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炎症性肠病:神经系统并发症的一个风险增加因素。

Inflammatory bowel disease: an increased risk factor for neurologic complications.

作者信息

Morís Germán

机构信息

Germán Morís, Neurology Department, Hospital Universitario Central Asturias, Oviedo, 33006 Asturias, Spain.

出版信息

World J Gastroenterol. 2014 Feb 7;20(5):1228-37. doi: 10.3748/wjg.v20.i5.1228.

Abstract

Only a very few systematic studies have investigated the frequency of neurologic disorders in patients with Crohn's disease (CD) and ulcerative colitis (UC), which are the two main types of inflammatory bowel disease (IBD). Results have been inconsistent and variable, owing to differences in case-finding methods and evaluated outcomes in different studies. The most frequent neurologic manifestations reported in CD and UC populations are cerebrovascular disease (with either arterial or venous events), demyelinating central nervous system disease, and peripheral neuropathy (whether axonal or demyelinating); however, the literature describes numerous nervous system disorders as being associated with IBD. The pathogenesis of nervous system tissue involvement in IBD has yet to be elucidated, although it seems to be related to immune mechanisms or prothrombotic states. The recently-introduced tumor necrosis factor (TNF) inhibitors have proven successful in controlling moderate to severe IBD activity. However, severe neurologic disorders associated with TNF inhibitors have been reported, which therefore raises concerns regarding the effect of anti-TNF-α antibodies on the nervous system. Although neurological involvement associated with IBD is rarely reported, gastroenterologists should be aware of the neurologic manifestations of IBD in order to provide early treatment, which is crucial for preventing major neurologic morbidity.

摘要

仅有极少数系统性研究调查了克罗恩病(CD)和溃疡性结肠炎(UC)患者中神经系统疾病的发生率,这两种疾病是炎症性肠病(IBD)的两种主要类型。由于不同研究中病例发现方法和评估结果存在差异,研究结果一直不一致且多变。在CD和UC患者群体中报告的最常见神经系统表现是脑血管疾病(包括动脉或静脉事件)、中枢神经系统脱髓鞘疾病以及周围神经病变(无论是轴索性还是脱髓鞘性);然而,文献中描述了许多与IBD相关的神经系统疾病。IBD中神经系统组织受累的发病机制尚未阐明,尽管其似乎与免疫机制或血栓前状态有关。最近引入的肿瘤坏死因子(TNF)抑制剂已被证明在控制中度至重度IBD活动方面取得了成功。然而,已有报告称与TNF抑制剂相关的严重神经系统疾病,因此引发了对抗TNF-α抗体对神经系统影响的担忧。尽管与IBD相关的神经受累很少被报告,但胃肠病学家应了解IBD的神经系统表现以便提供早期治疗,这对于预防严重神经疾病至关重要。

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