Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Solna, Sweden.
Department of Medical Science Hematology, Uppsala Universitet, Uppsala, Sweden.
J Thromb Haemost. 2016 Apr;14(4):807-14. doi: 10.1111/jth.13267. Epub 2016 Feb 17.
Infections after diagnosis of primary chronic immune thrombocytopenia (cITP) have mostly been connected to the immunomodulation treatment. Infections may trigger autoimmune diseases and may be a complication of an already impaired immune system.
To investigate the association of cITP with infection before diagnosis. We also estimated the incidence of cITP based on the new definition by the International ITP Working Group.
We identified 1087 adults with primary cITP between 2006 and 2012 using the Swedish Patient Register. Data on infections not already associated with secondary ITP were also retrieved from the register. The standardized incidence ratios (SIRs), using the rates from the general population, and 95% confidence intervals (CIs) were estimated as a measure of relative risk. We used data from the Prescribed Drug Register to estimate SIR for anti-infective treatment.
The incidence of cITP was 2.30 per 100 000 person-years (95% CI, 2.15-2.45). cITP was associated with an increased risk of serious infections requiring inpatient or outpatient care within 5 years before cITP diagnosis (SIR = 8.74; 95% CI, 7.47-10.18). Higher magnitude SIRs were observed for candidiasis, viral infection at an unspecified site and acute upper respiratory infections. For anti-infective drugs the SIR was 1.37 (1.25-1.50) and the highest SIRs were observed for amoxicillin, macrolides, nitrofurantoin and antivirals.
Patients with cITP have increased risks of infection and anti-infective treatments before their cITP diagnosis, with a more marked risk for candidiasis and viral infections. The findings indicate that infection is not only related to the immunomodulation treatment but also to the disease itself.
原发性慢性免疫性血小板减少症（cITP）诊断后的感染大多与免疫调节治疗有关。感染可能引发自身免疫性疾病，也可能是已经受损的免疫系统的并发症。
研究 cITP 与诊断前感染的关系。我们还根据国际 ITP 工作组的新定义估计了 cITP 的发病率。
我们使用瑞典患者登记处确定了 2006 年至 2012 年间的 1087 名原发性 cITP 成年患者。还从登记处检索了与继发性 ITP 无关的感染数据。使用一般人群的比率作为衡量相对风险的指标，计算标准化发病率比（SIR）和 95%置信区间（CI）。我们使用处方药物登记处的数据来估计抗感染治疗的 SIR。
cITP 的发病率为每 100000 人年 2.30 例（95%CI，2.15-2.45）。cITP 与诊断前 5 年内需要住院或门诊治疗的严重感染风险增加相关（SIR = 8.74；95%CI，7.47-10.18）。未明确部位的真菌感染、病毒感染和急性上呼吸道感染的 SIR 更高。抗感染药物的 SIR 为 1.37（1.25-1.50），阿莫西林、大环内酯类、呋喃妥因和抗病毒药物的 SIR 最高。
cITP 患者在 cITP 诊断前有更高的感染和抗感染治疗风险，真菌感染和病毒感染的风险更为显著。这些发现表明，感染不仅与免疫调节治疗有关，也与疾病本身有关。
