Barbalho Sandra Maria, Matias Julia Novaes, Flato Uri Adrian Prync, Pilon Joao Paulo Galletti, Bitelli Piero, Pagani Junior Marcos Alberto, de Carvalho Antonelly Cassio Alves, Haber Jesselina Francisco Dos Santos, Reis Carlos Henrique Bertoni, Goulart Ricardo de Alvares
Department of Biochemistry and Pharmacology, School of Medicine, University of Marilia (UNIMAR), Avenida Higino Muzzi Filho, 1001, Marilia, Sao Paulo, Brazil.
Postgraduate Program in Structural and Functional Interactions in Rehabilitation, UNIMAR, Marilia, SP, Brazil.
Gastroenterology Res. 2021 Feb;14(1):1-12. doi: 10.14740/gr1358. Epub 2021 Feb 19.
Inflammatory bowel diseases (IBD) are a group of immune and inflammatory diseases; and patients seem to be more vulnerable to influenza and coronavirus disease 2019 (COVID-19). These conditions are characterized by the augmented release of inflammatory cytokines that have been suggested as potential triggers for the acute respiratory distress syndrome, which may favor severe and even fatal outcomes. For these reasons, this review aims to evaluate what influenza and COVID-19 may represent for patients with IBD.
The search was performed in MEDLINE/PubMed, EMBASE, and Cochrane databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to build the review.
The conventional therapies used by IBD patients may also interfere in the outcomes of influenza and COVID-19. Immune-suppressors agents are associated with a higher risk of infections due to the inhibition of intracellular signals necessary to the host act against pathogens. On the other hand, drugs related to the suppression of the production of cytokines in IBD could bring benefits to reduce mucosal inflammation, and for preventing pneumonia. Moreover, coronaviruses can bind to the target cells through angiotensin-converting enzyme 2 (ACE-2) receptor that is expressed in epithelial cells of the lung and largely the colon and the terminal ileum suggesting that human intestinal tract could be an alternative route for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Once the cytokine storm observed in influenza and COVID-19 is similar to the cytokine pattern observed in IBD patients during the disease flares, the advice is that avoiding the infections is still an optimal option for IBD subjects.
炎症性肠病（IBD）是一组免疫和炎症性疾病；IBD患者似乎更容易感染流感和2019冠状病毒病（COVID-19）。这些疾病的特征是炎症细胞因子释放增加，这些细胞因子被认为是急性呼吸窘迫综合征的潜在触发因素，这可能导致严重甚至致命的后果。基于这些原因，本综述旨在评估流感和COVID-19对IBD患者可能意味着什么。
在MEDLINE/PubMed、EMBASE和Cochrane数据库中进行检索。遵循系统评价和Meta分析的首选报告项目（PRISMA）指南来构建本综述。
IBD患者使用的传统疗法也可能影响流感和COVID-19的结局。免疫抑制剂由于抑制宿主对抗病原体所需的细胞内信号，与感染风险较高相关。另一方面，IBD中与抑制细胞因子产生相关的药物可能有助于减轻黏膜炎症并预防肺炎。此外，冠状病毒可通过血管紧张素转换酶2（ACE-2）受体与靶细胞结合，该受体在肺上皮细胞中表达，在结肠和回肠末端也大量表达，这表明人类肠道可能是严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的另一条传播途径。
鉴于在流感和COVID-19中观察到的细胞因子风暴与IBD患者疾病发作期间观察到的细胞因子模式相似，建议对IBD患者而言，避免感染仍然是最佳选择。
