本文選題：炎癥性腸疾病 + 克羅恩病��； 參考：《東南大學》2016年碩士論文

【摘要】：背景：雖然抗腫瘤壞死因子-α治療不是一線治療方案,但是它具有維持病情緩解、促進粘膜愈合、改善生活質(zhì)量等優(yōu)勢。目前已經(jīng)用于臨床治療的抗腫瘤壞死因子-α制劑有英夫利昔單抗、阿達木單抗、賽妥珠單抗、戈利木單抗等。由于生物制劑治療可顯著抑制自身免疫系統(tǒng),存在著增加肺結(jié)核復發(fā)或者進展的風險,也可引起其他嚴重的感染性疾病如病毒性肝炎、惡性腫瘤、皮膚病以及藥物引起的系統(tǒng)性紅斑狼瘡樣綜合征和脫髓鞘疾病的風險。這項研究的目的在于對過去和近幾年IBD患者在抗腫瘤壞死因子-α治療前和治療過程中潛伏性結(jié)核感染的發(fā)病率予進行調(diào)查并分析。方法：計算機檢索Cochrane library, Pubmed, EMBASE和BMJBestPractice, Google scholar, Annals Gastroenterology, JCC journal等數(shù)據(jù)庫中已發(fā)表的或未發(fā)表的抗腫瘤壞死因子a治療炎癥性腸病的所有英文文獻,檢索起止時間為2003-2015。檢索關(guān)鍵詞為與英夫力昔相關(guān)的詞語‘"infliximab," immunogenicity," "human anti-chimeric antibodies (HACAs)," "ulcerative colitis," "Crohn's disease," "Tuberculosis; Latent Tuberculosis;" "Anti TNF-a agents"。并設(shè)定入組標準及排除標準,采用STATA12.0軟件進行分析,我們設(shè)計了一個隨機效應(yīng)模型的Meta分析,來評估結(jié)果變量順序的變化。通過隨機效應(yīng)模型對OR值和異質(zhì)性進行分析,如果P0.05,則說明異質(zhì)性是顯著的,并繪制漏斗圖評定有無發(fā)表偏倚。結(jié)果：我們檢索了923篇引文和16篇包括完整的文章和摘要的文獻用于Meta分析,對于選中的12篇文獻中分析了抗TNF-α治療中抗結(jié)核治療患者與未抗結(jié)核治療患者中新發(fā)結(jié)核感染和結(jié)核復發(fā)的風險,因存在異質(zhì)性使用了固定效應(yīng)模型(I2：47.6%)。合并估計95% CI=7.83(4.44,1 3.79),P=0.033顯示對于存在結(jié)核潛伏感染陽性的患者予以預防性抗結(jié)核治療后復發(fā)率降低的研究具有顯著統(tǒng)計學意義,而且在抗TNFα治療中潛伏結(jié)核感染測試陰性患者發(fā)展成為結(jié)核可能性較低。結(jié)核感染的發(fā)病率也許根據(jù)結(jié)核病流行區(qū)域的不同存在著差異,在抗TNF-α治療前存在潛伏結(jié)核感染的研究中,我們從16篇文獻中剔除了2個研究(因其不符合納入標準中對于潛伏性結(jié)核感染的計算結(jié)果)。余14篇研究中均存在顯著的潛伏性結(jié)核感染,整體綜合評估95% Cl：0.14(0.11,0.18),P0.05,顯示研究中的IBD患者在抗腫瘤壞死因子-α治療前就存在著不同數(shù)目的潛伏性結(jié)核感染。在所有研究中結(jié)核感染(復發(fā)或新發(fā))進行了測量,并通過隨機效應(yīng)模型進行異質(zhì)性分析。在抗TNF-α治療后出現(xiàn)潛伏性結(jié)核感染的研究中,16項研究分別顯示結(jié)核復發(fā)率顯著的減少,整體綜合評估95% Cl：0.02 (0.01～0.02,P0.05說明研究結(jié)果存在顯著的統(tǒng)計學意義。繪制漏斗圖評定并通過進行Begg's和Egger's檢驗顯示可能存在發(fā)表偏倚,對于不對稱的漏斗圖結(jié)果進行敏感性分析顯示分析結(jié)果是穩(wěn)定的。結(jié)論：盡管抗腫瘤壞死因子-α治療非常有效,但是增加了潛伏性結(jié)核感染風險。在抗TNF-a治療前,篩查潛伏性結(jié)核感染及預防性治療可減少潛伏性結(jié)核轉(zhuǎn)化為結(jié)核感染。所以,臨床醫(yī)生應(yīng)該在使用生物制劑之前意識到治療可能存在的風險。
[Abstract]:Background: Although antitumor necrosis factor - alpha therapy is not a first-line treatment, it has the advantages of maintaining the remission of the disease, promoting the healing of the mucous membrane and improving the quality of life. The antitumor necrosis factor - alpha preparation currently used for clinical treatment is infliximab, adadumumab, cetuzumab, and GL mAb, and so on. Preparations can significantly inhibit the autoimmune system, the risk of increasing the recurrence or progression of tuberculosis, and other serious infectious diseases such as viral hepatitis, malignant tumor, dermatosis and the risk of systemic lupus erythematosus syndrome and demyelinating disease caused by drugs. This study aims at the past. And in recent years, the incidence of latent tuberculosis infection in IBD patients before and during the treatment of TNF - alpha was investigated and analyzed. Methods: computer retrieval of Cochrane library, Pubmed, EMBASE and BMJBestPractice, Google scholar, Annals Gastroenterology, JCC journal and so on. All the English literature of the antitumor necrosis factor A for the treatment of inflammatory bowel disease, the retrieval time and stop time of 2003-2015. retrieval key words "infliximab," immunogenicity, "" human anti-chimeric antibodies (HACAs), "" ulcerative colitis, "" Crohn's disease, "" "Is;" "Anti TNF-a agents". And setting up group standards and exclusion criteria, using STATA12.0 software to analyze. We designed a Meta analysis of a random effect model to evaluate the change in the sequence of the result variables. By analyzing the OR value and heterogeneity through the random effect model, if P0.05, it shows that heterogeneity is significant and draws a leak. Results: We searched 923 quotations and 16 articles including complete articles and abstracts for Meta analysis. In the 12 selected articles, we analyzed the risk of new tuberculosis infection and tuberculosis relapse in anti tuberculosis treatment and non anti tuberculosis treatment patients in the 12 selected articles, because of heterogeneity. The fixed effect model (I2:47.6%) was used. The combined estimate of 95% CI=7.83 (4.44,1 3.79) was used, and P=0.033 showed significant statistical significance for the study of the decrease in the recurrence rate after the preventive anti tuberculosis treatment of the patients with positive tuberculosis infection, and the development of the negative patients with the latent tuberculosis infection in the anti TNF alpha therapy was developed into a knot. There is a low nuclear possibility. The incidence of tuberculosis infection may vary according to the difference in the epidemic area of tuberculosis. In the study of latent tuberculosis infection in the presence of TNF- alpha before treatment, we have removed 2 studies from 16 articles (because of the results of the latent tuberculosis infection in the incompatible inclusion criteria). The remaining 14 studies are all deposited. In the significant latent tuberculosis infection, the overall comprehensive assessment of 95% Cl:0.14 (0.11,0.18), P0.05, showed that the IBD patients in the study had different number of latent tuberculosis infection before the TNF - alpha therapy. Sex analysis. In the study of latent tuberculosis infection after anti TNF- alpha therapy, 16 studies showed a significant reduction in the recurrence rate of tuberculosis and a comprehensive comprehensive assessment of 95% Cl:0.02 (0.01 to 0.02, P0.05 showed significant statistical significance.) the funnel map was assessed and the Begg's and Egger's tests showed possible survival. Sensitivity analysis of asymmetric funnel map results showed that the results were stable in the publication bias. Conclusion: Although anti TNF - alpha therapy is very effective, it increases the risk of latent tuberculosis infection. Screening latent tuberculosis infection and preventive treatment can reduce latent tuberculosis transformation before anti TNF-a treatment. For TB infection, clinicians should be aware of possible risks before using biologics.

