慢性炎症性皮肤病患者会影响炎症性肠病的发生率吗?

2022-06-25 医路坦克 MedSci原创

最近一些研究将各种慢性炎症性皮肤病(CISD)与炎症性肠病(IBD)联系起来,但结论不一。我们比较了溃疡性结肠炎(UC)和克罗恩病(CD)在患有CISD的患者与没有CISD的类似人员中的发病率。

最近一些研究将各种慢性炎症性皮肤病(CISD)与炎症性肠病(IBD)在一系列数据来源中联系起来,结论不一。

目的我们比较了IBD--溃疡性结肠炎(UC)和克罗恩病(CD)--在患有CISD的患者与没有CISD的类似人员中的发病率。

方法在这项队列研究中,我们利用美国全国范围内的纵向商业保险索赔数据,确定了2004-2020年期间由皮肤科医生接诊的成人和儿童,并诊断为银屑病、特应性皮炎、斑秃、白癜风或化脓性皮炎。通过风险设置抽样确定对照组的;如果他们至少被皮肤科医生看过两次,并且没有被诊断为CISD,那么他们就有资格。患者随访持续到IBD诊断、死亡、退出或数据流结束,以先到者为准。溃疡性结肠炎(UC)或克罗恩病(CD)等IBD事件是通过--住院或经内镜确认的诊断来确定的。发病率在通过倾向分数(PS)分层调整之前和之后进行计算,以考虑IBD风险因素。估计危险比(HR)和95%置信区间,以比较CISD与非CISD的IBD发病率。

结果我们确定了特应性皮炎(n=123,614)、银屑病(n=83,049)、斑秃(n=18,135)、白癜风(n=9,003)或化脓性皮炎(n=6,806)患者以及无CISD的对比患者(n=2,376,120)。在718天的中位随访时间内,在对IBD风险因素进行PS调整后,我们观察到化脓性皮炎患者的UC(HRUC=2.30;1.61-3.28)和CD(HRCD=2.70;1.69-4.32)的风险增加,CD(HRCD=1.23;1. 03-1.46)而不是UC(HRUC=1.01;0.89-1.14),而特应性皮炎患者IBD的风险没有增加(HRUC=1.02;0.92-1.12,HRCD=1. 08;0.94-1.23)、斑秃(HRUC=1.18;0.89-1.56,HRCD=1.26;0.86-1.86)或白癜风(HRUC=1.14;0.77-1.68,HRCD=1.45;0.87-2.41)。

结论IBD在化脓性皮炎患者中有所增加。银屑病患者中仅克罗恩病就有增加。溃疡性结肠炎和克罗恩病在特应性皮炎、斑秃或白癜风患者中都没有增加。

文献来源:Schneeweiss MC,  Kirchgesner J,  Wyss R,Occurrence of inflammatory bowel disease in patients with chronic inflammatory skin diseases: a cohort study.Br J Dermatol 2022 Jun 19;

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