Pierre & Marie Curie University, Faculté de médecine, AP-HP, Department of Gastroenterology and Nutrition, Hôpital Saint-Antoine, Paris, France.
Inflamm Bowel Dis. 2011 Feb;17(2):565-72. doi: 10.1002/ibd.21330.
Nodular regenerative hyperplasia (NRH) is a rare hepatic disorder that may lead to severe portal hypertension. Cases of NRH have been reported in patients receiving thiopurines for inflammatory bowel disease (IBD). Since azathioprine (AZA) is used more and more frequently as a maintenance treatment in IBD, the risk of NRH must be known. The objective of this study was to evaluate the prevalence of NRH and its predictive factors in IBD patients treated with AZA.
From the same tertiary referral center, 1888 consecutive IBD patients treated with AZA were studied. Clinical diagnosis of NRH was proven by liver biopsy in all cases except one. The cumulative risk of NRH was estimated with the Kaplan-Meier method. Factors associated with NRH were tested independently with the log-rank method and multivariate proportional hazards model with time-dependent covariates.
Fifteen patients developed NRH in a median treatment duration of 52.4 months (SE 1.6). The cumulative incidence of NRH was 1.28±0.45% at 10 years. Only two variables were independently associated with NRH occurrence: male gender (P=0.0001, hazard ratio [HR] 8.5, 95% confidence interval [CI] 1.9-37.9) and small bowel resection≥50 cm (P<0.0001, HR 6.6, 95% CI 2.2-20.0), either prior to or after AZA initiation.
The risk of developing NRH during AZA treatment is low. This study suggests that male patients with small bowel resection≥50 cm constitute the group with the higher risk of developing NRH while treated with AZA.
结节性再生性增生 (NRH) 是一种罕见的肝脏疾病，可导致严重的门静脉高压。有报道称，接受硫唑嘌呤 (AZA) 治疗炎症性肠病 (IBD) 的患者出现 NRH 病例。由于 AZA 在 IBD 的维持治疗中越来越多地被使用，因此必须了解 NRH 的风险。本研究的目的是评估接受 AZA 治疗的 IBD 患者中 NRH 的患病率及其预测因素。
从同一三级转诊中心，研究了 1888 例连续接受 AZA 治疗的 IBD 患者。除 1 例外，所有病例均通过肝活检证实临床诊断为 NRH。用 Kaplan-Meier 法估计 NRH 的累积风险。用对数秩检验法独立检测与 NRH 相关的因素，并采用具有时间依赖性协变量的多变量比例风险模型进行检测。
15 例患者在中位治疗 52.4 个月（SE 1.6）后发展为 NRH。NRH 的累积发生率为 10 年内 1.28±0.45%。仅有两个变量与 NRH 发生独立相关：男性（P=0.0001，风险比 [HR] 8.5，95%置信区间 [CI] 1.9-37.9）和小肠切除术≥50cm（P<0.0001，HR 6.6，95%CI 2.2-20.0），无论在 AZA 治疗前还是治疗后。
在 AZA 治疗期间发展为 NRH 的风险较低。本研究表明，在接受 AZA 治疗时，有小肠切除术≥50cm 的男性患者构成发生 NRH 的风险更高的群体。
