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篇名
膝關節置換術前使用免疫抑制劑與感染的關係
並列篇名
Association between immunosuppressive medications and postoperative infection following total knee arthroplasty
作者 柯絲珊劉冠麟鍾和肯溫淑惠
中文摘要
目標:類風濕性關節炎(Rheumatoid Arthritis,簡稱RA)使用抗腫瘤壞死因子(anti-tumor-necrosis-factor alpha,簡稱anti-TNFα)在全人工膝關節置換術(Total Knee Arthroplasty,簡稱TKA)後發生感染的風險較高,但仍未有定論。本研究欲探討RA患者術前使用anti-TNFα在TKA術後發生感染的風險。方法:我們使用2012至2015年全民健康保險資料庫之全人口檔,納入1,126位RA患者並接受TKA手術,追蹤術後三個月內發生感染情形。研究樣本TKA術前三個月RA用藥分為三組:疾病調節抗風濕藥物(Disease-modifying anti-rheumatic drugs,簡稱DMARDs)組(n=854)、anti-TNFα組(n=178)與皮質類固醇組(n=94),並以多重邏輯斯迴歸分析RA用藥與術後感染之勝算比(Odds Ratio,簡稱OR)及95%信賴區間(confidence interval,簡稱CI)。結果:三組TKA術後感染發生率(人月)依序為DMARDs組0.011(95% CI:0.006~0.014),anti-TNFα組0.008(95% CI:0.0002~0.0176)與皮質類固醇組為0.005(95% CI:0.0002~0.0157)。校正干擾因子後,anti-TNFα組發生術後感染的OR為DMARDs組之0.862倍(95% CI:0.291~2.548);若與皮質類固醇組相比,發生術後感染的OR為2.662倍(95% CI:0.25~28.342),皆無統計顯著。結論:RA患者TKA術前三個月使用anti-TNFα,與DMARDs或皮質類固醇相比,術後三個月之感染風險並無顯著不同。 Objectives: Patients with rheumatoid arthritis (RA) receiving anti-tumor necrosis factor alpha (anti-TNFα) therapy may have an increased risk of infection after total knee arthroplasty (TKA). However, conflicting results have been provided for the association of anti-TNFα and postoperative infection. In this study, we examined whether RA patients receiving anti- TNFα therapy have an elevated risk of postoperative infection after TKA. Methods: We used the Taiwan National Health Insurance Research Database of the whole population from 2012 to 2015. The medical records of patients with RA who had undergone TKA were obtained (n = 1126). We divided patients into three groups based on RA medications: disease-modifying anti-rheumatic drugs (DMARDs) (n = 854), anti-TNFα (n = 178), and corticosteroids (n = 94). Multivariate logistic regression was used to estimate the odds ratio (OR) of infection as well as the corresponding 95% confidence interval (CI). Results: The incidence rate (per person-month) of postoperative infection for each group was as follows: DMARDs: 0.011 (95% CI: 0.006-0.014), anti-TNFα: 0.008 (95% CI: 0.0002-0.0176), and corticosteroids: 0.005 (95% CI: 0.0002-0.0157). After adjustment for potential confounders, RA patients with anti-TNFα use did not have increased risk of infection compared to those with DMARDs (OR = 0.862, 95% CI: 0.291-2.548). Similar finding was found for comparison with corticosteroids (OR = 2.662, 95% CI: 0.25-28.342). Conclusions: The risk of postoperative infection in RA patients receiving anti- TNFα is similar to the risk in those treated with DMARDs or corticosteroids.
起訖頁 551-561
關鍵詞 全人工膝關節置換術抗腫瘤壞死因子術後感染類風濕性關節炎total knee arthroplastyanti-tumor necrosis factor alphapost-operative infection
刊名 台灣公共衛生雜誌  
期數 201910 (38:5期)
出版單位 台灣公共衛生學會
該期刊-上一篇 環境低溫對於類流感急診就診之影響:時間序列分析
 

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