Gastrounit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Inflamm Bowel Dis. 2021 May 17;27(6):927-939. doi: 10.1093/ibd/izaa167.
Patients with inflammatory bowel diseases (IBDs) are at risk of developing a variety of other immune-mediated inflammatory diseases (IMIDs). The influence of co-occurring IMIDs on the disease course of IBD remains unknown. The aim of this study was therefore to conduct a systematic review and meta-analysis of the impact of IMIDs on phenotypic presentation and outcome in patients with IBD.
PubMed and Embase were searched from their earliest records through December 2018 and updated in October 2019 for studies reporting proportions or ratios of IBD-related disease outcomes in patients with and without co-occurring IMIDs. Meta-analyses were performed to estimate summary proportions and risks of the main outcomes. PRISMA guidelines were used, and study quality was assessed according to the Newcastle-Ottawa Scale.
A total of 93 studies were identified, comprising 16,064 IBD patients with co-occurring IMIDs and 3,451,414 IBD patients without IMIDs. Patients with IBD and co-occurring IMIDs were at increased risk of having extensive colitis or pancolitis (risk ratio, 1.38; 95% Cl, 1.25-1.52; P < 0.01, I2 = 86%) and receiving IBD-related surgeries (risk ratio, 1.17; 95% Cl, 1.01-1.36; P = 0.03; I2 = 85%) compared with patients without IMIDs. Co-occurrence of IMIDs other than primary sclerosing cholangitis in patients with IBD was associated with an increased risk of receiving immunomodulators (risk ratio, 1.15; 95% Cl, 1.06-1.24; P < 0.01; I2 = 60%) and biologic therapies (risk ratio, 1.19; 95% Cl, 1.08-1.32; P < 0.01; I2 = 53%).
This meta-analysis found that the presence of co-occurring IMIDs influences the disease course of IBD, including an increased risk of surgery and its phenotypical expression.
炎症性肠病（IBD）患者存在发生多种其他免疫介导性炎症性疾病（IMIDs）的风险。共存的 IMIDs 对 IBD 病程的影响尚不清楚。因此，本研究旨在对共存 IMIDs 对 IBD 患者表型表现和结局的影响进行系统评价和荟萃分析。
从 PubMed 和 Embase 的最早记录开始检索，检索时间截至 2018 年 12 月，并于 2019 年 10 月更新，以检索报告 IBD 患者共存和不共存 IMIDs 时 IBD 相关疾病结局比例或比值的研究。进行荟萃分析以估计主要结局的综合比例和风险。采用 PRISMA 指南，并根据纽卡斯尔-渥太华量表评估研究质量。
共确定了 93 项研究，包括 16064 例共存 IMIDs 的 IBD 患者和 3451414 例无 IMIDs 的 IBD 患者。与无 IMIDs 的患者相比，IBD 患者伴共存 IMIDs 发生广泛性结肠炎或全结肠炎（风险比，1.38；95%Cl，1.25-1.52；P < 0.01，I2 = 86%）和接受 IBD 相关手术（风险比，1.17；95%Cl，1.01-1.36；P = 0.03；I2 = 85%）的风险增加。IBD 患者共存原发性硬化性胆管炎以外的其他 IMIDs 与接受免疫调节剂（风险比，1.15；95%Cl，1.06-1.24；P < 0.01；I2 = 60%）和生物治疗（风险比，1.19；95%Cl，1.08-1.32；P < 0.01；I2 = 53%）的风险增加相关。
本荟萃分析发现，共存 IMIDs 的存在影响 IBD 的病程，包括手术风险及其表型表达增加。
