炎癥性腸病患者患帶狀皰疹的風(fēng)險增高
炎癥性腸病是累及回腸、結(jié)腸、直腸的腸道疾病，通常臨床上指的就是潰瘍性結(jié)腸炎（UC）和結(jié)腸克羅恩?。↖BD）。它們的臨床表現(xiàn)是腹痛、腹瀉，血便，因病因不明，一般采用皮質(zhì)類固醇激素類藥物、抗腫瘤壞死因子藥物及硫代嘌呤類藥物等對癥治療。
臨床發(fā)現(xiàn)炎癥性腸病患者使用這些藥物治療后，患帶狀皰疹的風(fēng)險增加，為確認這兩種疾病的關(guān)聯(lián)性，及是否與應(yīng)用上述藥物有關(guān)，來自美國的Long醫(yī)生和同事對既往采用上述藥物治療的炎癥性腸病患者進行了回顧性大規(guī)模隊列研究。該研究在線發(fā)表于2012年12月13日《《營養(yǎng)藥理學(xué)與治療學(xué)（Aliment Pharmacol Ther）》雜志上。
隊列包括50932名IBD患者，56403名UC患者和1269名非特異性炎癥性腸病患者，他們與434416名非IBD患者相匹配，采用條件logistic回歸方法比較兩組之間發(fā)生帶狀皰疹的關(guān)聯(lián)性。結(jié)果顯示，與非IBD患者相比，IBD患者患帶狀皰疹的風(fēng)險增高，抗腫瘤壞死因子藥物、皮質(zhì)類固醇激素、硫代嘌呤類藥物的使用與帶狀皰疹的發(fā)生明顯相關(guān)，其中使用抗腫瘤壞死因子藥物和硫代嘌呤藥物患帶狀皰疹的風(fēng)險最高。
愛愛醫(yī)評論：帶狀皰疹由水痘帶狀皰疹病毒引起，屬機會致病性病毒，在機體免疫力正常時在神經(jīng)根內(nèi)“休眠”，當機體受到外界刺激，免疫力低下的時候，病毒就被激活從而引起疾病。免疫抑制劑是一把雙刃劍，在達到疾病治療效果的同時，其免疫抑制的副作用也可能展現(xiàn)出來。在采用免疫抑制治療的時候，需密切注意用藥反應(yīng)，還可通過增加營養(yǎng)，鍛煉身體等方式提高機體抵抗力。
Increased risk of Herpes zoster among 108 604 patients with inflammatory bowel disease
M. D. Long, C. Martin, R. S. Sandler,M. D. Kappelman
Background: Patients with inflammatory bowel disease (IBD) on certain immunosuppressants have increased herpes zoster (HZ) risk.
Aim: To determine the risk of HZ in IBD and how antitumour necrosis factor-alpha (anti-TNF) agents affect this risk.
Methods: We performed a retrospective cohort and nested case–control study using administrative data from IMS LifeLink® Information Assets-Health Plan Claims Database. In the cohort, we identified IBD patients <age 64 by diagnosis codes; matched to four individuals without IBD. HZ risk was evaluated by incidence rate ratio (IRR) and adjusted Cox proportional hazards models (HR). In the nested case–control analysis, 2659 IBD patients with HZ were each matched to four IBD patients without HZ. We determined associations between medications and HZ using conditional logistic regression.
Results: The cohort included 50 932 patients with Crohn's disease (CD), 56 403 patients with ulcerative colitis (UC) and 1269 with unspecified IBD, matched to 434 416 individuals without IBD. The IBD cohort had increased HZ risk compared with non-IBD (IRR: 1.68, 95% CI: 1.60–1.76). After adjustment, IBD patients had a higher risk of HZ than non-IBD (HR: 1.49, 95% CI: 1.42–1.57). In the nested case–control multivariate-adjusted analyses, anti-TNF medications (OR: 1.81, 95% CI: 1.48–2.21), corticosteroids (OR: 1.73, 95% CI: 1.51–1.99) and thiopurines (OR: 1.85, 95% CI: 1.61–2.13) were independently associated with HZ. Risk of HZ was highest with combination anti-TNF and thiopurine therapy (OR: 3.29, 95% CI: 2.33–4.65).
Conclusions: Patients with inflammatory bowel disease are at increased risk for herpes zoster. Use of thiopurines, anti-TNF agents, combination therapy and corticosteroids increases herpes zoster risk.
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