系统评价和荟萃分析：术前使用抗肿瘤坏死因子-α生物制剂治疗炎症性肠病患者的术后并发症风险。

Systematic review and meta-analysis: risks of postoperative complications with preoperative use of anti-tumor necrosis factor-alpha biologics in inflammatory bowel disease patients.

机构信息

Department of Internal Medicine, University of California, Irvine, Orange.

University of California, Irvine, Irvine, California.

出版信息

Eur J Gastroenterol Hepatol. 2021 Jun 1;33(6):799-816. doi: 10.1097/MEG.0000000000001944.

DOI:10.1097/MEG.0000000000001944

PMID:33079779

Abstract

OBJECTIVE

The preoperative use of anti-tumor necrosis factor-alpha (anti-TNF) in inflammatory bowel disease (IBD) patients undergoing surgery has been controversial due to concern for increased risks of postoperative complications. We aimed to determine the effect of preoperative anti-TNF therapy on postoperative complications in IBD patients undergoing abdominal surgery.

METHODS

A literature search of Google Scholar, PubMed, The Cochrane Library, EMBASE, and CINAHL was performed through October 2019. Studies reporting postoperative complication rates of Crohn's disease (CD), ulcerative colitis (UC), and IBD-unspecified patients with preoperative anti-TNF treatment undergoing abdominal surgery compared to controls without preoperative anti-TNF treatment were included. The main outcomes measured were overall, infectious, and noninfectious postoperative complications.

RESULTS

Forty-one studies totaling 20 274 patients were included. There was a significant increase in overall complications in all patients treated with anti-TNF vs. controls [odds ratio (OR) = 1.13, 95% confidence interval (CI), 1.01-1.25, P = 0.03, I2 = 6%] with an absolute risk increase (ARI) of 5.5% and a number needed to harm (NNH) of 18. There was also a significant increase in infectious complications in CD patients (OR = 1.44; 95% CI 1.02-2.03, P = 0.04, I2 = 49%, ARI = 5.5%, NNH = 20) only. Contrastingly, there was a significant increase in noninfectious complications in all patients (OR = 1.44, 95% CI 1.13-1.85, P = 0.003, I2 = 8%, ARI = 6.4%, NNH = 16) and UC patients (OR = 1.57, 95% CI 1.15-2.14, P = 0.005, I2 = 25%, ARI = 8.5%, NNH = 12) only.

CONCLUSION

Preoperative use of anti-TNF agents in IBD patients undergoing abdominal surgery is associated with increases in overall postoperative complications in all patients, infectious postoperative complications in CD patients, and noninfectious postoperative complications in UC patients.

摘要

目的

由于担心增加术后并发症的风险，在接受手术的炎症性肠病（IBD）患者中术前使用抗肿瘤坏死因子-α（anti-TNF）一直存在争议。我们旨在确定术前抗 TNF 治疗对接受腹部手术的 IBD 患者术后并发症的影响。

方法

通过 Google Scholar、PubMed、The Cochrane Library、EMBASE 和 CINAHL 对截至 2019 年 10 月的文献进行了检索。纳入了报告术前接受抗 TNF 治疗的克罗恩病（CD）、溃疡性结肠炎（UC）和 IBD 未特指患者与未接受术前抗 TNF 治疗的对照组患者腹部手术后术后并发症发生率的研究。主要测量的结果是总体、感染性和非感染性术后并发症。

结果

共纳入 41 项研究，总计 20274 例患者。与对照组相比，所有接受抗 TNF 治疗的患者的总体并发症均显著增加[比值比（OR）=1.13，95%置信区间（CI）1.01-1.25，P=0.03，I2=6%]，绝对风险增加（ARI）为 5.5%，需要治疗的人数（NNH）为 18。仅在 CD 患者中，感染性并发症也显著增加（OR=1.44；95%CI 1.02-2.03，P=0.04，I2=49%，ARI=5.5%，NNH=20）。相反，所有患者（OR=1.44，95%CI 1.13-1.85，P=0.003，I2=8%，ARI=6.4%，NNH=16）和 UC 患者（OR=1.57，95%CI 1.15-2.14，P=0.005，I2=25%，ARI=8.5%，NNH=12）的非感染性并发症均显著增加。