Erasmus MC, University Medical Center, Gastroenterology and Hepatology, Rotterdam, The Netherlands.
Erasmus MC, University Medical Center, Public Health, Rotterdam, The Netherlands.
J Crohns Colitis. 2021 Sep 25;15(9):1464-1473. doi: 10.1093/ecco-jcc/jjab036.
Women with inflammatory bowel disease [IBD] may be at higher risk for cervical intraepithelial neoplasia [CIN]. However, data are conflicting. The aim of this study was to assess the risk of high-grade dysplasia and cancer [CIN2+] in IBD women and identify risk factors.
Clinical data from adult IBD women in a multicentre Dutch IBD prospective cohort [PSI] from 2007 onwards were linked to cervical cytology and histology records from the Dutch nationwide cytology and pathology database [PALGA], from 2000 to 2016. Patients were frequency-matched 1:4 to a general population cohort. Standardised detection rates [SDR] were calculated for CIN2+. Longitudinal data were assessed to calculate CIN2+ risk during follow-up using incidence rate ratios [IRR] and risk factors were identified in multivariable analysis.
Cervical records were available from 2098 IBD women [77%] and 8379 in the matched cohort; median follow-up was 13 years. CIN2+ detection rate was higher in the IBD cohort than in the matched cohort (SDR 1.27, 95% confidence interval [CI] 1.05-1.52). Women with IBD had an increased risk of CIN2+ [IRR 1.66, 95% CI 1.21-2.25] and persistent or recurrent CIN during follow-up (odds ratio [OR] 1.89, 95% CI 1.06-3.38). Risk factors for CIN2+ in IBD women were smoking and disease location (ileocolonic [L3] or upper gastrointestinal [GI] [L4]). CIN2+ risk was not associated with exposure to immunosuppressants.
Women with IBD are at increased risk for CIN2+ lesions. These results underline the importance of human papillomavirus [HPV] vaccination and adherence to cervical cancer screening guidelines in IBD women, regardless of exposure to immunosuppressants.
患有炎症性肠病（IBD）的女性可能面临更高的宫颈上皮内瘤变（CIN）风险。然而，目前的数据存在矛盾。本研究旨在评估 IBD 女性发生高级别发育不良和癌症（CIN2+）的风险，并确定相关风险因素。
自 2007 年以来，纳入了来自荷兰多中心炎症性肠病前瞻性队列研究（PSI）的成年 IBD 女性的临床数据，并与荷兰全国细胞学和病理学数据库（PALGA）中 2000 年至 2016 年的宫颈细胞学和组织学记录进行了关联。患者按照 1:4 的频率与一般人群队列进行匹配。计算了 CIN2+的标准化检出率（SDR）。通过使用发病率比（IRR）对纵向数据进行评估，计算了随访期间发生 CIN2+的风险，并在多变量分析中确定了风险因素。
2098 例 IBD 女性（77%）和 8379 例匹配队列的女性的宫颈记录均可获取；中位随访时间为 13 年。IBD 队列的 CIN2+检出率高于匹配队列（SDR 1.27，95%置信区间[CI]1.05-1.52）。IBD 女性发生 CIN2+（IRR 1.66，95%CI 1.21-2.25）和随访期间持续或复发 CIN 的风险增加（比值比[OR]1.89，95%CI 1.06-3.38）。IBD 女性发生 CIN2+的风险因素为吸烟和疾病部位（回结肠[L3]或上胃肠道[GI][L4]）。CIN2+的风险与免疫抑制剂的暴露无关。
患有 IBD 的女性发生 CIN2+病变的风险增加。这些结果强调了在 IBD 女性中接种人乳头瘤病毒（HPV）疫苗和遵循宫颈癌筛查指南的重要性，无论其是否接触免疫抑制剂。
