术前使用维多珠单抗治疗的溃疡性结肠炎患者术后并发症的风险：一项匹配病例对照研究。
Risk of postoperative complications among ulcerative colitis patients treated preoperatively with vedolizumab: a matched case-control study.
作者信息
Kim Jeong Yeon, Zaghiyan Karen, Lightner Amy, Fleshner Phillip
机构信息
Department of Surgery, Hallym University College of Medicine, Dongtan, South Korea.
Division of Colorectal Surgery, Cedars-Sinai Medical Center, 7 Beverly Blvd., Suite 101, Los Angeles, California, 90048, USA.
出版信息
BMC Surg. 2020 Mar 5;20(1):46. doi: 10.1186/s12893-020-00698-8.
BACKGROUND
Although biologic agents have revolutionized the medical management of severe ulcerative colitis (UC), there is considerable controversy regarding adverse effects of vedolizumab on surgical outcomes. We evaluated 30-day postoperative morbidity in UC patients undergoing abdominal colectomy (AC) treated with vedolizumab before surgery.
METHODS
From 2007 to 2017, 285 patients were enrolled in prospectively maintained database evaluating the role of clinical, serologic markers with clinical phenotypes in UC. The patients treated with vedolizumab within 12 weeks of AC was queried, then matched 1:3:3 into 3 preoperative treatment groups based on age, gender and surgical treatment of UC; ileal pouch-anal anastomosis (IPAA) with ileostomy vs total colectomy with end stoma: a) vedolizumab (n = 25); b) anti-tumor necrosis factor (anti-TNF) (n = 74); and c) no biologics (n = 54). Thirty-day postoperative complications among patient groups were compared.
RESULTS
The 3 patient groups were well-matched in other characteristics including disease duration, disease extent, medication history and preoperative serological data. There were no significant differences in the overall incidence of postoperative complications among patients treated preoperatively with vedolizumab, anti-TNFs, or no biologics (44% vs. 45% vs. 37%; p = 0.67). Although there was no significant difference between patient cohorts in infectious complications (p = 0.20), postoperative ileus (POI) was significantly more common among the vedolizumab group (n = 9; 36%) compared to anti-TNF (n = 12; 16%) or no biologics (n = 5; 9%) (p = 0.01). Multivariable analysis showed that vedolizumab treatment prior to surgery was an independent risk factor for POI (OR: 5.16, 95% CI; 1.71-15.52; p = .004).
CONCLUSION
Although preoperative vedolizumab exposure did not influence the rate of overall 30-day postoperative complications, vedolizumab tends to increase incidence of POI.
背景
尽管生物制剂彻底改变了重度溃疡性结肠炎（UC）的药物治疗方式，但关于维多珠单抗对手术结局的不良影响仍存在相当大的争议。我们评估了术前接受维多珠单抗治疗的UC患者行腹部结肠切除术（AC）后30天的术后发病率。
方法
2007年至2017年，285例患者被纳入前瞻性维护的数据库，该数据库评估临床、血清学标志物与UC临床表型的关系。查询在AC前12周内接受维多珠单抗治疗的患者，然后根据年龄、性别和UC的手术治疗情况按1:3:3匹配分为3个术前治疗组；回肠储袋肛管吻合术（IPAA）加回肠造口术与全结肠切除术加末端造口术：a）维多珠单抗组（n = 25）；b）抗肿瘤坏死因子（抗TNF）组（n = 74）；c）未使用生物制剂组（n = 54）。比较各患者组术后30天的并发症情况。
结果
3个患者组在疾病持续时间、疾病范围、用药史和术前血清学数据等其他特征方面匹配良好。术前接受维多珠单抗、抗TNF或未使用生物制剂治疗的患者术后并发症的总体发生率无显著差异（44%对45%对37%；p = 0.67）。尽管各患者队列之间的感染性并发症无显著差异（p = 0.20），但与抗TNF组（n = 12；16%）或未使用生物制剂组（n = 5；9%）相比，维多珠单抗组术后肠梗阻（POI）明显更常见（n = 9；36%）（p = 0.01）。多变量分析显示，术前使用维多珠单抗治疗是POI的独立危险因素（OR：5.16，95%CI；1.71 - 15.52；p = 0.004）。
结论
尽管术前接触维多珠单抗不影响术后30天总体并发症发生率，但维多珠单抗倾向于增加POI的发生率。
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