原发性硬化性胆管炎和原位肝移植患者的回肠袋-肛门吻合时机是否重要?系统回顾与元分析》。

IF 1.8 Q3 GASTROENTEROLOGY & HEPATOLOGY
Crohn's & Colitis 360 Pub Date : 2024-06-21 eCollection Date: 2024-07-01 DOI:10.1093/crocol/otae036
Saqr Alsakarneh, Mohamed Ahmed, Fouad Jaber, Mir Zulqarnain, Raffi Karagozian, Fadi Francis, Francis A Farraye, Jana G Hashash
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引用次数: 0

摘要

简介:肠袋炎是回肠肠袋-肛门吻合术(IPAA)患者最常见的并发症,多达 66% 的患者会患上肠袋炎。关于正位肝移植(OLT)对罹患肠袋炎风险的影响,目前的数据还很有限。我们的目的是客观评估OLT本身是否会显著降低重叠型PSC和炎症性肠病(IBD)患者罹患肠袋炎的风险:我们检索了 Medline、Scopus 和 Embase 数据库中从开始到 2023 年 9 月描述有 OLT 史的 PSC 和 IBD 患者 IPAA 结果的研究。利用随机效应模型计算了数据的汇总比例、比值比 (OR) 和 95% 置信区间 (CI)。此外,还采用弗里曼-土耳其双弧线转换(FTT)法计算了各组临床结果的加权调整后事件发生率的汇总估计值。研究之间的异质性采用 Cochrane Q 统计量(I2)进行评估:共确定了七项研究,涉及 291 名有 PSC、IBD 和 OLT 病史的患者。有 OLT 病史的 PSC/IBD 患者发生储袋炎的总风险为 65%(95% CI:0.57-0.72),分析中未发现异质性(I2 = 0%)。在对IPAA后进行OLT的患者进行的亚组分析中,纳入了3项研究,共28名患者;IPAA和OLT后发生储袋炎的总风险为83%(95% CI:0.71-0.94;I2 = 0%),明显更高(P 2 = 0%)。OLT组和非OLT组发生胃袋炎的风险没有差异(OR = 1.36; 95% CI: 0.37-5.0):我们的荟萃分析表明,PSC患者接受OLT治疗后,尤其是在OLT前接受IPAA治疗的患者中,常会出现储袋炎。在 IPAA 之前进行 OLT 可降低发生胃袋炎的风险。有必要进行更大规模的研究来重现这一结果,并调查这种差异背后的原因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Does Timing of Ileal Pouch-Anal Anastomosis Matter in Patients With Primary Sclerosing Cholangitis and Orthotopic Liver Transplantation? A Systematic Review and Meta-analysis.

Introduction: Pouchitis is the most common complication in patients with ileal pouch-anal anastomosis (IPAA), which can develop in up to 66% of patients. There is limited data on the effect of orthoptic liver transplantation (OLT) on the risk of developing pouchitis. We aimed to objectively assess whether OLT itself significantly modifies the risk of developing pouchitis in patients with overlap PSC and inflammatory bowel disease (IBD).

Method: We searched Medline, Scopus, and Embase databases from inception through September 2023 for studies that describe the outcomes of IPAA in patients with PSC and IBD who also have a history of OLT. Pooled proportions, Odds Ratio (OR), and 95% confidence intervals (CI) for data were calculated utilizing a random effects model. Using the Freeman-Turkey double arcsine transformation (FTT) method, the pooled weight-adjusted estimate of event rates for clinical outcomes in each group was also calculated. Heterogeneity between studies was assessed using the Cochrane Q statistic (I2).

Results: Seven studies with a total of 291 patients with a history of PSC, IBD, and OLT were identified. The pooled overall risk of pouchitis in PSC/IBD patients with a history of OLT was 65% (95% CI: 0.57-0.72), with no heterogeneity observed in the analysis (I2 = 0%). In a subgroup analysis of patients who had IPAA followed by OLT, 3 studies with 28 patients were included; the pooled risk of pouchitis after IPAA and OLT was 83% (95% CI: 0.71-0.94; I2 = 0%), which was significantly higher (P < .001) than the OLT followed by IPAA group (59%; 95 CI: 0.48-0.71; I2 = 0%). There was no difference in the risk of pouchitis between OLT and non-OLT groups (OR = 1.36; 95% CI: 0.37-5.0).

Conclusions: Our meta-analysis revelaed that pouchitis is common in patients who underwent OLT for PSC, especially in those who had IPAA before the OLT. OLT before IPAA may reduce the risk of pouchitis. Further larger studies are warranted to reproduce this and investigate the reason behind this difference.

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来源期刊
Crohn's & Colitis 360
Crohn's & Colitis 360 Medicine-Gastroenterology
CiteScore
2.50
自引率
0.00%
发文量
41
审稿时长
12 weeks
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