流行病学调查探讨炎症性肠病的危险因素

目的通过问卷式大样本病例调查，探讨炎症性肠病（IBD）致病的可能危险因素。方法采用问卷法，对140例确诊IBD患者及140例配对的健康个体调查，问卷包括遗传、吸烟的年限、牛奶摄入量、油炸食品摄入量和酒精摄入量等共14项内容，收回问卷后对结果进行COX回归分析，筛选出IBD的具有统计学意义的致病危险因素。结果COX回归分析提示牛奶摄入量、油炸食品摄入量、吸烟的年限在IBD致病因素中具有统计学意义。结论牛奶摄入、油炸食品摄入、吸烟可能是IBD的致病危险因素。     

炎症性肠病的流行病学研究进展

炎症性肠病(IBD)是指一组病因不明的非特异性肠道炎症,包括溃疡性结肠炎(UC)和克罗恩病(CD).IBD的病因和发病机制至今仍未完全明确.近年来流行病学研究显示IBD的发病率有明显上升趋势,且IBD的发病与遗传、饮食、吸烟、围产期和儿童时期因素、感染、避孕药、阑尾切除术、精神心理等因素密切相关,此文就此作一综述.     

炎症性肠病发生静脉血栓的危险因素与治疗进展

炎症性肠病(IBD)是一种累及回肠、结肠、直肠,病因尚未明确的肠道慢性疾病,其总发病率在各国均有所增加.IBD的肠道并发症是造成患者病情反复发作和死亡率高的重要原因,其中IBD合并静脉血栓形成是导致患者病情预后不良的重要原因之一.IBD合并静脉血栓形成由许多遗传和获得性危险因素的相互作用共同导致,具体发病机制尚未明确....     

炎症性肠病癌变的研究进展

炎症性肠病(IBD)是一组肠道慢性非特异性炎性疾病,其确切的病因不明。近年来,IBD的发病率逐年增高,IBD相关结直肠癌(IBD-CRC)是其一种严重的并发症。本文就IBD-CRC的流行病学、癌变机制、危险因素、监测和预防等内容作一简要综述。     

炎症性肠病流行病学研究进展

炎症性肠病(IBD)在不同地区、种族人群中的发病率有显著差异。近年来,IBD在既往高发病率的西方国家趋于稳定,而在亚洲国家呈逐渐增加趋势。IBD发病率在发展中国家逐年增高,可能与发展中国家经济高速发展、工业化进程加速有关,提示环境因素在IBD病因中扮演重要角色。目前国内关于IBD流行病学的研究处于起步阶段,有待联合更多医学中心进行以人群为基础的IBD流行病学研究。     

炎症性肠病与免疫学关系研究进展

炎症性肠病是一组病因未明的慢性肠道炎症性疾病,其临床症状以腹痛和腹泻为主,病因和发病机制错综复杂,包括多种因素,其中与机体免疫系统关系密切,目前研究发现免疫异常是炎症性肠病发病的重要因素,包括肠道内环境、免疫细胞、人类白细胞抗原、自身抗体、抗Laminaribioside糖抗体(ALCA)和抗Chitobioside lgA糖抗体(ACCA)、细胞因子、黏附分子、一氧化氮和核因子NF-kB等,他们在炎症的起始和持续发展中起重要的作用,本文就免疫因素在炎症性肠病中的作用作一综述.     

重视炎症性肠病的临床研究

炎症性肠病(Inflammatory bowel disease,IBD)包括溃疡性结肠炎(UC)和克罗恩病(CD),在西方国家相当常见,最新统计资料显示二者患病率最高者均在200人/105左右.国内近年报道逐渐增多,据不完全统计二者病例总数已超过2万,其中尤以UC为多,是主要的胃肠道疾病和慢性腹泻的主要原因,其临床诊断与治疗变得复杂而棘手,因此,受到同行普遍重视.有研究指出,初诊时的UC大约有50%最终证实为感染性结肠炎(IC),而CD与肠结核相互误诊率有的高达70%,对此不可掉以轻心.传统的治疗对UC和CD的缓解率分别为80%和70%左右.在维持缓解方面,有报道指出即使最佳的维持治疗方案也仅能使复发率降低50%左右.国人维持治疗意识差、药物种类有限,短期治疗后停药更易导致疾病复发.UC与CD最终分别有1/3与2/3的病例需要手术,使疾病致残率高,生活质量受到相当大的影响.因此,应对IBD的诊断与治疗问题引起足够重视.     

