Christian Karime, Jana G Hashash, Michael F Picco, Emily C Craver, Joseph A Murray, Francis A Farraye
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Data on clinical, radiologic, and procedural surrogate markers of inflammatory bowel disease were collected in the subsequent 3, 5, and 10 years and compared with matched controls using univariate and multivariate analyses.</p><p><strong>Results: </strong>Compared with controls, patients taking ARBs had fewer instances of corticosteroid use (1.06 vs 2.88, P < 0.01) at 10 years. Patients taking ACEIs had an overall worse disease course, with more imaging studies (3.00 vs 1.75, P = 0.03) and endoscopic procedures (2.70 vs 1.78, P = 0.01) at 5 years, and more imaging studies (6.19 vs 3.50, P < 0.01), endoscopic procedures (5.91 vs 3.78, P < 0.01), and gastrointestinal operations (0.59 vs 0.18, P < 0.02) at 10 years. Results remained significant on multivariate analysis, adjusting for CD characteristics and the use of other antihypertensive medications.</p><p><strong>Conclusions: </strong>Our study provides insight into the long-term use of RAAS-blocking agents in patients with CD, suggesting that differences exist among commonly prescribed medication classes. While ACEIs were associated with an overall worse disease course at 5 and 10 years, patients taking ARBs were noted to have fewer instances of corticosteroid use at 10 years. 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引用次数: 0
摘要
背景:肾素-血管紧张素-醛固酮系统(RAAS肾素-血管紧张素-醛固酮系统(RAAS)与胃肠道炎症和纤维化有关,这表明阻断RAAS可能对炎症性肠病患者有益。通过回顾性分析,我们旨在比较克罗恩病(CD)患者服用两种常用的 RAAS 阻断剂的病程:研究:研究人员招募了2000年至2016年间开始服用血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体阻滞剂(ARB)的克罗恩病患者。在随后的3年、5年和10年中收集了炎症性肠病的临床、放射学和程序代用指标数据,并通过单变量和多变量分析与匹配对照组进行了比较:与对照组相比,服用 ARBs 的患者在 10 年内使用皮质类固醇的次数较少(1.06 vs 2.88,P < 0.01)。服用 ACEIs 的患者总体病程较长,5 年时接受更多影像学检查(3.00 vs 1.75,P = 0.03)和内镜手术(2.70 vs 1.78,P = 0.01),10 年时接受更多影像学检查(6.19 vs 3.50,P < 0.01)、内镜手术(5.91 vs 3.78,P < 0.01)和胃肠道手术(0.59 vs 0.18,P < 0.02)。在多变量分析中,根据CD特征和使用其他降压药的情况进行调整后,结果仍有意义:我们的研究有助于深入了解 CD 患者长期使用 RAAS 阻断剂的情况,表明常用药物类别之间存在差异。虽然ACEIs与5年和10年后总体病情恶化有关,但服用ARBs的患者在10年后使用皮质类固醇的情况较少。今后还需要进行大规模研究,进一步探讨这种关联。
The Effect of Renin-Angiotensin-Aldosterone System Blocking Agents on the Long-term Disease Course of Patients With Crohn's Disease.
Background: The renin-angiotensin-aldosterone system (RAAS) has been associated with gastrointestinal inflammation and fibrosis, suggesting that RAAS blockade may be beneficial in patients with inflammatory bowel disease. Using retrospective analysis, we aimed to compare the disease course of patients with Crohn's disease (CD) taking two commonly prescribed classes of RAAS-blocking agents.
Study: Patients with CD initiated on an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) between 2000 and 2016 were enrolled. Data on clinical, radiologic, and procedural surrogate markers of inflammatory bowel disease were collected in the subsequent 3, 5, and 10 years and compared with matched controls using univariate and multivariate analyses.
Results: Compared with controls, patients taking ARBs had fewer instances of corticosteroid use (1.06 vs 2.88, P < 0.01) at 10 years. Patients taking ACEIs had an overall worse disease course, with more imaging studies (3.00 vs 1.75, P = 0.03) and endoscopic procedures (2.70 vs 1.78, P = 0.01) at 5 years, and more imaging studies (6.19 vs 3.50, P < 0.01), endoscopic procedures (5.91 vs 3.78, P < 0.01), and gastrointestinal operations (0.59 vs 0.18, P < 0.02) at 10 years. Results remained significant on multivariate analysis, adjusting for CD characteristics and the use of other antihypertensive medications.
Conclusions: Our study provides insight into the long-term use of RAAS-blocking agents in patients with CD, suggesting that differences exist among commonly prescribed medication classes. While ACEIs were associated with an overall worse disease course at 5 and 10 years, patients taking ARBs were noted to have fewer instances of corticosteroid use at 10 years. Future large-scale studies are needed to further explore this association.
期刊介绍:
Journal of Clinical Gastroenterology gathers the world''s latest, most relevant clinical studies and reviews, case reports, and technical expertise in a single source. Regular features include cutting-edge, peer-reviewed articles and clinical reviews that put the latest research and development into the context of your practice. Also included are biographies, focused organ reviews, practice management, and therapeutic recommendations.