炎症性肠病与慢性肝脏疾病的关系及其管理策略

Association between inflammatory bowel disease and chronic liver diseases and related management strategies

炎症性肠病(IBD)在多种情况下都可以合并慢性肝脏疾病。IBD与包括原发性硬化性胆管炎、原发性胆汁性胆管炎、自身免疫性肝炎在内的自身免疫性肝病在发病机制上有重叠因素,故合并存在的现象并不少见,其中原发性硬化性胆管炎合并IBD的几率最高,可达80%以上;IBD合并慢性HBV/HCV感染的几率与当地的感染率相关,若在应用免疫抑制剂之前忽略了对HBV/HCV感染的筛查,则存在HBV/HCV感染加重或HBV再激活的发生风险;IBD患者在长期治疗中应用的抗生素、类固醇激素类药物、免疫抑制剂时有诱导药物性肝损伤的可能;尽管IBD患者常因腹泻、吸收障碍等因素导致消瘦,但其合并非酒精性脂肪性肝病的几率却明显高于当地一般人群。

Inflammatory bowel disease(IBD)is often accompanied by chronic liver diseases in a variety of situations.Due to the overlapping factors in the pathogenesis of IBD and autoimmune liver diseases including primary sclerosing cholangitis(PSC),primary biliary cholangitis,and autoimmune hepatitis,the co-existence of these diseases is not uncommon,among which PSC with IBD has the highest probability of more than 80%.The probability of IBD with chronic hepatitis B virus(HBV)/hepatitis C virus(HCV)infection is associated with local infection rate,and if the screening for HBV/HCV infection is ignored before the application of immunosuppressive agents,there may be a risk of aggravated HBV/HCV infection or HBV reactivation.Long-term treatment with antibiotics,steroids,and immunosuppressants may cause drug-induced liver injury in patients with IBD.Although IBD patients often have weight loss due to the factors including diarrhea and absorption disorders,these patients may have a higher probability of nonalcoholic fatty liver disease than the general population.