Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada.
Am J Gastroenterol. 2021 Jul 1;116(7):1476-1484. doi: 10.14309/ajg.0000000000001237.
Venous thromboembolism (VTE) is known to be increased in inflammatory bowel disease (IBD). We aimed to determine whether rates of VTE in IBD have reduced over the past 30 years.
We used the population-based University of Manitoba IBD Epidemiology Database (1984-2018) to determine the incidence of VTE in IBD and the incidence rate ratio vs matched controls. In persons with IBD with and without VTE, we assessed for variables that were associated with an increased risk of VTE on multivariate logistic regression.
The incidence of VTE in the IBD cohort was 7.6% which was significantly greater than in controls (3.3%, P < 0.0001). The overall age-standardized incidence rate of VTE was 433 per 100,000 in IBD and 184 per 100,000 in controls. The incidence of VTE was higher in Crohn's disease (8.4%) than in ulcerative colitis (6.9%, P = 0.0028). The incidence rate ratio in IBD vs controls was 2.36 (95% confidence interval 2.16-2.58). The increased risk was similar in males and females and in Crohn's disease compared with ulcerative colitis. The incidence rate among persons with IBD from 1985 to 2018 decreased very slowly, with annual percent change of -0.7% (P = 0.0003). Hospital admission, high comorbidity, use of antibodies to tumor necrosis factor for less than 3 years up until the time of the VTE, and the combination of steroid and antibodies to tumor necrosis factor increased the risk of VTE.
Despite advancements in IBD management in the past 30 years, the rates of VTE have only been slowly decreasing and remain significantly increased compared with controls.
静脉血栓栓塞症（VTE）在炎症性肠病（IBD）中较为常见。本研究旨在确定过去 30 年来 IBD 患者的 VTE 发生率是否有所降低。
我们利用基于人群的曼尼托巴大学 IBD 流行病学数据库（1984-2018 年）来确定 IBD 患者的 VTE 发生率以及与匹配对照组相比的发病率比值比。在患有 VTE 和未患有 VTE 的 IBD 患者中，我们通过多变量逻辑回归评估了与 VTE 风险增加相关的变量。
IBD 队列的 VTE 发生率为 7.6%，显著高于对照组（3.3%，P<0.0001）。IBD 患者和对照组的 VTE 年龄标准化发生率分别为 433/100000 和 184/100000。与溃疡性结肠炎（UC）相比，克罗恩病（CD）的 VTE 发生率更高（8.4% vs. 6.9%，P=0.0028）。IBD 与对照组相比，发病率比值比为 2.36（95%置信区间 2.16-2.58）。男性和女性、CD 与 UC 之间的风险增加情况相似。1985 年至 2018 年间，IBD 患者的发病率下降非常缓慢，年变化率为-0.7%（P=0.0003）。住院治疗、高合并症、VTE 发生前使用肿瘤坏死因子抗体治疗时间不足 3 年、类固醇和肿瘤坏死因子抗体联合使用均增加了 VTE 的风险。
尽管过去 30 年来 IBD 管理取得了进展，但 VTE 的发生率仅缓慢下降，与对照组相比仍显著增加。
