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RA的复发性感染—来自BSRBR的统计结果

作者：佚名来源：中华风湿日期：2017-06-19

导读

2017EULAR热点报道：类风湿关节炎患者的复发性感染——来自BSRBR的统计结果

关键字： RA | 复发性感染

类风湿关节炎患者的复发性感染——来自BSRBR的统计结果

背景：

类风湿关节炎（RA）患者对感染的易感性增加。

目的：

1. 探讨英国风湿病学会生物制剂登记类风湿关节炎（BSRBR-RA）中RA患者的复发性感染比例；2. 探讨指标感染的器官类别能否预测未来的严重感染。

方法：

如前所述，BSRBR-RA是一个前瞻性观察性队列。纳入抗风湿药物治疗期间或停药时间短于5个药物半衰期时至少发作一次需要住院的严重感染患者。感染类别根据国际医学用语词典（MedDRA）分为7类，首次指标感染后14天内发生的感染为新事件。调整年龄、性别、病程、吸烟、基线DAS28评分和血清阳性等指标，用Cox比例风险模型计算并比较事件发生率。

结果：

见表。

研究共纳入患者21943例，随访115423病人年，其中5365例至少报告一次严重感染。各组的年龄、病程、基线DAS28评分和HAQ评分具有可比性，比较基线时有既往感染的器官类别的组间差异。队列特征见表。基线时首次严重感染的年发生率为4.6%（95%CI 4.5~4.7）。指标感染后，严重感染的年发生率为12.7%（95%CI 12.1～13.3）。最常见的是呼吸系统感染（事件占比41.4%）。指标感染的系统类别与复发性感染事件的风险有关。败血症患者12个月内发生严重感染的风险最高，达19,7%。和呼吸道感染相比，败血症患者1年内的复发性严重感染风险增加33%（HR 1.33，95%CI 1.01～1.76）。年龄增长是感染复发的重要预测因子。

结论：

既往有严重感染的RA患者的复发性感染风险升高。复发性感染事件的器官类别能否反映指标事件以及对感染后的生物治疗策略有何影响仍待进一步研究。

原文

RECURRENT INFECTIONS IN RHEUMATOID ARTHRITIS PATIENTS, RESULTS FROM THE BSRBR

S.Subesinghe ¹ , A.I. Rutherford ¹ , R. Byng-Maddick ², J.B. Galloway ¹ .1 Rheumatology, King’s College London; 2 HomertonHospital, London, United

KingdomBackground: Rheumatoid arthritis (RA) patients have an increased susceptibilityto infection.

Objectives:

1.To establish the rate of recurrent infection in RA patients recruited to the British Society of Rheumatology Biologics Registry Rheumatoid Arthritis (BSRBR-RA).2.To establish whether the organ class of index infection predicted

future serious infection.

Methods:

The BSRBR-RA is a prospective observational cohort, previously described. Patients with at least one episode of serious infection requiring hospitalisation were included if they occurred whilst on anti-rheumatic drug therapy or within 5 drug half-lives of stopping. Infections were coded by MedDRA classification in to 7 categories. Infections occurring over 14 days after the first index infection were considered as new events. Event rates were calculated and compared using a Cox proportional hazards model with adjustments made for age, gender, disease duration, baseline DAS28 score, smoking status and seropositivity.

Results:

See Table 1.

In total, 21,943 subjects with 115,423 patient-years follow up were studied, 5365 subjects reported at least one serious infection. Comparing organ classes of prior

infection at baseline, each group had comparable age, disease duration, baseline DAS28 and HAQ scores. The cohort characteristics are tabulated. The baseline annual rate of first serious infection was 4.6% (95% CI 4.5–4.7). Following an index infection, the annual rate of serious infection was 12.7% (95% CI 12.1–13.3). Respiratory infections were the most common (41.4% of all events). The system class of index infection was associated with the risk of a recurrent event; subjects who experienced sepsis had the highest risk of subsequent serious infection within 12 months:19.7%. Compared to an index respiratory tract infection, sepsis conferred a 33% increased hazard for recurrent serious infection within a year (HR 1.33, 95% CI 1.01–1.76). Increasing age was a significant predictor of infection recurrence.

Conclusions:

There is a high risk of recurrent infection in RA patients with past serious infection. Work is ongoing to determine whether organ class of recurrent infection event mirrors index events and the impact of biologic treatment decisions following the index infection.

Disclosure of Interest:None declared

DOI: 10.1136/annrheumdis-2017-eular.1501