氨基水杨酸不耐受的患者溃疡性结肠炎结肠切除术的风险增加。

5-aminosalicylate-intolerant patients are at increased risk of colectomy for ulcerative colitis.

机构信息

Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan.

Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan.

出版信息

Aliment Pharmacol Ther. 2021 Jan;53(1):103-113. doi: 10.1111/apt.16120. Epub 2020 Nov 7.

DOI:10.1111/apt.16120

PMID:33159485

Abstract

BACKGROUND

Although 5-aminosalicylate (5-ASA) is the therapy of first choice in ulcerative colitis (UC), some patients cannot tolerate it because of side effects. Previous reports have not investigated whether 5-ASA intolerance is associated with the risk of colectomy.

AIM

To investigate the associations between 5-ASA tolerance and colectomy among UC patients METHODS: The data of UC patients who visited any of three hospitals during 2014-2018 in and around Tokyo, Japan, were retrospectively obtained from the medical records. Patients were categorized as (a) tolerant to any 5-ASA compounds ("tolerant to 5-ASA") and (b) patients who were intolerant to one or more 5-ASA compounds leading to refrainment from their further use ("intolerant to 5-ASA"). The association between 5-ASA tolerance and colectomy was examined by Cox proportional hazards model adjusted for sex, age, smoking and extent of colitis.

RESULTS

Of 1788 patients, 1684 were "tolerant to 5-ASA" while 104 were "intolerant to 5-ASA". Colectomy was performed in 43 (2.6%) of the patients tolerant to 5-ASA and 12 (11.5%) of the patients intolerant to 5-ASA. After adjusting for all covariates, the risk of undergoing colectomy was higher in the "intolerant to 5-ASA" group than in the "tolerant to 5-ASA" group (hazard ratio: 4.92; 95% confidence interval: 2.58-9.38).

CONCLUSION

Patients in whom 5-ASA was discontinued due to intolerance had a higher risk of undergoing colectomy than patients tolerant to their first, second or third 5-ASA compounds.

摘要

背景

虽然 5-氨基水杨酸（5-ASA）是溃疡性结肠炎（UC）的首选治疗药物，但由于副作用，有些患者无法耐受。之前的报告并未研究 5-ASA 不耐受是否与结肠切除术的风险相关。

目的

调查溃疡性结肠炎患者中 5-ASA 耐受与结肠切除术之间的关联。

方法

本研究回顾性地从日本东京及其周边地区的三家医院在 2014 年至 2018 年期间就诊的 UC 患者的病历中获取数据。患者分为（a）任何 5-ASA 化合物耐受的患者（“5-ASA 耐受”）和（b）因不耐受一种或多种 5-ASA 化合物而停止使用的患者（“5-ASA 不耐受”）。通过 Cox 比例风险模型，调整性别、年龄、吸烟和结肠炎程度等因素，检验 5-ASA 耐受与结肠切除术之间的关联。

结果

在 1788 名患者中，1684 名患者为“5-ASA 耐受”，104 名患者为“5-ASA 不耐受”。在 5-ASA 耐受的患者中，有 43 例（2.6%）接受了结肠切除术，而在 5-ASA 不耐受的患者中，有 12 例（11.5%）接受了结肠切除术。调整所有协变量后，“5-ASA 不耐受”组患者接受结肠切除术的风险高于“5-ASA 耐受”组（风险比：4.92；95%置信区间：2.58-9.38）。