低蛋白血症，而非生物暴露，与接受回结肠切除术的克罗恩病患者的术后并发症相关。
Hypoalbuminaemia, Not Biologic Exposure, Is Associated with Postoperative Complications in Crohn's Disease Patients Undergoing Ileocolic Resection.
机构信息
Department of Internal Medicine, Cleveland Clinic, OH, USA.
Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
出版信息
J Crohns Colitis. 2021 Jul 5;15(7):1142-1151. doi: 10.1093/ecco-jcc/jjaa268.
BACKGROUND
There are limited data on the postoperative outcomes in Crohn's disease patients exposed to preoperative ustekinumab or vedolizumab. We hypothesised that preoperative biologic use in Crohn's disease is not associated with postoperative complications after ileocolic resection.
METHODS
Crohn's disease patients who underwent ileocolic resection over 2009-2019 were identified at a large regional health system. Preoperative biologic use within 12 weeks of surgery was categorised as no biologic, anti-tumour necrosis factor, vedolizumab, or ustekinumab. The primary endpoint was 90-day intra-abdominal septic complication. Risk factors included preoperative medical therapies, demographics, disease characteristics, laboratory values, and surgical approach. Regression models assessed the association of biologic use with intra-abdominal septic complication.
RESULTS
A total of 815 Crohn's disease patients who underwent an ileocolic resection were included [62% no biologic, 31.4% anti-tumour necrosis factor, 3.9% vedolizumab, 2.6% ustekinumab]. Primary anastomosis was performed in 85.9% of patients [side-to-side 48.8%, end-to-side 26%, end-to-end 25%] in primarily a stapled [77.2%] manner. Minimally invasive approach was used in 41.4%. The 90-day postoperative intra-abdominal sepsis rate of 810 patients was 12%, abscess rate was 9.6%, and anastomotic leak rate was 3.2%. Multivariable regression modelling controlling for confounding variables demonstrated that preoperative biologic use with anti-tumour necrosis factor [p = 0.21], vedolizumab [p = 0.17], or ustekinumab [p = 0.52] was not significantly associated with intra-abdominal septic complication. Preoperative albumin < 3.5 g/dl was independently associated with intra-abdominal septic complication (odds ratio [OR] 1.76 [1.03, 3.01]).
CONCLUSIONS
In Crohn's disease patients undergoing ileocolic resection, preoperative biologics are not associated with 90-day postoperative intra-abdominal septic complication. Preoperative biologic exposure should not delay necessary surgery.
背景
在接受术前乌司奴单抗或维得利珠单抗治疗的克罗恩病患者中，术后结局的数据有限。我们假设克罗恩病患者术前使用生物制剂与回结肠切除术后的术后并发症无关。
方法
在一个大型区域卫生系统中，确定了 2009 年至 2019 年期间接受回结肠切除术的克罗恩病患者。将手术前 12 周内使用的术前生物制剂分为无生物制剂、抗肿瘤坏死因子、维得利珠单抗或乌司奴单抗。主要终点是 90 天的腹腔内感染性并发症。危险因素包括术前药物治疗、人口统计学、疾病特征、实验室值和手术方法。回归模型评估了生物制剂使用与腹腔内感染性并发症的关系。
结果
共纳入 815 例接受回结肠切除术的克罗恩病患者[62%无生物制剂、31.4%抗肿瘤坏死因子、3.9%维得利珠单抗、2.6%乌司奴单抗]。85.9%的患者行一期吻合术[侧侧吻合 48.8%、端侧吻合 26%、端端吻合 25%]，主要采用吻合器吻合[77.2%]。微创方法的使用率为 41.4%。810 例患者的 90 天术后腹腔内感染率为 12%，脓肿发生率为 9.6%，吻合口漏发生率为 3.2%。多变量回归模型控制混杂变量后显示，术前使用抗肿瘤坏死因子[P=0.21]、维得利珠单抗[P=0.17]或乌司奴单抗[P=0.52]与腹腔内感染性并发症无显著相关性。术前白蛋白<3.5 g/dl 与腹腔内感染性并发症独立相关（优势比[OR]1.76[1.03，3.01]）。
结论
在接受回结肠切除术的克罗恩病患者中，术前生物制剂与 90 天术后腹腔内感染性并发症无关。术前生物制剂的暴露不应延迟必要的手术。
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