Irving Peter M, Gibson Peter R
Department of Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia.
Nat Clin Pract Gastroenterol Hepatol. 2008 Jan;5(1):18-27. doi: 10.1038/ncpgasthep1004.
An interaction between infection and IBD was identified soon after Crohn's disease and ulcerative colitis were first described. Since then it has become apparent that infectious agents are involved with both the etiopathogenesis and clinical course of IBD on several levels. Whilst our understanding of this interplay is incomplete, it is clear that infections can initiate both the onset and relapse of IBD. Furthermore, the disease process itself predisposes patients to certain infections, and many drugs used to treat IBD also increase the risk of infectious complications. Attempts to establish the relative infectious risks associated with the drugs used to treat IBD remain in an early stage; but it seems that the greatest risks relate to the combined use of immunomodulating agents rather than to individual drugs. The risk of infections in patients with IBD might also be exacerbated by underuse of, and perhaps substandard response to, vaccinations. It is axiomatic that physicians treating patients with IBD must be aware of these infectious risks and of strategies to minimize them. Meanwhile, intriguing advances in the use of parasitic agents as a treatment for ulcerative colitis and Crohn's disease have introduced a new angle to the interplay between infections and IBD.
在克罗恩病和溃疡性结肠炎首次被描述后不久，就发现了感染与炎症性肠病（IBD）之间的相互作用。从那时起，很明显感染因子在多个层面上参与了IBD的病因发病机制和临床病程。虽然我们对这种相互作用的理解并不完整，但很清楚感染可引发IBD的发作和复发。此外，疾病过程本身使患者易患某些感染，并且许多用于治疗IBD的药物也会增加感染并发症的风险。确定与用于治疗IBD的药物相关的相对感染风险的尝试仍处于早期阶段；但似乎最大的风险与免疫调节剂的联合使用有关，而非个别药物。IBD患者的感染风险也可能因疫苗接种不足以及可能对接种的反应不达标而加剧。治疗IBD患者的医生必须了解这些感染风险以及将其降至最低的策略，这是不言而喻的。与此同时，将寄生虫制剂用作溃疡性结肠炎和克罗恩病治疗方法的有趣进展为感染与IBD之间的相互作用引入了一个新视角。
