Ungprasert Patompong, Crowson Cynthia S, Matteson Eric L
Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, USA.
Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj hospital, Mahidol University, Bangkok, Thailand.
Sarcoidosis Vasc Diffuse Lung Dis. 2018;35(3):239-244. doi: 10.36141/svdld.v35i3.6561. Epub 2018 Apr 28.
An increased risk of gastrointestinal (GI) diseases has been observed in immune-mediated disease but the risk in patients with sarcoidosis is not known. This study was undertaken to characterize the risk of GI diseases in patients with sarcoidosis. A population-based cohort of 345 incident cases of sarcoidosis among Olmsted County, Minnesota residents in 1976-2013 was identified. A cohort of 345 sex and age-matched comparators were also identified from the same underlying population. Medical records of both groups were reviewed for GI diseases. Cox models adjusted for age, sex and calendar year were used to compare the rate of development of GI diseases between the groups. In addition, Cox models were used to evaluate the association between use of immunosuppressive agents and the development of GI diseases among patients with sarcoidosis. GI events occurred in 101 cases and 63 comparators, corresponding to an adjusted hazard ratio (HR) of 1.90 (95% confidence interval [CI] 1.38-2.61). Patients with sarcoidosis had an increased risk for both upper (HR 1.90; 95%CI 1.27-2.83) and lower GI events (HR 1.97; 95%CI 1.27-3.05) relative to comparators. By disease type, patients with sarcoidosis had a significantly elevated risk of upper GI ulcer, upper GI hemorrhage and diverticulitis. Regarding medication use, the only significant association was an increased risk of upper GI events among biologic agent users (HR 11.09; 95%CI 2.16-56.97). Patients with sarcoidosis have a higher risk of both upper and lower GI events compared with subjects without sarcoidosis. .
在免疫介导性疾病中已观察到胃肠道（GI）疾病风险增加，但结节病患者的风险尚不清楚。本研究旨在描述结节病患者发生GI疾病的风险。确定了1976 - 2013年明尼苏达州奥尔姆斯特德县居民中345例结节病新发病例的人群队列。还从同一基础人群中确定了345名性别和年龄匹配的对照者。回顾两组的医疗记录以查找GI疾病。使用调整了年龄、性别和日历年的Cox模型比较两组之间GI疾病的发生速率。此外，使用Cox模型评估免疫抑制剂的使用与结节病患者发生GI疾病之间的关联。101例病例和63名对照者发生了GI事件，对应的调整后风险比（HR）为1.90（95%置信区间[CI] 1.38 - 2.61）。与对照者相比，结节病患者上消化道（HR 1.90；95%CI 1.27 - 2.83）和下消化道事件（HR 1.97；95%CI 1.27 - 3.05）的风险均增加。按疾病类型，结节病患者发生上消化道溃疡、上消化道出血和憩室炎的风险显著升高。关于药物使用，唯一显著的关联是生物制剂使用者发生上消化道事件的风险增加（HR 11.09；95%CI 2.16 - 56.97）。与无结节病的受试者相比，结节病患者发生上消化道和下消化道事件的风险更高。
