Annese Vito, Duricova Dana, Gower-Rousseau Corinne, Jess Tine, Langholz Ebbe
Emergency Department, Gastroenterology Unit, AOU Careggi, Florence, Italy
Clinical and Research Centre for Inflammatory Bowel Disease, ISCARE a.s. and Charles University in Prague, Prague, Czech Republic.
J Crohns Colitis. 2016 Feb;10(2):216-25. doi: 10.1093/ecco-jcc/jjv190. Epub 2015 Oct 31.
The medical management of inflammatory bowel disease has changed considerably over time with wider use of immunosuppressant therapy and the introduction of biological therapy. To what extent this change of medical paradigms has influenced and modified the disease course is incompletely known. To address this issue, an extensive review of the literature has been carried out on time trends of hospitalization, surgery, infections, cancer, and mortality rates in inflammatory bowel disease [IBD] patients. Preference was given to population-based studies but, when data from these sources were limited, large cohort studies and randomised controlled trials were also considered. In general, data on hospitalisation rates are strikingly heterogeneous and conflicting. In contrast, the consistent drop in surgery/colectomy rates suggests that the growing use of immunosuppressants and biological agents has had a positive impact on the course of IBD. Most clinical trial data indicate that the risk of serious infections is not increased in patients treated with anti-tumour necrosis factor alpha [TNFα] agents, but a different picture emerges from cohort studies. The use of thiopurines increases the risk for non-melanoma skin cancers and to a lesser extent for lymphoma and cervical cancer [absolute risk: low], whereas no clear increase in the cancer risk has been reported for anti-TNF agents. Finally, the majority of studies reported in the literature do not reveal any increase in mortality with immunosuppressant therapy or biologicals/anti-TNF agents.
随着免疫抑制疗法的更广泛应用和生物疗法的引入，炎症性肠病的药物治疗在过去一段时间里发生了很大变化。这种医学模式的转变在多大程度上影响和改变了疾病进程，目前尚不完全清楚。为了解决这个问题，我们对炎症性肠病（IBD）患者的住院率、手术率、感染率、癌症发生率和死亡率的时间趋势进行了广泛的文献综述。我们优先考虑基于人群的研究，但当这些来源的数据有限时，也考虑了大型队列研究和随机对照试验。总体而言，关于住院率的数据存在显著的异质性和冲突。相比之下，手术/结肠切除术率的持续下降表明，免疫抑制剂和生物制剂的使用增加对IBD的病程产生了积极影响。大多数临床试验数据表明，接受抗肿瘤坏死因子α（TNFα）药物治疗的患者发生严重感染的风险并未增加，但队列研究呈现出不同的情况。硫唑嘌呤的使用会增加非黑色素瘤皮肤癌的风险，在较小程度上增加淋巴瘤和宫颈癌的风险（绝对风险：低），而抗TNF药物并未报告癌症风险有明显增加。最后，文献中报道的大多数研究并未显示免疫抑制疗法或生物制剂/抗TNF药物会导致死亡率增加。
