免疫介导性疾病与克罗恩病或溃疡性结肠炎风险：一项前瞻性队列研究。
Immune-mediated diseases and risk of Crohn's disease or ulcerative colitis: a prospective cohort study.
机构信息
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
出版信息
Aliment Pharmacol Ther. 2021 Mar;53(5):598-607. doi: 10.1111/apt.16210. Epub 2020 Dec 5.
BACKGROUND
Although immune-mediated diseases (IMDs) including inflammatory bowel diseases (IBDs) are known to cluster, to what extent this is due to common environmental influences is unknown.
AIM
To examine the incidence of IBD in individuals with another IMD.
METHODS
We used data from the prospective Nurses' Health Study II cohort (1995-2017) to examine the effect of diagnoses of several common IMDs on subsequent risk of Crohn's disease (CD) or ulcerative colitis (UC) using Cox proportional hazards models, adjusting for detailed diet and lifestyle confounders.
RESULTS
We documented 132 cases of CD and 186 cases of UC over 2 016 163 person-years of follow-up (median age at IBD diagnosis 50 years). Compared to participants with no history of IMD, the HRs of CD for those with 1 and ≥ 2 IMDs were 2.57 (95% CI 1.77-3.74) and 2.74 (95% CI 1.36 to 5.49), respectively (P < 0.0001). This association was only modestly attenuated by adjustment for environmental risk factors (HR 2.35 and 2.46, respectively). The risk of UC was not increased, with multivariable-adjusted HRs of 1.22 (95% CI 0.85-1.76) and 1.33 (95% CI 0.67-2.65) for those with 1 and ≥ 2 IMDs, respectively, compared to those with none (P 0.16) (P comparing CD and UC 0.037). Asthma, atopic dermatitis, psoriasis and rosacea were individually associated with higher risk of CD (HR ranging from 2.15 to 3.39) but not UC.
CONCLUSIONS
Individuals with one or more IMDs are at an increased risk for CD but not UC.
背景
虽然已知免疫介导的疾病（IMD）包括炎症性肠病（IBD）存在聚集现象，但这种聚集在多大程度上是由于共同的环境影响尚不清楚。
目的
研究其他 IMD 患者中 IBD 的发病情况。
方法
我们使用前瞻性护士健康研究 II 队列（1995-2017 年）的数据，通过 Cox 比例风险模型，在调整详细的饮食和生活方式混杂因素后，研究几种常见 IMD 的诊断对随后发生克罗恩病（CD）或溃疡性结肠炎（UC）的影响。
结果
在 2016163 人年的随访中，我们记录了 132 例 CD 和 186 例 UC（IBD 诊断的中位年龄为 50 岁）。与无 IMD 病史的参与者相比，患有 1 种和≥2 种 IMD 的参与者发生 CD 的 HR 分别为 2.57（95%CI 1.77-3.74）和 2.74（95%CI 1.36-5.49）（P<0.0001）。通过调整环境风险因素，这种关联仅略有减弱（HR 分别为 2.35 和 2.46）。UC 的风险没有增加，多变量调整后的 HR 分别为 1.22（95%CI 0.85-1.76）和 1.33（95%CI 0.67-2.65），与无 IMD 的参与者相比（P=0.16）（P 比较 CD 和 UC=0.037）。哮喘、特应性皮炎、银屑病和酒渣鼻单独与 CD 的风险增加相关（HR 范围为 2.15 至 3.39），但与 UC 无关。
结论
患有一种或多种 IMD 的个体患 CD 的风险增加，但患 UC 的风险没有增加。
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