炎症性肠病中抗生素暴露模式与临床疾病活动：一项为期4年的前瞻性研究。

Patterns of Antibiotic Exposure and Clinical Disease Activity in Inflammatory Bowel Disease: A 4-year Prospective Study.

作者信息

Hashash Jana G, Chintamaneni Preethi, Ramos Rivers Claudia M, Koutroubakis Ioannis E, Regueiro Miguel D, Baidoo Leonard, Swoger Jason M, Barrie Arthur, Schwartz Marc, Dunn Michael A, Binion David G

机构信息

Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

出版信息

Inflamm Bowel Dis. 2015 Nov;21(11):2576-82. doi: 10.1097/MIB.0000000000000534.

DOI:10.1097/MIB.0000000000000534

PMID:26296061

Abstract

BACKGROUND

Antimicrobial treatment is known to cause short- and long-term changes in the composition of normal human microbiota. The relationship between antibiotic use and overall clinical behavior in inflammatory bowel disease (IBD) has not been explored. We aim to prospectively characterize patterns of antibiotic use and clinical IBD activity in a large IBD cohort.

METHODS

Prospective observational study from a longitudinal IBD natural history registry between 2009 and 2012. Antibiotic prescriptions were identified and categorized using electronic medical record data. Cumulative rates over the 4-year study period were compared. Demographic, clinical, laboratory, health care utilization, and treatment data of the patients with IBD were collected and analyzed. Quality of life was measured by Short IBD Questionnaire data. Primary outcomes were markers of disease activity including Short IBD Questionnaire scores, C-reactive protein levels, health care utilization, and medication use.

RESULTS

Seven hundred eighteen patients followed over 4 years were included (47.6% male; mean age, 46.7 ± 15.2 yr), 59.9% had Crohn's disease, whereas 38.6% had ulcerative colitis. Most patients (66.3%) were exposed to antibiotics during the study period. Antibiotic-exposed patients were more likely to have Crohn's disease (63% versus 53.7%; P = 0.05), require narcotics (43.7% versus 14.9%; P < 0.0001), receive antidepressants (43.1% versus 18.6%; P < 0.001), prednisone (52.7% versus 31%; P < 0.0001), or biological therapy (52% versus 36.5%; P < 0.0001). Antibiotic-exposed patients had a lower mean Short IBD Questionnaire (50.2 ± 11.5 versus 56.4 ± 9.5; P < 0.0001), higher rates of C-reactive protein elevation (49.2% versus 31.8%; P < 0.0001), and higher health care utilization compared with nonantibiotic-exposed patients.

CONCLUSIONS

The majority of patients with IBD receive antibiotic treatment, and these individuals demonstrate a more severe clinical course.

摘要

背景

已知抗菌治疗会导致正常人类微生物群组成发生短期和长期变化。抗生素使用与炎症性肠病（IBD）的整体临床行为之间的关系尚未得到探讨。我们旨在对一个大型IBD队列中抗生素使用模式和IBD临床活动进行前瞻性特征分析。

方法

对2009年至2012年期间一个纵向IBD自然史登记处进行前瞻性观察研究。使用电子病历数据识别并分类抗生素处方。比较4年研究期间的累积发生率。收集并分析IBD患者的人口统计学、临床、实验室、医疗保健利用和治疗数据。通过简短IBD问卷数据测量生活质量。主要结局是疾病活动标志物，包括简短IBD问卷评分、C反应蛋白水平、医疗保健利用和药物使用情况。

结果

纳入了4年间随访的718例患者（男性占47.6%；平均年龄46.7±15.2岁），59.9%患有克罗恩病，38.6%患有溃疡性结肠炎。大多数患者（66.3%）在研究期间接受过抗生素治疗。接受抗生素治疗的患者更有可能患有克罗恩病（63%对53.7%；P=0.05），需要使用麻醉药品（43.7%对14.9%；P<0.0001），接受抗抑郁药治疗（43.1%对18.6%；P<0.001）、泼尼松治疗（52.7%对31%；P<0.0001）或生物治疗（52%对36.5%；P<0.0001）。与未接受抗生素治疗的患者相比，接受抗生素治疗的患者的简短IBD问卷平均得分较低（50.2±11.5对56.4±9.5；P<0.0001），C反应蛋白升高率较高（49.2%对31.8%；P<0.0001），医疗保健利用率也较高。