术前使用甲氨蝶呤对炎症性肠病患者术后早期并发症的影响

来源：医学界消化频道

翻译：练磊   中山大学附属第六医院结直肠外科

摘要来源：Afzali A1, Park CJ, Zhu K, Hu JK, Sharma P, Sinanan MN, Lee SD.

Inflamm Bowel Dis 2016;0:1–9

背景

克罗恩病或溃疡性结肠炎患者在术前使用免疫抑制剂可能导致术后并发症风险增高。对于炎症性肠病（IBD）患者术前使用甲氨蝶呤（MTX）的安全性研究较少。

方法

对1993-2012年间因IBD行腹部手术的患者进行回顾性病历资料分析，包括术前使用MTX、硫唑嘌呤/6-巯基嘌呤、抗肿瘤坏死因子以及糖皮质激素。确定早期术后并发症包括死亡、感染性和非感染性并发症。对于IBD或者风湿性关节炎患者术前使用甲氨蝶呤也进行了meta分析。

结果

共有180例IBD患者行腹部手术。其中共有15例患者使用了MTX单药治疗或联合治疗。总共71例（39%）患者出现早期并发症，其中5例为口服MTX患者。并发症共包括51（28%）例感染性和20（11%）例非感染性。使用MTX和术后早期并发症之间无显著性关联。出现并发症与未出现并发症之间的风险比（OR）与MTX相关的为0.75（95%置信区间， 0.25-2.29），与硫唑嘌呤/6-巯基嘌呤相关的为1.48（95%置信区间， 0.77-2.84）。meta分析也没有发现IBD或者风湿性关节炎患者术前使用甲氨蝶呤增加术后早期并发症的风险。

结论

术前使用MTX似乎与IBD患者术后早期并发症不相关。

Abstract

Background:Preoperative immunosuppressive use among patients with Crohn’s disease or ulcerative colitis may lead to an increased risk of postoperative complications. There is limited information on the preoperative safety profile of methotrexate (MTX) in inflammatory bowel disease (IBD). Methods:A retrospective study of patients who underwent abdominal surgery for IBD between 1993 and 2012 was performed and records abstracted, including preoperative use of MTX, azathioprine/6-mercaptopurine, antitumor necrosis factor, and corticosteroids. Early postoperative complications, including death, septic, and nonseptic complications were identified. A meta-analysis was also performed on the use of preoperative MTX in patients with IBD or rheumatoid arthritis. Results:A total of 180 patients with IBD underwent abdominal surgery. A total of 15 patients received MTX either monotherapy or in combination therapy. Total early postoperative complications were identified in 71 (39%) patients, specifically 5 patients on oral MTX. A total of 51 cases (28%) of septic complications and 20 (11%) nonseptic. No significant association between the use of MTX and early postoperative complications was found. The

odds ratio (OR) of complications versus no complications associated with MTX was 0.75 (95% CI, 0.25–2.29) and with azathioprine/6-mercaptopurine, OR 1.48 (95% CI, 0.77–2.84). The odds of a septic complication associated with MTX were 0.58 (95% CI, 0.09–3.73), and higher in azathioprine/6-mercaptopurine, OR 3.97 (95% CI, 1.03–15.3). Our meta-analysis also did not reveal an increased risk of postoperative complications in IBD or rheumatoid arthritis on preoperative MTX (OR 0.62, 95% CI, 0.34–1.15). Conclusions:Preoperative MTX use does not seem to be associated with early postoperative complications in IBD.

IBD及类风湿性关节炎患者术前使用MTX发生术后并发症的荟萃分析

专家简介：

练磊，（结直肠外科）副教授，副主任医师，博士生导师。中山大学“百人计划”引进人才。

中国中西医结合学会普通外科专委会青年副主任委员

中国中西医结合学会炎症性肠病专家组副组长

中华消化病学会炎症性肠病学组成员

中国医师协会外科医师分会结直肠外科医师委员会委员

中国医师协会肛肠医师分会炎症性肠病委员会委员

《中华胃肠外科杂志》通讯编委、英文编辑

广东省抗癌协会遗传性大肠癌协作组副主任委员

在美国克利夫兰医院（Cleveland Clinic）进修学习4年

主要方向为炎症性肠病、结直肠肿瘤的治疗

擅长溃疡性结肠炎及遗传性大肠癌的储袋手术（IPAA）。在炎症性肠病患者手术必要性、手术时机的把握、手术方式的选择等方面积累了丰富经验。

发表临床医学SCI论文60余篇。担任《Inflammatory Bowel Disease》（影响因子4.9）、《Chinese Medical Journal》（影响因子0.952）及《Gastroenterology Research and Practice》、《BMC Gastroenterology》特约审稿人。

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