Cruz Mabel, Mahillo-Fernandez Ignacio, Rábano Alberto, Siden Ake, Calero Miguel, Laursen Henning, Mølbak Kåre, Almazán Javier, de Pedro-Cuesta Jesus
Department of Applied Epidemiology, National Center for Epidemiology, Carlos III Institute of Health, C/ Sinesio Delgado 6, Madrid 28029, Spain.
Emerg Themes Epidemiol. 2013 May 23;10(1):5. doi: 10.1186/1742-7622-10-5.
There is increasing epidemiological evidence of etiological links between general surgery and sporadic Creutzfeldt-Jakob disease (sCJD) with long incubation periods. The purpose of this study was to identify specific surgical procedures potentially associated with sCJD to be targeted for preventive presurgical-intervention guidance.
We propose a three-step clinical guidance outline where surgical procedures associated with sCJD clinical onset - potentially more contaminant - are taken into account. Data on hospital discharges and surgical procedures were obtained from Danish and Swedish national in-patient hospital registries for 167 sCJD cases, onset 1987-2003, and for 835 matched and 2,224 unmatched population controls. Surgery was allocated to different life-time periods as previously reported, and frequencies were compared using logistic regression analysis. In the year preceding clinical onset, persons with sCJD underwent a statistically significant higher number of minor surgical interventions (OR (95% CI): 17.50 (3.64-84.24)), transluminal endoscopies (OR: 2.73 (1.01-7.37)) and gastrointestinal operations (OR: 3.51 (1.21-10.19)) compared to matched controls. Surgical discharges clustered towards clinical onset. These differences increased during the clinical period, with statistically significant higher frequencies for both endoscopies and minor surgery (OR: 13.91 (5.87-32.95), and for main surgical procedures (OR: 2.10 (1.00-4.39)), particularly gastrointestinal surgery (OR: 6.00 (1.83-19.66)), and surgery contacting skeletal muscle. Comparisons with unmatched controls yielded similar results for neurosurgery in the clinical period (OR: 19.40 (2.22-168.34)).
These results suggest that some types of surgical procedures are associated with sCJD, after clinical onset or particularly just before onset. Selective planning of such surgery to minimize instrument/device contamination or quarantining might be feasible. Conditional to progress in sCJD etiological research, results are relevant for guidance development.
越来越多的流行病学证据表明，普通外科手术与潜伏期较长的散发性克雅氏病（sCJD）之间存在病因学联系。本研究的目的是确定可能与sCJD相关的特定外科手术，以便为预防性术前干预指导提供目标。
我们提出了一个三步临床指导大纲，其中考虑了与sCJD临床发病相关的外科手术——可能污染性更强。从丹麦和瑞典国家住院患者医院登记处获取了167例1987 - 2003年发病的sCJD病例以及835例匹配和2224例不匹配的人群对照的出院和外科手术数据。如先前报道，将手术分配到不同的生命时期，并使用逻辑回归分析比较频率。与匹配对照相比，在临床发病前一年，sCJD患者接受的小型外科干预（比值比（95%可信区间）：17.50（3.64 - 84.24））、腔内内镜检查（比值比：2.73（1.01 - 7.37））和胃肠道手术（比值比：3.51（1.21 - 10.19））在统计学上显著更多。手术出院集中在临床发病期。这些差异在临床期间增加，内镜检查和小型手术的频率在统计学上显著更高（比值比：13.91（5.87 - 32.95）），主要外科手术也是如此（比值比：2.10（1.00 - 4.39）），特别是胃肠道手术（比值比：6.00（1.83 - 19.66））以及接触骨骼肌的手术。与不匹配对照的比较在临床期间的神经外科手术中产生了类似结果（比值比：19.40（2.22 - 168.34））。
这些结果表明，某些类型的外科手术与sCJD相关，在临床发病后或特别是在发病前。选择性规划此类手术以尽量减少器械/设备污染或隔离可能是可行的。取决于sCJD病因学研究的进展，这些结果与指导方针的制定相关。