炎症性肠病的治疗

炎症性肠病(IBD)的病因致今未明,因此缺乏特效治疗。溃疡性结肠炎(UC)与克隆病(CD)的治疗原则基本相同,但二者在近期疗效与防止复发方面则有区别,一般在UC优于CD.本病应以内科治疗为主,手术仅适用于UC有中毒性巨结肠经积     

生长因子治疗炎症性肠病

炎症性肠病(IBD)的病因和发病机制尚未完全明确,多种细胞因子,包括各种生长因子(GF)参与免疫反应和炎症过程,GF在IBD发病中的作用是当前IBD发病机制和治疗的研究热点之一.此文就GF治疗IBD的研究进展作一综述.     

炎性肠病患者发生非酒精性脂肪性肝病的危险因素

目的探讨炎症肠病(inflammatory bowel disease,IBD)患者非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患病情况及相关危险因素。方法以2017年1月至2019年10月新疆军区总医院收治的409例IBD患者为研究对象,应用腹部超声筛查NAFLD,根据是否合并NAFLD分为NAFLD组(131例)和对照组(278例),比较两组患者年龄、性别、体重指数(body mass index,BMI)、腹围、病程及并发症(高血压、糖尿病、吸烟)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、γ-谷氨酰转移酶(gamma-glutamyltransferase,GGT)、白蛋白、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、血肌酐、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)和C-反应蛋白(C-reactive protein,CRP)等的差异。采用Logistic回归分析IBD患者发生NAFLD的独立危险因素。结果IBD患者NAFLD的患病率为32.03%(131/409)。NAFLD组患者年龄[(50.24±12.83)岁vs(38.74±10.91)岁]、BMI[(28.24±4.90)kg/m2 vs(23.52±3.73)kg/m2]、腹围[(93.10±11.52)cm vs(85.52±10.06)cm]、病程[(8.52±1.84)年vs(5.84±1.28)年]、高血压比例[20.61%(27/131)vs 4.68%(13/278)]、糖尿病比例[9.92%(13/131)vs 1.80%(5/278)]、吸烟比例[50.38%(66/131)vs 38.13%(106/278)]、GGT[(26.57±8.19)U/L vs(18.46±4.36)U/L]和HbA1c[(6.65±2.17)%vs(3.64±1.05)%]水平均显著高于对照组,差异有统计学意义(P均<0.05)。多因素Logistic回归分析表明年龄(OR=1.33,95%CI:1.15~1.82,P=0.018)、BMI(OR=1.80,95%CI:1.25~3.27,P=0.002)、病程(OR=2.60,95%CI:1.10~3.26,P=0.010)和糖尿病(OR=1.77,95%CI:1.23~4.79,P=0.006)是IBD患者发生NAFLD的独立危险因素。结论IBD患者NAFLD的患病率高,年龄、BMI、病程和糖尿病均是IBD患者发生NAFLD的独立危险因素,可通过促进健康生活方式进行代谢干预,以减少NAFLD的发生。     

Environmental risk factors for inflammatory bowel diseases: Evidence based literature review

AIM: To advances in genetics and immunology have contributed to the current understanding of the pathogenesis of inflammatory bowel diseases(IBD). METHODS: The current opinion on the pathogenesis of IBD suggests that genetically susceptible individuals develop intolerance to dysregulated gut microflora(dysbiosis) and chronic inflammation develops as a result of environmental insults. Environmental exposures are innumerable with varying effects during the life course of individuals with IBD. Studying the relationship between environmental factors and IBD may provide the missing link to increasing our understanding of the etiology and increased incidence of IBD in recent years with implications for prevention, diagnosis, and treatment. Environmental factors are heterogeneous and genetic predisposition, immune dysregulation, or dysbiosis do not lead to the development of IBD in isolation. RESULTS: Current challenges in the study of environmental factors and IBD are how to effectively translate promising results from experimental studies to humans in order to develop models that incorporate the complex interactions between the environment, genetics, immunology, and gut microbiota, and limited high quality interventional studies assessing the effect of modifying environmental factors on the natural history and patient outcomes in IBD.CONCLUSION: This article critically reviews the current evidence on environmental risk factors for IBD and proposes directions for future research.     

Prevalence and associated factors of obesity in inflammatory bowel disease: A case-control study

