Gastrointestinal Unit, Western General Hospital, Edinburgh, UK.
Inflamm Bowel Dis. 2009 Nov;15(11):1621-9. doi: 10.1002/ibd.20959.
It has been variously reported that women with inflammatory bowel disease (IBD) have an increased risk of cervical dysplasia. We aimed to assess in a large, accurately phenotyped, case-controlled population whether women with IBD had increased rates of abnormal cervical smears and if this was affected by immunosuppressant therapy or disease phenotype.
Women with IBD diagnosed prior to the age of 60 were studied at a single tertiary referral center in Scotland. Full cervical smear histories were available on 411 women (204 Crohn's disease, 207 ulcerative colitis, median age at diagnosis 28.4 years, median current age 44.1 years). All the cases were matched 1:4 to healthy controls (n = 1644) from the same geographical location.
There was no difference in rates of abnormal smears between patients with IBD (80.5% negative, 10.5% low-grade, and 9.0% high-grade dysplasia) and controls (85.4%, 7.7%, and 6.9%, P = 0.37). The use of immunosuppressant therapy had no impact on rates of cervical dysplasia or neoplasia. Furthermore, there was no effect of disease location, behavior, or oral contraceptive use. However, there were significantly more abnormal cervical smears in IBD patients who were current smokers compared with exsmokers and those who had never smoked (27.4% versus 11.4%, P = 0.001, odds ratio = 2.95, 95% confidence interval = 1.55-5.50).
Women with IBD are not at increased risk of abnormal cervical smears unless they smoke. These data suggest that young women with IBD should be managed as per the background population; attending for regular smear testing, and undergoing vaccination against cervical cancer when available.
有报道称，患有炎症性肠病（IBD）的女性宫颈发育不良的风险增加。我们旨在评估在一个大型、准确表型的病例对照人群中，IBD 女性是否有更高的异常宫颈涂片率，以及免疫抑制剂治疗或疾病表型是否会影响这一结果。
在苏格兰的一家三级转诊中心研究了年龄在 60 岁之前被诊断出患有 IBD 的女性。在 411 名女性（204 名克罗恩病，207 名溃疡性结肠炎，诊断时的中位年龄为 28.4 岁，当前的中位年龄为 44.1 岁）中，有完整的宫颈涂片史。所有病例都与来自同一地理位置的健康对照组（n=1644）进行了 1:4 匹配。
IBD 患者（80.5%阴性，10.5%低级别，9.0%高级别发育不良）和对照组（85.4%，7.7%和 6.9%，P=0.37）之间的异常涂片率没有差异。免疫抑制剂治疗的使用对宫颈发育不良或肿瘤的发生率没有影响。此外，疾病部位、行为或口服避孕药的使用也没有影响。然而，与曾经吸烟和从不吸烟的患者相比，目前吸烟的 IBD 患者有更多的异常宫颈涂片（27.4%比 11.4%，P=0.001，比值比=2.95，95%置信区间=1.55-5.50）。
除非吸烟，否则 IBD 女性患异常宫颈涂片的风险不会增加。这些数据表明，应按照普通人群的标准来管理患有 IBD 的年轻女性，定期进行涂片检查，并在有疫苗时接种宫颈癌疫苗。
