Kridin Khalaf, Comaneshter Doron, Cohen Arnon D
Department of Dermatology, Rambam Health Care Campus, Haifa.
Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv.
Eur J Gastroenterol Hepatol. 2018 Jul;30(7):727-729. doi: 10.1097/MEG.0000000000001140.
Although the coexistence of Crohn's disease (CD) and pemphigus has been reported in several individuals, the association between the two conditions was not investigated systematically in the past. A recent association between pemphigus and ulcerative colitis has been reported. The study aims to estimate the association between pemphigus and CD using a large-scale real-life computerized database.
A cross-sectional study was carried out comparing pemphigus patients with age-matched, sex-matched, and ethnicity-matched control participants in terms of the prevalence of CD. χ-Test and t-test were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was carried out utilizing the computerized database of Clalit Health Services ensuring 4.5 million patients.
A total of 1985 pemphigus patients and 9874 controls were included in the study. The prevalence of CD was comparable in patients with pemphigus and controls [0.4 vs. 0.3%, respectively; odds ratio (OR): 1.2; 95% confidence interval (CI): 0.5-2.5; P=0.688]. In an age-stratified analysis, a significant association was observed between pemphigus and CD in patients younger than 40 years (2.1 vs. 0.4%, respectively; OR: 5.1; 95% CI: 1.0-25.7; P=0.027). In a multivariate analysis adjusting for potential confounding factors, no independent association between the two conditions was found (OR: 0.9; 95% CI: 0.4-2.0; P=0.828). Study findings were robust to sensitivity analysis that included patients under pemphigus-specific treatments.
Unlike ulcerative colitis, CD was not associated with pemphigus. Further research is warranted to understand the pathophysiology of these observations better.
尽管已有数例克罗恩病（CD）与天疱疮共存的报道，但过去并未对这两种疾病之间的关联进行系统研究。最近有报道称天疱疮与溃疡性结肠炎之间存在关联。本研究旨在利用大规模真实世界计算机数据库评估天疱疮与CD之间的关联。
开展一项横断面研究，比较天疱疮患者与年龄、性别和种族匹配的对照参与者中CD的患病率。采用χ检验和t检验进行单因素分析，采用逻辑回归模型进行多因素分析。该研究利用克拉利特医疗服务机构的计算机数据库进行，该数据库涵盖450万患者。
本研究共纳入1985例天疱疮患者和9874例对照。天疱疮患者和对照中CD的患病率相当[分别为0.4%和0.3%；优势比（OR）：1.2；95%置信区间（CI）：0.5 - 2.5；P = 0.688]。在年龄分层分析中，40岁以下患者中天疱疮与CD之间存在显著关联（分别为2.1%和0.4%；OR：5.1；95% CI：1.0 - 25.7；P = 0.027）。在对潜在混杂因素进行调整的多因素分析中，未发现这两种疾病之间存在独立关联（OR：0.9；95% CI：0.4 - 2.0；P = 0.828）。研究结果在包括接受天疱疮特异性治疗患者的敏感性分析中具有稳健性。
与溃疡性结肠炎不同，CD与天疱疮无关。有必要进一步开展研究以更好地理解这些观察结果的病理生理学机制。
