目的:炎症性肠病(IBD)是可能伴有自身免疫性肝病(AILD)的慢性疾病,最常见的原发性硬化性胆管炎(PSC)。这项研究的目的是评估与AILD相关的IBD患者的行为,并比较PSC组和非PSC组。
方法:与PSC相关的IBD患者的医疗记录,自身免疫性胆管炎,原发性胆汁性胆管炎,小管道PSC,评估了自身免疫性肝炎(AIH)和重叠综合征。
结果:54例患者包括:48例(88.9%)患有溃疡性结肠炎,6例(11.1%)患有克罗恩病;35例(64.8%)患有PSC,19例(35.2%)没有PSC。结果没有差异(IBD的手术治疗,两组之间的肝移植或死亡)。自诊断IBD以来的时间与IBD的手术治疗有关(p=0.041;OR:1.139,95%CI:1.006-1.255)。自诊断AILD以来的时间(p=0.003;OR:1.259,95%CI:1.1-1.396),以及诊断时门脉高压(p=0.014;OR:18.22,95%CI:1.815-182.96),与肝移植有关。此外,AIH的既往诊断与新发IBD相关(p=0.012;OR:7.1,95%CI:1.215~42.43).
结论:两组的疾病行为相似。诊断为IBD的时间越长,手术治疗的风险就会增加(13.9%/年)。诊断为AILD后,肝移植增加25.9%/年,门静脉高压症的存在增加了18.22倍。此外,AIH的诊断与新发IBD的诊断数量增加相关(7.1).
OBJECTIVE: Inflammatory bowel diseases (IBD) are chronic conditions that may be accompanied by autoimmune liver disease (AILD), most commonly primary sclerosing cholangitis (PSC). The objective of this study was to evaluate the behaviour of patients with IBD associated with AILD and compare a PSC group with a non-PSC group.
METHODS: Medical records of patients with IBD associated with PSC, autoimmune cholangitis, primary biliary cholangitis, small-duct PSC, autoimmune hepatitis (AIH) and overlapping syndromes were assessed.
RESULTS: Fifty-four patients were included: 48 (88.9%) had ulcerative colitis and six (11.1%) had Crohn\'s disease; 35 (64.8%) had PSC and 19 (35.2%) did not have PSC. There was no difference in outcomes (surgical treatment for IBD, liver transplantation or death) between the groups. Time since the diagnosis of IBD was associated with surgical treatment of IBD (p=0.041; OR: 1.139, 95% CI: 1.006-1.255). Time since the diagnosis of AILD (p=0.003; OR: 1.259, 95% CI: 1.1-1.396), as well as portal hypertension at diagnosis (p=0.014; OR: 18.22, 95% CI: 1.815-182.96), were associated with liver transplantation. In addition, previous diagnosis of AIH was associated with de novo IBD (p=0.012; OR: 7.1, 95% CI: 1.215-42.43).
CONCLUSIONS: Both groups had similar disease behaviour. A longer time since the diagnosis of IBD increased the risk for surgical treatment (13.9%/year). A 25.9%/year increase in liver transplantation was observed after the diagnosis of AILD, which was increased 18.22 times by the presence of portal hypertension. In addition, the diagnosis of AIH was associated with an increase in the number of diagnoses of de novo IBD (7.1).