Ananthakrishnan A N, Cagan A, Cai T, Gainer V S, Shaw S Y, Churchill S, Karlson E W, Murphy S N, Kohane I, Liao K P
Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Aliment Pharmacol Ther. 2015 Jun;41(11):1141-8. doi: 10.1111/apt.13195. Epub 2015 Apr 13.
Infections are an important concern in patients using immunosuppressive therapy for their inflammatory bowel disease (IBD). Diabetes affects nearly 10% of Americans. Whether it confers an additional risk with immunosuppression in IBD has not been examined previously.
To examine the association between diabetes and infections with immunomodulator use in IBD METHODS: Using a validated, multi-institutional IBD cohort, we identified all patients who received at least one prescription for immunomodulators (thiopurines, methotrexate). Our primary outcome was infection within 1 year of the prescription of the immunomodulator. Multivariable logistic regression adjusting for relevant confounders was used to estimate the independent association with diabetes.
Our study included 2766 patients receiving at least one prescription for immunomodulators among whom 210 (8%) developed an infection within 1 year. Patients who developed an infection were likely to be older, have more comorbidities, more likely to have received a prescription for steroids but similar in initiation of anti-TNF therapy within that year. Only 8% of those without an infection had diabetes compared to 19% of those who developed an infection within 1 year [odds ratio (OR) 2.74, 95% confidence interval (CI) 1.88-3.98, P < 0.001]. On multivariate analysis, diabetes was independently associated with a nearly two-fold increase in risk of infections (OR: 1.80, 95% CI: 1.20-2.68). There was no increase in risk of infections with addition of anti-TNF therapy (OR: 1.14, 95% CI: 0.80-1.63).
Diabetes is an independent risk factor for infection in IBD patients using immunomodulator therapy.
感染是炎症性肠病（IBD）患者使用免疫抑制疗法时的一个重要问题。糖尿病影响近10%的美国人。此前尚未研究其在IBD免疫抑制情况下是否会带来额外风险。
研究IBD患者中糖尿病与使用免疫调节剂时感染之间的关联。
利用一个经过验证的多机构IBD队列，我们确定了所有接受至少一张免疫调节剂（硫唑嘌呤、甲氨蝶呤）处方的患者。我们的主要结局是免疫调节剂处方开具后1年内的感染情况。采用多变量逻辑回归对相关混杂因素进行调整，以估计与糖尿病的独立关联。
我们的研究纳入了2766名接受至少一张免疫调节剂处方的患者，其中210名（8%）在1年内发生了感染。发生感染的患者年龄可能更大，合并症更多，更有可能接受过类固醇处方，但在该年内开始抗TNF治疗的情况相似。未发生感染的患者中只有8%患有糖尿病，而1年内发生感染的患者中这一比例为19%[比值比（OR）2.74，95%置信区间（CI）为1.88 - 3.98，P < 0.001]。多变量分析显示，糖尿病与感染风险几乎增加两倍独立相关（OR：1.80，95% CI：1.20 - 2.68）。添加抗TNF治疗并未增加感染风险（OR：1.14，95% CI：0.80 - 1.63）。
糖尿病是IBD患者使用免疫调节剂治疗时感染的独立危险因素。
