Division of Research, Kaiser Permanente Northern California, Oakland, 94612, USA.
Am J Gastroenterol. 2011 Dec;106(12):2146-53. doi: 10.1038/ajg.2011.283. Epub 2011 Oct 25.
The objective of this study was to assess inflammatory bowel disease (IBD) medications in relation to lymphoma risk.
Information on IBD and relevant medications and other utilization was obtained from the Kaiser Permanente IBD Registry, 1996-2009. Lymphoma cases were ascertained from the Kaiser Permanente Cancer Registry. Lymphoma incidence was compared between the IBD cohort and the general Kaiser Permanente population.
Of the 16,023 IBD patients without human immunodeficiency virus followed an average 5.8 years, 43 developed lymphoma. IBD patients with and without lymphoma did not differ with respect to past IBD-related visits, procedures, or tests. The standardized incidence rate ratio (SIRR) for lymphoma among IBD patients with no dispensing of thiopurine or anti-tumor necrosis factor (TNF) was 1.0 (95% confidence interval (CI): 0.96-1.1). Of the 21,282 person-years involving exposure to thiopurine or anti-TNF, 81% involved thiopurine alone; 3%, anti-TNF alone; and 16%, combination therapy. Among patients with thiopurine but not anti-TNF dispensings, the SIRR was 0.3 (95% CI: 0.2-0.4) for past use and 1.4 for current use (95% CI: 1.2-2.7). Among patients with dispensing of anti-TNF (with and without thiopurine), the SIRR was 5.5 for past use (95% CI: 4.5-6.6) and 4.4 for current use (95% CI: 3.4-5.4). The most common lymphoma subtypes were diffuse large B-cell lymphoma (44%), follicular lymphoma (14%), and Hodgkin's disease (12%).
Our study provides evidence that IBD alone is not associated with the risk of lymphoma. Use of anti-TNF with thiopurine and current use of thiopurine alone were associated with increased risk, although the effect of disease severity merits further evaluation.
本研究旨在评估炎症性肠病（IBD）药物与淋巴瘤风险的关系。
1996 年至 2009 年，从 Kaiser Permanente IBD 注册中心获取 IBD 及相关药物和其他使用情况的信息。从 Kaiser Permanente 癌症登记处确定淋巴瘤病例。比较 IBD 队列和 Kaiser Permanente 一般人群的淋巴瘤发病率。
在未感染人类免疫缺陷病毒的 16023 名 IBD 患者中，平均随访 5.8 年，有 43 人发生淋巴瘤。有和没有淋巴瘤的 IBD 患者在过去的 IBD 相关就诊、程序或检查方面没有差异。无巯嘌呤或抗肿瘤坏死因子（TNF）配药的 IBD 患者的淋巴瘤标准化发病比（SIRR）为 1.0（95%置信区间[CI]：0.96-1.1）。在涉及巯嘌呤或抗 TNF 暴露的 21282 人年中，81%涉及单独使用巯嘌呤；3%单独使用抗 TNF；16%联合治疗。在仅使用巯嘌呤但未使用抗 TNF 的患者中，过去使用的 SIRR 为 0.3（95%CI：0.2-0.4），当前使用的 SIRR 为 1.4（95%CI：1.2-2.7）。在使用抗 TNF（有和没有巯嘌呤）的患者中，过去使用的 SIRR 为 5.5（95%CI：4.5-6.6），当前使用的 SIRR 为 4.4（95%CI：3.4-5.4）。最常见的淋巴瘤亚型是弥漫性大 B 细胞淋巴瘤（44%）、滤泡性淋巴瘤（14%）和霍奇金病（12%）。
本研究提供的证据表明，IBD 本身与淋巴瘤的风险无关。使用抗 TNF 联合巯嘌呤和单独使用当前的巯嘌呤与风险增加相关，尽管疾病严重程度的影响值得进一步评估。
