effect of 5-aminosalicylic acid (5-ASA) therapy in patients with inflammatory bowel disease (IBD). This effect has not been reported in IBD patients using thiopurines. We investigated the association between thiopurine or 5-ASA use and the risk of advanced neoplasia (AN), including high-grade dysplasia and colorectal cancer, in a large cohort of patients with IBD in the Netherlands.
METHODS
PALGA, the nationwide network and registry of histo- and cytopathology in The Netherlands was linked to an anonymised computerised database of a Dutch health insurance company to identify patients with IBD with or without AN. Pharmaceutical data, including type and duration of medication use, were collected between January 2001 and December 2009. Cox proportional hazard regression analysis was used to calculate risk of AN in patients with and without thiopurine or 5-ASA use.
RESULTS
A total of 2578 patients with IBD were included. Of these, 973 patients (38%) used 5-ASA, 314 (12%) thiopurines, 456 (18%) both 5-ASA and thiopurines and 835 (32%) none of these drugs. Twenty-eight patients (1%) developed AN during 16,289 person-years of follow-up. Of these, 11 patients (39%) had used 5-ASA, two (7%) thiopurines and one (4%) both drugs. Thiopurine use was associated with a significantly decreased risk of developing AN (adjusted HR 0.10, 95% CI 0.01 to 0.75). 5-ASA therapy also had a protective effect on developing AN, but this was not statistically significant (adjusted HR 0.56, 95% CI 0.22 to 1.40).
CONCLUSION
Thiopurine use protects IBD patients against the development of AN. The effect of 5-ASA appeared to be less pronounced.
背景与目的
先前的研究表明，5-氨基水杨酸（5-ASA）治疗在炎症性肠病（IBD）患者中具有化学预防作用。然而，在使用硫嘌呤类药物的 IBD 患者中，尚未有报道显示这种作用。我们在荷兰的一个大型 IBD 患者队列中，调查了硫嘌呤或 5-ASA 使用与高级别异型增生（AN）（包括高级别异型增生和结直肠癌）风险之间的关系。
方法
荷兰全国性的组织病理学和细胞病理学网络 PALGA 与荷兰一家健康保险公司的匿名计算机数据库相链接，以确定有无 AN 的 IBD 患者。收集了 2001 年 1 月至 2009 年 12 月期间的药物数据，包括药物类型和使用时间。使用 Cox 比例风险回归分析计算了有和无硫嘌呤或 5-ASA 使用的患者发生 AN 的风险。
结果
共纳入 2578 例 IBD 患者。其中，973 例（38%）使用了 5-ASA，314 例（12%）使用了硫嘌呤，456 例（18%）同时使用了 5-ASA 和硫嘌呤，835 例（32%）未使用这些药物。在 16289 人年的随访中，28 例（1%）患者发生了 AN。其中，11 例（39%）使用了 5-ASA，2 例（7%）使用了硫嘌呤，1 例（4%）同时使用了这两种药物。硫嘌呤的使用与发生 AN 的风险显著降低相关（调整后的 HR 0.10，95%CI 0.01 至 0.75）。5-ASA 治疗也对发生 AN 有保护作用，但无统计学意义（调整后的 HR 0.56，95%CI 0.22 至 1.40）。
结论
硫嘌呤的使用可预防 IBD 患者发生 AN。5-ASA 的作用似乎不那么明显。
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