BACKGROUNDIn recent years, an increasing prevalence of obesity in inflammatory bowel disease (IBD) has been observed. Obesity, moreover, has been directly correlated with a more severe clinical course and loss of response to treatment.AIMTo assess the prevalence and associated factors of obesity in IBD.METHODSWe collected data about IBD disease pattern and activity, drugs and laboratory investigations in our center. Anthropometric measures were retrieved and obesity defined as a body mass index (BMI) > 30. Then, we compared characteristics of obese vs non obese patients, and Chi-squared test and Student’s t test were used for discrete and continuous variables, respectively, at univariate analysis. For multivariate analysis, we used binomial logistic regression and estimated odd ratios (OR) and 95% confidence intervals (CI) to ascertain factors associated with obesity.RESULTSWe enrolled 807 patients with IBD, either ulcerative colitis (UC) or Crohn’s disease (CD). Four hundred seventy-four patients were male (58.7%); the average age was 46.2 ± 13.2 years; 438 (54.2%) patients had CD and 369 (45.8%) UC. We enrolled 378 controls, who were comparable to IBD group for age, sex, BMI, obesity, diabetes and abdominal circumference, while more smokers and more subjects with hypertension were observed among controls. The prevalence of obesity was 6.9% in IBD and 7.9% in controls (not statistically different; P = 0.38). In the comparison of obese IBD patients and obese controls, we did not find any difference regarding diabetes and hypertension prevalence, nor in sex or smoking habits. Obese IBD patients were younger than obese controls (51.2  ± 14.9 years vs 60.7 ± 12.1 years, P = 0.03). At univariate analysis, obese IBD were older than normal weight ones (51.2 ± 14.9 vs 44.5 ± 15.8, P = 0.002). IBD onset age was earlier in obese population (44.8 ± 13.6 vs 35.6 ± 15.6, P = 0.004). We did not detect any difference in disease extension. Obese subjects had consumed more frequently long course of systemic steroids (66.6% vs 12.5%, P = 0.02) as well as antibiotics such as metronidazole or ciprofloxacin (71.4% vs 54.7%, P = 0.05). No difference about other drugs (biologics, mesalazine or thiopurines) was observed. Disease activity was similar between obese and non obese subjects both for UC and CD. Obese IBD patients suffered more frequently from arterial hypertension, type 2 diabetes, non-alcoholic fatty liver disease. Regarding laboratory investigations, obese IBD patients had higher levels of triglyceridemia, fasting blood glucose, gamma-glutamyl-transpeptidase. On multivariate analysis, however, the only factor that appeared to be independently linked to obesity in IBD was the high abdominal circumference (OR = 16.3, 95%CI: 1.03-250, P = 0.04).CONCLUSIONObese IBD patients seem to have features similar to general obese population, and there is no disease-specific factor (disease activity, extension or therapy) that may foster obesity in IBD.     

Trefoil factors in inflammatory bowel disease

Inflammatory bowel disease(IBD),which comprises ulcerative colitis and Crohn’s disease,is characterized by inflammation of the gastrointestinal tract.The trefoil factors 1,2,and 3(TFF1-3)are a family of peptides that play important roles in the protection and repair of epithelial surfaces,including the gastrointestinal tract.TFFs may be involved in IBD pathogenesis and are a potential treatment option.In the present review,we describe the TFF family and their potential role in IBD by summarizing the current knowledge of their expression,possible function and pharmacological role in IBD.     

Population‐based cases control study of inflammatory bowel disease risk factors

Background and Aim: The rapid increase in inflammatory bowel disease (IBD) incidence confirms the importance of environment in its etiology. We aimed to assess the role of childhood and other environmental risk factors in IBD. Methods: A population‐based case‐control study was carried out in Canterbury, New Zealand. Participants comprised 638 prevalent Crohn's disease (CD) cases, 653 prevalent ulcerative colitis (UC) cases and 600 randomly‐selected sex and age matched controls. Exposure rates to environmental risk factors were compared. Unadjusted and adjusted odds ratios (OR) with 95% confidence intervals (CI) are presented. Results: A family history of IBD (CD OR 3.06 [2.18–4.30], UC OR 2.52 [1.90–3.54]), cigarette smoking at diagnosis (CD OR 1.99 [1.48–2.68], UC OR 0.67 [0.48–0.94]), high social class at birth (CD and UC trend, P < 0.001) and Caucasian ethnicity (CD OR 2.04 [1.05–4.38], UC OR 1.47 [1.01–2.14]) were significantly associated with IBD. City living was associated with CD (P < 0.01). Being a migrant was associated with UC (UC OR 1.40 [1.14–2.01]). Having a childhood vegetable garden was protective against IBD (CD OR 0.52 [0.36–0.76], UC OR 0.65 [0.45–0.94]) as was having been breast‐fed (CD OR 0.55 [0.41–0.74], UC OR 0.71 [0.52–0.96]) with a duration‐response effect. Appendicectomy, tonsillectomy, infectious monomucleosis and asthma were more common in CD patients than controls (P < 0.01). Conclusions: The importance of childhood factors in the development of IBD is confirmed. The duration‐response protective association between breast‐feeding and subsequent development of IBD requires further evaluation, as does the protective effect associated with a childhood vegetable garden.     

