炎症性肠病合并自身免疫病54例的临床特征及药物选择分析

Clinical features and drug selection in 54 patients with inflammatory bowel disease and comorbid autoimmune disease

目的 探讨IBD合并自身免疫病（AD）患者与单纯IBD患者病变部位、病理、疾病严重程度、肠外表现,以及药物治疗差异.方法 回顾性分析2009年1月至2014年12月收治的54例IBD合并AD患者与同期住院的74例单纯IBD患者临床资料.按IBD病种及是否合并AD分为CD＋ AD组16例,CD组26例,UC＋ AD组38例,UC组48例.采用卡方检验比较合并与未合并AD的IBD患者的疾病严重程度、病变部位、肠外表现、治疗方案.结果 4组间病变部位差异无统计学意义（P均＞0.05）.IBD合并的AD中最常见的是类风湿关节炎[20.4％（11/54）]和强直性脊柱炎[13.0％（7/54）].CD＋ AD组中,轻度活动期患者比例明显低于CD组[2/16比53.8％（14/26）,x2=7.180,P=0.007],重度比例明显高于CD组（6/16比0,x2=8.519,P=0.004）,而两组间中度活动期比例差异无统计学意义（P=0.808）.UC＋AD组和UC组均以中度活动期患者为主[UC＋AD组占76.3％（29/38）,UC组占68.8％（33/48）],疾病分期分布差异均无统计学意义（P均＞0.05）.IBD＋ AD组肠外表现发生率[55.6％（30/54）]明显高于IBD组[9.5％（7/74）,x2=32.279,P＜0.01],主要表现为关节炎[37.0％（20/54）比5.4％（4/74）,x2=20.504,P＜0.01].IBD合并AD患者糖皮质激素及免疫抑制剂使用率均明显高于IBD患者[40.7％（22/54）比17.6％（13/74）,x2=8.438,P=0.004;20.4％（11/54）比0,x2=14.000,P＜0.01].结论 IBD合并AD患者病情较重,肠外器官受累率高,早期予糖皮质激素和免疫抑制剂治疗能有效缓解病情.

Objective To explore the differences in disease location,pathological feature,disease severity,extraintestinal manifestations and drug treatment between inflammatory bowel disease （IBD） patients with comorbid autoimmune disease （AD） and simple IBD patients.Methods From January 2009 to December 2014,the clinical data of 54 IBD patients with comorbid AD and at the same period 74 simple hospitalized IBD patients were retrospectively analyzed.According to IBD type and whether combined with AD,patients were divided into Crohn＇s disease （CD）＋AD group （n=16）,CD group （n=26）,ulcerative colitis （UC）＋AD group （n=38） and UC group （n=48）.Chi square test was performed to compare the differences in disease severity,location,extraintestinal manifestations and drug treatment between IBD patients with and without AD.Results There was no statistically significant difference in location among four groups （all P〉0.05）.The most common concomitant AD of IBD was rheumatoid arthritis （20.4%,11/54） and ankylosing spondylitis （13.0%,7/54）.The proportion of mild active patients of CD＋ AD group was lower than that of CD group （2/16 vs 53.8% （14/26）,x2 =7.180,P=0.007）,while the proportion of severe active patients was significantly higher that of CD group （6/16 vs 0,x2 =8.519,P=0.004）.There was no statistically significant difference in moderate active patients between the two groups （P=0.808）.Main type of patients of UC＋ AD group （76.3 %,29/38） and UC group （68.8 %,33/48） were moderate active patients.There was no statistically significant difference in disease stage and location （all P〉0.05）.The incidence of extraintestinal manifestations of IBD＋AD group （55.6 %,30/ 54） was significantly higher than that of IBD group （9.5 %,7/74,x2 =32.279,P〈0.01）,and the main manifestation was arthritis （37.0% （20/54） vs 5.4% （4/74）,x2=20.504,P〈0.01）.The rate of glucocorticoid and immunosuppressant application in IBD＋AD group was higher than that of IBD group （40.7% （22/54） vs 17.6%（13/74）,x2 =8.438,P=0.004;20.4%（11/54） vs 0,x2=14.000,P〈 0.01）.Conclusions The condition of patients with IBD and comorbid AD is more severe,and the incidence of extraintestinal manifestations is higher.Early treated with glucocorticoid and immunosuppressant could effectively achieve remission.