克罗恩病术前使用抗肿瘤坏死因子-α单克隆抗体与术后感染性并发症的相关性研究

Relationship between preoperative use of anti-tumor necrosis factor-α and postoperative infectious complications in Crohn's disease

目的研究克罗恩病(CD)患者术前使用抗肿瘤坏死因子(TNF)-α单克隆抗体治疗对一期肠管切除吻合术后感染性并发症的影响。方法回顾性纳入2017年1月至2021年12月在东部战区总医院连续收治的行一期部分肠管切除吻合术的CD患者的病例资料。采用倾向性评分匹配法,以1:2的比例匹配出术前12周内未接受与接受抗TNF-α单克隆抗体治疗的CD患者。分析术前使用抗TNF-α单克隆抗体治疗与术后感染性并发症的关系,并通过Logistic回归分析术后感染性并发症的相关危险因素。结果共收集501例一期肠管切除吻合术CD患者,经倾向性评分匹配后,共135例CD患者纳入分析,治疗组45例,对照组90例。两组的术后总体并发症发生率(24.4%比25.6%,P=0.889)以及感染性并发症发生率(13.3%比14.4%,P=0.861),差异均无统计学意义。既往因CD的肠管切除史和手术部位为结肠是术后30 d内感染性并发症的独立危险因素。结论CD肠管切除史以及结肠手术与一期肠管切除吻合术后感染性并发症相关。

Objective To investigate the impact of preoperative anti-tumor necrosis factor(anti-TNF)-α monoclonal antibody therapy on postoperative infectious complications in patients with Crohn's disease(CD)after intestinal resection with primary anastomosis.Methods The clinical data of CD patients who underwent intestinal resection with primary anastomosis at Jinling Hospital from January 2017 to December 2021 were retrospectively analyzed.Propensity score matching was used to match patients who did not receive or received anti-TNF treatment within 12 weeks before surgery at a ratio of 1∶2.The relationship between preoperative anti-TNF treatment and postoperative infectious complications was analyzed,and the related risk factors of postoperative infectious complications were analyzed by logistic regression analysis.Results A total of 501 patients with CD who underwent resection and primary anastomosis were collected.After propensity score matching,135 patients with CD were included in the analysis,45 in the treatment group and 90 in the control group.There were no significant differences in the incidence of overall postoperative complications(24.4%vs.25.6%,P=0.889)and infectious complications(13.3%vs.14.4%,P=0.861)between the two groups.Previous history of intestinal resection due to CD and surgical site of colon were independent risk factors for infectious complications within 30 days after surgery.Conclusion Previous history of intestinal resection of CD and colon surgery are associated with infectious complications after intestinal resection with primary anastomosis.