Nested case-control study on risk factors for opportunistic infections in patients with inflammatory bowel disease

BACKGROUND When opportunistic infections occur, patients with inflammatory bowel disease(IBD) commonly display a significantly increased rate of morbidity and mortality.With increasing use of immunosuppressive agents and biological agents,opportunistic infections are becoming a hot topic in the perspective of drug safety in IBD patients. Despite the well-established role of opportunistic infections in the prognosis of IBD patients, there are few epidemiological data investigating the incidence of opportunis-tic infections in IBD patients in China. Besides, the risk factors for opportunistic infection in Chinese IBD patients remain unclear.AIM To predict the incidence of opportunistic infections related to IBD in China, and explore the risk factors for opportunistic infections.METHODS A single-center, prospective study of IBD patients was conducted. The patients were followed for up to 12 mo to calculate the incidence of infections. For each infected IBD patient, two non-infected IBD patients were selected as controls. A conditional logistic regression analysis was used to assess associations between putative risk factors and opportunistic infections, which are represented as odds ratios(OR) and 95% confidence intervals(CIs).RESULTS Seventy(28.11%) out of 249 IBD patients developed opportunistic infections.Clostridium difficile infections and respiratory syncytial virus infections were found in 24 and 16 patients, respectively. In a univariate analysis, factors such as the severity of IBD, use of an immunosuppressant or immunosuppressants, high levels of fecal calprotectin, and C-reactive protein or erythrocyte sedimentation rate were individually related to a significantly increased risk of opportunistic infection. Multivariate analysis indicated that the use of any immunosuppressant yielded an OR of 3.247(95%CI: 1.128-9.341), whereas the use of any two immunosuppressants yielded an OR of 6.457(95%CI: 1.726-24.152) for opportunistic infection. Interestingly, when immunosuppressants were used in combination with infliximab(IFX) or 5-aminosalicylic acid, a significantly increased risk of opportunistic infection was also observed. The relative risk of opportunistic infection was greatest in IBD patients with severe disease activity(OR = 9.090; 95%CI: 1.532-53.941, relative to the remission stage). However, the use of IFX alone did not increase the risk of opportunistic infection.CONCLUSION Factors such as severe IBD, elevated levels of fecal calprotectin, and the use of immunosuppressive medications, especially when used in combination, are major risk factors for opportunistic infections in IBD patients. The use of IFX alone does not increase the risk of opportunistic infection.     

炎症性肠病患者的肠外表现(附201例临床分析)

目的了解炎症性肠病(IBD)患者肠外表现的发生情况。方法对1978-01~2003-12期间北京大学第一医院收治的201例IBD患者的临床资料进行回顾性分析。结果25年间共收治IBD患者201例,其中溃疡性结肠炎(UC)患者182例,克罗恩病(CD)患者19例。IBD伴肠外表现发生率为20·9%(42/201),UC患者为21·43%(39/182),CD患者为15·79%(3/19)。女性显著多于男性(P<0·05)。UC患者年龄小于20岁者肠外表现发生率高(P<0·01),年龄大于50岁者肠外表现发生率低(P<0·01)。发生于UC活动期者占89·74%(35/39),而发生在缓解期者仅占10·26%(4/39);CD患者肠外表现均发生在活动期。肠外表现中关节、肌肉损害最为多见,其次为皮肤损害。侵犯泌尿系统、甲状腺及肝胆系统者罕见。伴有结节性红斑、坏疽性脓皮病及外周关节炎的患者多易合并其他种肠外表现。结论IBD患者伴有肠外表现者并非少见,女性年轻患者肠外表现发生率高,关节、肌肉及皮肤损害是IBD患者最多见的肠外表现,肠外表现的发生随IBD疾病活动性、疾病严重程度、病变范围的增加有增多的趋势。     

Risk factors for osteoporosis in inflammatory bowel disease patients

Inflammatory bowel disease (IBD) patients exhibit higher risk for bone loss than the general population. The chronic inflammation causes a reduction in bone mineral density (BMD), which leads to osteopenia and osteoporosis. This article reviewed each risk factor for osteoporosis in IBD patients. Inflammation is one of the factors that contribute to osteoporosis in IBD patients, and the main system that is involved in bone loss is likely RANK/RANKL/osteoprotegerin. Smoking is a risk factor for bone loss and fractures, and many mechanisms have been proposed to explain this loss. Body composition also interferes in bone metabolism and increasing muscle mass may positively affect BMD. IBD patients frequently use corticosteroids, which stimulates osteoclastogenesis. IBD patients are also associated with vitamin D deficiency, which contributes to bone loss. However, infliximab therapy is associated with improvements in bone metabolism, but it is not clear whether the effects are because of inflammation improvement or infliximab use. Ulcerative colitis patients with proctocolectomy and ileal pouches and Crohn’s disease patients with ostomy are also at risk for bone loss, and these patients should be closely monitored.