Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea.
Aliment Pharmacol Ther. 2017 Jan;45(2):253-263. doi: 10.1111/apt.13851. Epub 2016 Nov 7.
The low incidence of Mycobacterium tuberculosis infection and lack of adequate controls have prevented researchers from estimating tuberculosis (TB) risk in inflammatory bowel disease (IBD) patients.
To evaluate the risk of incident TB among IBD patients.
Using the 2011-2013 data of the South Korean National Health Insurance (NHI) system, we calculated the incidence rates (IRs), standardised incidence ratio (SIR) and number needed to screen (NNS) for incident TB in IBD patients compared to the general population in terms of subtype, age, gender and IBD medications.
The IR, SIR and NNS for TB in IBD patients were 223.9/100 000 person-years, 2.64 (2.30-3.01) and 446.6 (392.8-517.6), respectively. The TB IR in Crohn's disease (CD) patients was significantly higher than that in ulcerative colitis (UC) patients (340.1/100 000 person-years vs. 165.5/100 000 person-years, respectively; P < 0.001). The SIR and NNS for TB among CD patients were 4.00 (3.59-4.45) and 604.2 (506.1-749.6), respectively; those among UC patients were 1.95 (1.66-2.27) and 294.0 (246.9-363.4). The TB IRs in IBD patients did not differ significantly by age or gender (P = 0.505 and P = 0.861, respectively). The TB IRs among IBD patients prescribed 5-ASA, corticosteroids, immunomodulators and anti-TNF-α were 143.5, 208.5, 284.6 and 554.1 per 100 000 person-years, respectively. Among IBD patients treated using anti-TNF-α, the TB IR was significantly higher than that among all IBD patients (P < 0.001); the SIR and NNS for TB were 6.53 (5.99-7.09) and 180.5 (144.6-240.1) respectively.
Clinicians should be aware of the increased risk of active tuberculosis in patients with IBD who are receiving anti-TNF-α therapy.
结核分枝杆菌感染发生率低且缺乏足够对照，这使得研究人员无法评估炎症性肠病（IBD）患者的结核病（TB）风险。
评估 IBD 患者中 TB 发病的风险。
利用韩国 2011-2013 年国家健康保险系统的数据，我们根据亚型、年龄、性别和 IBD 药物，计算了 IBD 患者与普通人群相比的 TB 发病率（IR）、标准化发病率比（SIR）和筛查人数（NNS）。
IBD 患者的 TB IR、SIR 和 NNS 分别为 223.9/100000 人年、2.64（2.30-3.01）和 446.6（392.8-517.6）。CD 患者的 TB IR 明显高于 UC 患者（340.1/100000 人年 vs. 165.5/100000 人年，P<0.001）。CD 患者的 SIR 和 NNS 分别为 4.00（3.59-4.45）和 604.2（506.1-749.6），UC 患者分别为 1.95（1.66-2.27）和 294.0（246.9-363.4）。IBD 患者的年龄和性别对 TB IR 无显著影响（P=0.505 和 P=0.861）。IBD 患者服用 5-ASA、皮质类固醇、免疫调节剂和抗 TNF-α 后，TB IR 分别为 143.5、208.5、284.6 和 554.1/100000 人年。在接受抗 TNF-α 治疗的 IBD 患者中，TB IR 明显高于所有 IBD 患者（P<0.001）；TB 的 SIR 和 NNS 分别为 6.53（5.99-7.09）和 180.5（144.6-240.1）。
临床医生应注意接受抗 TNF-α 治疗的 IBD 患者中活动性结核的风险增加。