【學位授予單位】：東南大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R574

【參考文獻】

相關(guān)期刊論文 前4條

1 Eun Soo Kim;Geun Am Song;Kwang Bum Cho;Kyung Sik Park;Kyeong Ok Kim;Byung Ik Jang;Eun Young Kim;Seong Woo Jeon;Hyun Seok Lee;Chang Heon Yang;Yong Kook Lee;Dong Wook Lee;Sung Kook Kim;Tae Oh Kim;Jonghun Lee;Hyung Wook Kim;Sam Ryong Jee;Seun Ja Park;Hyun Jin Kim;;Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents[J];World Journal of Gastroenterology;2015年11期

2 Nynne Nyboe Andersen;Tine Jess;;Risk of infections associated with biological treatment in inflammatory bowel disease[J];World Journal of Gastroenterology;2014年43期

3 Jannie Pedersen;Mehmet Coskun;Christoffer Soendergaard;Mohammad Salem;Ole Haagen Nielsen;;Inflammatory pathways of importance for management of inflammatory bowel disease[J];World Journal of Gastroenterology;2014年01期

4 Spiros D.Ladas;Elias Mallas;Konstantinos Giorgiotis;Georgios Karamanolis;Dimitrios Trigonis;Apostolos Markadas;Vana Sipsa;Sotirios A.Raptis;;Incidence of ulcerative colitis in Central Greece: A prospective study[J];World Journal of Gastroenterology;2005年12期

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本文編號：1791051