Department of Paediatrics, Sheffield Children's Hospital, Sheffield.
School of Medicine, University of Glasgow.
J Pediatr Gastroenterol Nutr. 2021 Sep 1;73(3):358-362. doi: 10.1097/MPG.0000000000003197.
The use of thiopurine therapy in Epstein-Barr virus (EBV)-naïve inflammatory bowel disease (IBD) patients remains controversial due to a risk of EBV-associated complications. We evaluated EBV status and outcomes within our paediatric IBD population over an 8-year period; finding that 217 of 409 (53%) screened patients were seropositive for EBV at IBD diagnosis; that thiopurines were used in 189 of 217 (87%) seropositive and 159 of 192 (83%) seronegative patients (P = 0.22); and that 7 of 192 (4%) previously seronegative patients subsequently tested positive for EBV with 6 of 7 (86%) patients having concurrently recorded thiopurine use. All six patients continued thiopurine with/without a period of cessation; no EBV-associated lymphoproliferative disorders/serious complications were recorded within our cohort. A significant proportion of our patients would not receive thiopurine therapy should their use be avoided in EBV-negative patients (47%) or seronegative males (30%). The small but significant risks of thiopurine treatment must be balanced against the potential benefits of successful IBD management; further research into this is required.
在 EBV 初治的炎症性肠病（IBD）患者中，使用硫嘌呤治疗仍然存在争议，因为存在 EBV 相关并发症的风险。我们在 8 年的时间里评估了我们的儿科 IBD 人群中的 EBV 状态和结局；发现 409 名筛查患者中有 217 名（53%）在 IBD 诊断时 EBV 血清阳性；189 名血清阳性和 159 名血清阴性患者中（87%）使用了硫嘌呤（P = 0.22）；192 名血清阴性患者中有 7 名（4%）随后 EBV 检测呈阳性，其中 6 名（86%）患者同时记录了硫嘌呤的使用。所有 6 名患者继续使用硫嘌呤/停药一段时间；我们的队列中没有记录到 EBV 相关的淋巴增生性疾病/严重并发症。如果在 EBV 阴性患者（47%）或血清阴性男性（30%）中避免使用硫嘌呤治疗，我们的患者中有相当一部分将不会接受硫嘌呤治疗。硫嘌呤治疗的风险很小，但很重要，必须与成功治疗 IBD 的潜在益处相平衡；需要对此进行进一步研究。
