Kounis Ilias, Renou Christophe, Nahon Stephane, Heluwaert Frederic, Macaigne Gilles, Amil Morgane, Talom Stephane, Lambare Benedicte, Charpignon Claire, Paupard Thierry, Stetiu Monica, Ripault Marie Pierre, Yamaga Armand, Ehrhard Florent, Audemar Franck, Ortiz Correro Maria Carmen, Zanditenas David, Skinazi Florence, Agostini Helene, Coilly Audrey, Roque-Afonso Anne Marie
Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, 94800 Villejuif, France.
Inserm, UMR-S 1193, Université Paris-Saclay, 94800 Villejuif, France.
Pathogens. 2023 Feb 15;12(2):332. doi: 10.3390/pathogens12020332.
Medical treatment of inflammatory bowel disease (IBD) has evolved significantly, and treatment with immunomodulators is recommended. These medications may alter the patient's immune response and increase the risk of opportunistic infections. Our aim was to evaluate the prevalence and the incidence of acute or chronic HEV infection in IBD patients under immunomodulatory treatment.
We conducted a retrospective, multicenter, observational study between 2017 and 2018. IBD outpatients hospitalized for the infusion of immunomodulators were included in 16 French centers. During their daily hospitalization, blood samples were drawn for HEV serology (IgM and IgG) and HEV RNA detection.
A total of 488 patients were included, of which 327 (67%) patients had Crohn's disease and 161 (33%) ulcerative colitis. HEV IgM was detected in 3 patients, but HEV RNA was undetectable in all patients. The HEV IgG seroprevalence rate was 14.2%. IgG-positive patients were older at sampling ( = 0.01) and IBD diagnosis ( = 0.03), had higher seafood consumption ( = 0.01) and higher doses of azathioprine ( = 0.03). Ileal and upper digestive tract involvement was more frequent in IgG-positive patients ( = 0.009), and ileocolic involvement was more frequent in IgG-negative patients ( = 0.01). Under multivariate analysis, age > 50 years [OR: 2.21 (1.26, to 3.85), = 0.004] was associated with previous HEV infection.
Systematic screening for HEV infection is not needed among IBD patients on immunomodulatory medications. However, in the event of abnormal liver test findings, HEV should be part of the classic diagnostic assessment.
炎症性肠病（IBD）的医学治疗已经有了显著进展，推荐使用免疫调节剂进行治疗。这些药物可能会改变患者的免疫反应，并增加机会性感染的风险。我们的目的是评估接受免疫调节治疗的IBD患者中急性或慢性戊型肝炎病毒（HEV）感染的患病率和发病率。
我们在2017年至2018年期间进行了一项回顾性、多中心、观察性研究。16个法国中心纳入了因输注免疫调节剂而住院的IBD门诊患者。在他们日常住院期间，采集血样进行HEV血清学检测（IgM和IgG）以及HEV RNA检测。
共纳入488例患者，其中327例（67%）为克罗恩病患者，161例（33%）为溃疡性结肠炎患者。3例患者检测到HEV IgM，但所有患者均未检测到HEV RNA。HEV IgG血清阳性率为14.2%。IgG阳性患者在采样时年龄更大（P = 0.01）且IBD诊断时年龄更大（P = 0.03），海鲜消费量更高（P = 0.01）且硫唑嘌呤剂量更高（P = 0.03）。IgG阳性患者回肠和上消化道受累更常见（P = 0.009），而IgG阴性患者回结肠受累更常见（P = 0.01）。在多变量分析中，年龄>50岁[比值比：2.21（1.26，至3.85），P = 0.004]与既往HEV感染相关。
对于接受免疫调节药物治疗的IBD患者，无需进行系统性的HEV感染筛查。然而，如果肝功能检查结果异常，HEV应作为经典诊断评估的一部分。
