PDF(Pubmed)
Abstract：
UNASSIGNED: The aim of this case-control study was to determine if exposure to tumor necrosis factor alpha inhibitors (TNFIs) or immunomodulators (thiopurines or methotrexate) was associated with development of primary gastrointestinal lymphoma (PGIL) in patients with chronic inflammatory conditions.
UNASSIGNED: Patients with PGIL and controls evaluated at a tertiary care center over 20 years were matched 1:3 using a medical record informatics search engine based on their chronic inflammatory condition (Crohn\'s disease [CD], ulcerative colitis [UC], rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) and duration of follow-up. Patients who started on TNFI within 3 months of PGIL diagnosis were excluded. We extracted demographics, medical history, and medications used. Univariate models using conditional logistic regression were used due to the small number of matched pairs.
UNASSIGNED: Twenty PGIL cases matched with 60 controls were followed for a mean 9.9 ± 6.9 and 9.7 ± 8.6 years, respectively. Mean age at time of PGIL diagnosis was 47.5 ± 22.0 (standard deviation) years and the majority (75%) were males. The most common inflammatory diagnosis was inflammatory bowel disease (80% of cases; 45% with UC and 35% with CD). Development of PGIL was not associated with TNFI (odds ratio [OR] = 2.6; 95% confidence interval [CI] 0.69-11.01; P = .18), but with use of TNFI in combination with thiopurines (OR = 8.93; 95% CI 1.43-80.25; P = .014). Risk of PGIL increased with every additional TNFI (2.277 (1.002-5.713); P = .0494). All cases exposed to multiple TNFI were also exposed to thiopurines. Use of thiopurines (alone or in combination) was the greatest risk factor (OR = 6.32; 95% CI 1.55-37.05; P = 0.006) to develop PGIL.
UNASSIGNED: TNFI therapy was not associated with increased risk for PGIL unless used in combination with thiopurines and with every switch to a different TNFI.
UNASSIGNED: Patients with PGIL and controls evaluated at a tertiary care center over 20 years were matched 1:3 using a medical record informatics search engine based on their chronic inflammatory condition (Crohn\'s disease [CD], ulcerative colitis [UC], rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) and duration of follow-up. Patients who started on TNFI within 3 months of PGIL diagnosis were excluded. We extracted demographics, medical history, and medications used. Univariate models using conditional logistic regression were used due to the small number of matched pairs.
UNASSIGNED: Twenty PGIL cases matched with 60 controls were followed for a mean 9.9 ± 6.9 and 9.7 ± 8.6 years, respectively. Mean age at time of PGIL diagnosis was 47.5 ± 22.0 (standard deviation) years and the majority (75%) were males. The most common inflammatory diagnosis was inflammatory bowel disease (80% of cases; 45% with UC and 35% with CD). Development of PGIL was not associated with TNFI (odds ratio [OR] = 2.6; 95% confidence interval [CI] 0.69-11.01; P = .18), but with use of TNFI in combination with thiopurines (OR = 8.93; 95% CI 1.43-80.25; P = .014). Risk of PGIL increased with every additional TNFI (2.277 (1.002-5.713); P = .0494). All cases exposed to multiple TNFI were also exposed to thiopurines. Use of thiopurines (alone or in combination) was the greatest risk factor (OR = 6.32; 95% CI 1.55-37.05; P = 0.006) to develop PGIL.
UNASSIGNED: TNFI therapy was not associated with increased risk for PGIL unless used in combination with thiopurines and with every switch to a different TNFI.
摘要：
■本病例对照研究的目的是确定暴露于肿瘤坏死因子α抑制剂（TNFI）或免疫调节剂（硫嘌呤或甲氨蝶呤）是否与原发性胃肠道淋巴瘤（PGIL）的发展有关慢性炎症患者。
■使用病历信息学搜索引擎，根据他们的慢性炎症状况（克罗恩病[CD]溃疡性结肠炎[UC]，类风湿性关节炎,强直性脊柱炎,和银屑病关节炎）和随访时间。在PGIL诊断后3个月内开始接受TNFI的患者被排除在外。我们提取了人口统计数据，病史,和使用的药物。由于匹配对的数量少，因此使用了使用条件逻辑回归的单变量模型。
■20例与60例对照匹配的PGIL病例平均随访9.9±6.9和9.7±8.6年，分别。PGIL诊断时的平均年龄为47.5±22.0（标准偏差）岁，大多数（75％）为男性。最常见的炎症诊断是炎症性肠病（80％的病例；45％的UC和35％的CD）。PGIL的发展与TNFI无关（比值比[OR]=2.6；95％置信区间[CI]0.69-11.01；P=.18），但与TNFI联合使用硫嘌呤（OR=8.93；95%CI1.43-80.25；P=0.014）。每增加一次TNFI，PGIL的风险就会增加（2.277（1.002-5.713）；P=.0494）。所有暴露于多种TNFI的病例也暴露于硫嘌呤。使用硫嘌呤（单独或联合使用）是发生PGIL的最大危险因素（OR=6.32；95％CI1.55-37.05；P=0.006）。
■TNFI治疗与PGIL的风险增加无关，除非与硫嘌呤联合使用以及每次切换到不同的TNFI。
■使用病历信息学搜索引擎，根据他们的慢性炎症状况（克罗恩病[CD]溃疡性结肠炎[UC]，类风湿性关节炎,强直性脊柱炎,和银屑病关节炎）和随访时间。在PGIL诊断后3个月内开始接受TNFI的患者被排除在外。我们提取了人口统计数据，病史,和使用的药物。由于匹配对的数量少，因此使用了使用条件逻辑回归的单变量模型。
■20例与60例对照匹配的PGIL病例平均随访9.9±6.9和9.7±8.6年，分别。PGIL诊断时的平均年龄为47.5±22.0（标准偏差）岁，大多数（75％）为男性。最常见的炎症诊断是炎症性肠病（80％的病例；45％的UC和35％的CD）。PGIL的发展与TNFI无关（比值比[OR]=2.6；95％置信区间[CI]0.69-11.01；P=.18），但与TNFI联合使用硫嘌呤（OR=8.93；95%CI1.43-80.25；P=0.014）。每增加一次TNFI，PGIL的风险就会增加（2.277（1.002-5.713）；P=.0494）。所有暴露于多种TNFI的病例也暴露于硫嘌呤。使用硫嘌呤（单独或联合使用）是发生PGIL的最大危险因素（OR=6.32；95％CI1.55-37.05；P=0.006）。
■TNFI治疗与PGIL的风险增加无关，除非与硫嘌呤联合使用以及每次切换到不同的TNFI。
