Department of Internal Medicine.
Divison of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic.
J Clin Gastroenterol. 2023;57(5):501-507. doi: 10.1097/MCG.0000000000001714. Epub 2022 Apr 21.
Alzheimer disease (AD) affects 5 million Americans and early recognition improves cognitive function. Chronic inflammation and gut microbiome alteration are linked to cognitive decline which are common in inflammatory bowel disease (IBD). We investigated the association of IBD with development of AD. A commercial database (Explorys Inc., Cleveland, OH), an aggregate of electronic health records from 26 major US health care systems, was surveyed. Cohorts of patients with Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnoses of Crohn's disease (CD), ulcerative colitis (UC), and AD were identified. IBD patients with new diagnosis of AD were characterized based on demographic and traditional AD risk factors and IBD-related features. Among 342,740 IBD patients in the database, AD developed in 5750 IBD patients (1.55%). After adjusting for traditional AD risk factors, IBD was identified as an independent risk factor for development of AD [odds ratio (OR)=2.30, 95% confidence interval (CI)=2.10-2.51]. IBD patients with AD were younger in comparison to AD patients without IBD. On sub-group analysis, patients with CD had higher odds of developing AD (adjusted OR=3.34, 95% CI=3.25-3.42) than UC (adjusted OR=1.09, 95% CI=1.06-1.14). Use of tumor necrosis factor (TNF-α) inhibitors in IBD was associated with significantly lower odds of developing AD in both CD and UC. In this population based study, IBD was independently associated with development of AD. Among IBD; the association was stronger in patients with CD in comparison with UC. Use of TNF-α inhibitors was associated with lower odds of developing AD.
阿尔茨海默病（AD）影响了 500 万美国人，早期识别可以改善认知功能。慢性炎症和肠道微生物群的改变与认知能力下降有关，而这些变化在炎症性肠病（IBD）中很常见。我们研究了 IBD 与 AD 发病之间的关系。调查了一个商业数据库（克利夫兰的 Explorys Inc.，来自 26 个美国主要医疗保健系统的电子健康记录的集合）。使用系统医学术语命名法-临床术语（SNOMED-CT）确定了克罗恩病（CD）、溃疡性结肠炎（UC）和 AD 的患者队列。根据人口统计学和传统 AD 风险因素以及与 IBD 相关的特征，对 IBD 患者中出现新诊断 AD 的患者进行了描述。在数据库中的 342740 名 IBD 患者中，5750 名 IBD 患者（1.55%）发生了 AD。在调整了传统 AD 风险因素后，IBD 被确定为 AD 发病的独立危险因素[比值比（OR）=2.30，95%置信区间（CI）=2.10-2.51]。与没有 IBD 的 AD 患者相比，患有 AD 的 IBD 患者年龄更小。在亚组分析中，与 UC 相比，CD 患者发生 AD 的几率更高（调整后的 OR=3.34，95%CI=3.25-3.42）。IBD 中使用肿瘤坏死因子（TNF-α）抑制剂与 CD 和 UC 中 AD 发病的几率显著降低相关。在这项基于人群的研究中，IBD 与 AD 的发病独立相关。在 IBD 中，与 UC 相比，CD 患者的相关性更强。使用 TNF-α 抑制剂与 AD 发病几率降低相关。
