Maev I V, Bakulin I G, Skalinskaya M I, Skazyvaeva E V
Yevdokimov Moscow State University of Medicine and Dentistry.
Mechnikov North-Western State Medical University.
Ter Arkh. 2023 Dec 28;95(12):1064-1074. doi: 10.26442/00403660.2023.12.202507.
The global burden of inflammatory bowel disease (IBD) is currently significant and continues to grow due to the increasing prevalence of ulcerative colitis (UC) and Crohn's disease (CD), the increasing costs of diagnosis and treatment, and the high level of disability in patients with this disease. Categories, which leads to the search for risk factors and predictors of aggressive course and extraintestinal manifestations. According to the latest data, the prevalence of UC in Russia is 16.6 per 100 000 population, the annual registered increase is 11.3%; the prevalence of CD is 5.6 per 100 000 population, and the increase is 13.7%. In the Russian population of patients with IBD, the average age of disease onset is 35.3 years for UC and 31.2 years for CD. Moreover, in 89.3% of patients with UC, it took at least 2 years to verify the diagnosis, and in CD, within 2 years from the onset of clinical symptoms, the diagnosis was established in only 72.6% of patients. One of the dominant characteristics of IBD is its multisystem nature, which leads to the development of extraintestinal manifestations (ECM), which can be observed in 50-60% of patients, while up to 25% of patients with IBD have several EMC and the most common variants are joint lesions. A higher frequency of extraintestinal manifestations is observed in CD (up to 45% of patients), in female patients, in smokers and with a longer duration of the disease. To predict clinical remission, the level of fecal calprotectin and CRP, the need for glucocorticosteroids are important, to predict endoscopic remission - the level of fecal calprotectin, and to predict histological remission, an endoscopic Schroeder index value of ≤1 is important. The absolute risk of developing colorectal cancer in IBD remains relatively low, ranging from 1.1 to 5.4% after 20 years of disease. The main risk factors for IBD are total intestinal damage, high inflammatory activity, the stricturing phenotype of CD and the presence of primary sclerosing cholangitis.
目前，炎症性肠病（IBD）的全球负担相当大，并且由于溃疡性结肠炎（UC）和克罗恩病（CD）的患病率不断上升、诊断和治疗成本不断增加以及该病患者的高残疾水平而持续增长。这促使人们寻找侵袭性病程和肠外表现的危险因素及预测因素。根据最新数据，俄罗斯UC的患病率为每10万人中16.6例，年登记增长率为11.3%；CD的患病率为每10万人中5.6例，增长率为13.7%。在俄罗斯IBD患者群体中，UC发病的平均年龄为35.3岁，CD为31.2岁。此外，89.3%的UC患者至少需要2年才能确诊，而在CD患者中，从临床症状出现起2年内，只有72.6%的患者得以确诊。IBD的一个主要特征是其多系统性质，这会导致肠外表现（ECM）的出现，50 - 60%的患者可出现这种表现，而高达25%的IBD患者有多种肠外表现，最常见的类型是关节病变。在CD患者（高达45%的患者）、女性患者、吸烟者以及病程较长的患者中，肠外表现的发生率更高。为预测临床缓解，粪便钙卫蛋白和CRP水平、糖皮质激素的使用需求很重要；为预测内镜缓解，粪便钙卫蛋白水平很重要；为预测组织学缓解，内镜施罗德指数值≤1很重要。IBD患者发生结直肠癌的绝对风险仍然相对较低，病程20年后为1.1%至5.4%。IBD的主要危险因素包括全肠道损伤、高炎症活性、CD的狭窄表型以及原发性硬化性胆管炎的存在。
