Department of Gastroenterology, Osaka City University Graduate School of Medicine, , Osaka, Japan.
Gut. 2014 Mar;63(3):409-14. doi: 10.1136/gutjnl-2013-304713. Epub 2013 May 22.
The role of tumour necrosis factor α (TNFα) in the pathogenesis of non-steroidal anti-inflammatory drug (NSAID)-induced small intestinal damage remains unclear. We evaluated the preventive effect of anti-TNF therapy against NSAID-induced enteropathy in rheumatoid arthritis (RA) patients.
Capsule endoscopy was performed in 95 consecutive RA patients who received NSAID for more than 3 months, with or without anti-TNF therapy over a period of 3 months. The findings were scored from 0 to 4: 0, normal; 1, red spots; 2, one to four erosions; 3, more than four erosions; and 4, large erosions/ulcers. The relationship between the use of anti-TNF therapy and the risk of severe damage (scores 3 or 4) or the most severe damage (score 4) was assessed using multiple logistic regression analysis. Furthermore, a propensity score matching analysis was performed to reduce the effects of TNF selection bias.
By stratifying the patients on the basis of anti-TNF therapy, we obtained crude OR of 0.23 for severe damage (95% CI 0.09 to 0.65) and 0.37 for the most severe damage (95% CI 0.16 to 0.86). This protective effect of anti-TNF therapy remained robust to adjustments for baseline characteristics, with the adjusted OR for severe damage and the most severe damage ranging from 0.23 to 0.26 and 0.06 to 0.41, respectively. Propensity score matching yielded similar results and showed the protective effects of anti-TNF therapy against severe and most severe damage.
Anti-TNF therapy may protect against NSAID-induced small intestinal damage in RA patients.
肿瘤坏死因子 α（TNFα）在非甾体抗炎药（NSAID）诱导的小肠损伤发病机制中的作用尚不清楚。我们评估了抗 TNF 治疗对类风湿关节炎（RA）患者 NSAID 诱导性肠病的预防作用。
对 95 例连续接受 NSAID 治疗超过 3 个月的 RA 患者进行胶囊内镜检查，在 3 个月的时间内接受或不接受抗 TNF 治疗。将发现从 0 到 4 分进行评分：0，正常；1，红斑；2，1 到 4 个糜烂；3，超过 4 个糜烂；4，大的糜烂/溃疡。使用多变量逻辑回归分析评估抗 TNF 治疗与严重损伤（评分 3 或 4）或最严重损伤（评分 4）的风险之间的关系。此外，进行倾向评分匹配分析以减少 TNF 选择偏倚的影响。
通过对基于抗 TNF 治疗的患者进行分层，我们获得了严重损伤的粗 OR 为 0.23（95%CI 0.09 至 0.65）和最严重损伤的粗 OR 为 0.37（95%CI 0.16 至 0.86）。抗 TNF 治疗的这种保护作用在调整基线特征后仍然稳健，严重损伤和最严重损伤的调整后 OR 范围分别为 0.23 至 0.26 和 0.06 至 0.41。倾向评分匹配得出了类似的结果，并显示了抗 TNF 治疗对严重和最严重损伤的保护作用。
抗 TNF 治疗可能会预防 RA 患者的 NSAID 诱导性小肠损伤。
