炎症性肠病患者的血管炎：32例患者的研究及文献系统评价
Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature.
作者信息
Sy Alice, Khalidi Nader, Dehghan Natasha, Barra Lillian, Carette Simon, Cuthbertson David, Hoffman Gary S, Koening Curry L, Langford Carol A, McAlear Carol, Moreland Larry, Monach Paul A, Seo Philip, Specks Ulrich, Sreih Antoine, Ytterberg Steven R, Van Assche Gert, Merkel Peter A, Pagnoux Christian
机构信息
Division of Rheumatology, Mount Sinai Hospital, University of Toronto, The Joseph and Wolf Lebovic Building, 60 Murray St, Ste 2-220, Toronto, Ontario, Canada M5T 3L9.
Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada.
出版信息
Semin Arthritis Rheum. 2016 Feb;45(4):475-82. doi: 10.1016/j.semarthrit.2015.07.006. Epub 2015 Jul 26.
BACKGROUND
Published small case series suggest that inflammatory bowel disease [IBD; Crohn's disease (CD) or ulcerative colitis (UC)] and vasculitis co-occur more frequently than would be expected by chance.
OBJECTIVES
To describe this association by an analysis of a large cohort of carefully studied patients and through a systematic literature review.
METHODS
Patients with both IBD and vasculitis enrolled in the Vasculitis Clinical Research Consortium (VCRC) Longitudinal Studies, followed in Canadian Vasculitis research network (CanVasc) centers and/or in the University of Toronto's IBD clinic were included in this case series. A systematic literature review of patients with IBD and vasculitis involved a PubMed search through February 2014. The main characteristics of patients with Takayasu arteritis (TAK) and IBD were compared to those in patients with TAK without IBD followed in the VCRC.
RESULTS
The study identified 32 patients with IBD and vasculitis: 13 with large-vessel vasculitis [LVV; 12 with TAK, 1 with giant cell arteritis (GCA); 8 with CD, 5 with UC]; 8 with ANCA-associated vasculitis [AAV; 6 granulomatosis with polyangiitis (GPA), 2 with eosinophilic granulomatosis with polyangiitis (EGPA)]; 5 with isolated cutaneous vasculitis; and 6 with other vasculitides. Patients with LVV and AAV were mostly female (18/21). The diagnosis of IBD preceded that of vasculitis in 12/13 patients with LVV and 8/8 patients with AAV. The review of the literature identified 306 patients with IBD and vasculitis: 144 with LVV (133 TAK; 87 with IBD preceding LVV), 19 with AAV [14 GPA, 1 EGPA, 4 microscopic polyangiitis (MPA)], 66 with isolated cutaneous vasculitis, and 77 with other vasculitides. Patients with IBD and TAK were younger and had more frequent headaches, constitutional symptoms, or gastrointestinal symptoms compared to those patients in the VCRC who had TAK without IBD.
CONCLUSIONS
These findings highlight the risk of vasculitis, especially TAK, in patients with IBD (both CD and UC).
背景
已发表的小病例系列研究表明，炎症性肠病（IBD；克罗恩病（CD）或溃疡性结肠炎（UC））与血管炎同时出现的频率高于偶然预期。
目的
通过对大量经过仔细研究的患者队列进行分析，并通过系统的文献综述来描述这种关联。
方法
本病例系列纳入了参加血管炎临床研究联盟（VCRC）纵向研究、在加拿大血管炎研究网络（CanVasc）中心和/或多伦多大学IBD诊所接受随访的同时患有IBD和血管炎的患者。对IBD和血管炎患者进行的系统文献综述涉及截至2014年2月的PubMed搜索。将高安动脉炎（TAK）和IBD患者的主要特征与VCRC中随访的无IBD的TAK患者的特征进行比较。
结果
该研究确定了32例同时患有IBD和血管炎的患者：13例患有大血管血管炎[LVV；12例患有TAK，1例患有巨细胞动脉炎（GCA）；8例患有CD，5例患有UC]；8例患有抗中性粒细胞胞浆抗体相关性血管炎[AAV；6例患有肉芽肿性多血管炎（GPA），2例患有嗜酸性肉芽肿性多血管炎（EGPA）]；5例患有孤立性皮肤血管炎；6例患有其他血管炎。LVV和AAV患者大多为女性（18/21）。在13例LVV患者中的12例和8例AAV患者中的8例中，IBD的诊断先于血管炎。文献综述确定了306例同时患有IBD和血管炎的患者：144例患有LVV（133例TAK；87例IBD先于LVV），19例患有AAV[14例GPA，1例EGPA，4例显微镜下多血管炎（MPA）]，66例患有孤立性皮肤血管炎，77例患有其他血管炎。与VCRC中无IBD的TAK患者相比，患有IBD和TAK的患者更年轻，头痛、全身症状或胃肠道症状更常见。
结论
这些发现突出了IBD（CD和UC）患者发生血管炎尤其是TAK的风险。
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