Biancone L, Pavia M, Del Vecchio Blanco G, D'Incà R, Castiglione F, De Nigris F, Doldo P, Cosco F, Vavassori P, Bresci G P, Arrigoni A, Cadau G, Monteleone I, Rispo A, Fries W, Mallardi B, Sturniolo G C, Pallone F
Università di Roma Tor Vergata, Rome, Italy.
Inflamm Bowel Dis. 2001 Nov;7(4):287-94. doi: 10.1097/00054725-200111000-00002.
Patients with Crohn's disease (CD) are at higher risk of hepatitis C (HCV) and B virus (HBV) infection, because of surgical and/or endoscopic procedures. However, the prevalence of HCV and HBV infection in CD is unknown. This issue may be relevant because of the growing use of immunomodulatory drugs in CD. The purpose of this study was to assess, in a multicenter study, the prevalence and risk factors of HCV and HBV infection in CD. The effect of immunomodulatory drugs for CD on the clinical course of hepatitis virus infections and of interferon-alpha (IFN-alpha) on the course of CD was examined in a small number of patients. Sera from 332 patients with CD and 374 control subjects (C) were tested for the following: hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), HBcAb, HBeAg, HBeAb, anti-HCV, and HCV-RNA. An additional 162 patients with ulcerative colitis (UC) were tested as a disease control group. Risk factors were assessed by multivariate statistical analysis. Infection by either HCV or HBV was detected in 24.7% of patients with CD. In the age groups younger than 50 years, HCV prevalence was higher in CD than in C (p = 0.01). HCV infection in CD was associated with surgery (OR 1.71; 95% CI 1.00-2.93; p = 0.04), blood transfusions (OR 3.39; 95% CI 1.04-11.04; p = 0.04), and age (OR 2.3; 95% CI 1.61-3.56; p < 0.001). The event CD-related surgery appeared to be the main risk factor for HCV infection in CD. HCV prevalence was higher in CD (7.4%) than in UC (0.6%) (p = 0.001). HBcAb positivity was higher in CD (10.9%) and UC (11.5%) than in C (5.1%) (CD vs. C: p = 0.016; UC vs. C: p = 0.02), associated with age (OR 2.08; 95% CI 1.37-3.17; p = 0.001) and female gender (OR 2.68; 95% CI 1.37-3.17; p = 0.001) in CD and to UC duration (OR 1.20; 95% CI 1.06-1.36; p = 0.002). Immunomodulatory drugs did not influence the course of HBV or HCV infection in seven patients with CD, and IFN-alpha for chronic hepatitis C did not affect CD activity in six patients with CD. It is concluded that HBV prevalence is higher in CD than in C at all ages, whereas HCV prevalence is increased in young patients with CD, because of a greater need for surgery. The higher HCV (but not HBV) prevalence in CD than in UC suggests that the host immune response may influence the risk of HCV infection. Although a relatively high proportion of patients with CD showed HBV and/or HCV infections, this should not influence treatment strategies for CD.
由于手术和/或内镜操作，克罗恩病（CD）患者感染丙型肝炎病毒（HCV）和乙型肝炎病毒（HBV）的风险更高。然而，CD患者中HCV和HBV感染的患病率尚不清楚。鉴于CD中免疫调节药物的使用日益增加，这一问题可能具有相关性。本研究的目的是在一项多中心研究中评估CD患者中HCV和HBV感染的患病率及危险因素。在少数患者中研究了CD免疫调节药物对肝炎病毒感染临床病程的影响以及α干扰素（IFN-α）对CD病程的影响。检测了332例CD患者和374例对照者（C）的血清，检测项目如下：乙肝表面抗原（HBsAg）、乙肝表面抗体（HBsAb）、HBcAb、HBeAg、HBeAb、抗HCV和HCV-RNA。另外162例溃疡性结肠炎（UC）患者作为疾病对照组进行检测。通过多变量统计分析评估危险因素。24.7%的CD患者检测到HCV或HBV感染。在年龄小于50岁的年龄组中，CD患者的HCV患病率高于对照组（C）（p = 0.01）。CD患者的HCV感染与手术（比值比[OR]1.71；95%置信区间[CI]1.00 - 2.93；p = 0.04）、输血（OR 3.39；95% CI 1.04 - 11.04；p = 0.04）和年龄（OR 2.3；95% CI 1.61 - 3.56；p < 0.001）相关。与CD相关的手术似乎是CD患者HCV感染的主要危险因素。CD患者的HCV患病率（7.4%）高于UC患者（0.6%）（p = 0.001）。CD患者（10.9%）和UC患者（11.5%）的HBcAb阳性率高于对照组（C）（5.1%）（CD与C比较：p = 0.016；UC与C比较：p = 0.02），在CD中与年龄（OR 2.08；95% CI 1.37 - 3.17；p = 0.001）和女性性别（OR 2.68；95% CI 1.37 - 3.17；p = 0.001）相关，在UC中与病程（OR 1.20；95% CI 1.06 - 1.36；p = 0.002）相关。免疫调节药物对7例CD患者的HBV或HCV感染病程没有影响，用于慢性丙型肝炎的IFN-α对6例CD患者的CD活动度也没有影响。结论是，各年龄段CD患者的HBV患病率均高于对照组，而由于手术需求更大，年轻CD患者的HCV患病率增加。CD患者中HCV（而非HBV）患病率高于UC，提示宿主免疫反应可能影响HCV感染风险。虽然相当比例的CD患者存在HBV和/或HCV感染，但这不应该影响CD的治疗策略。
