炎症性肠病与慢性肝脏疾病的关系及其管理策略

王江滨

doi:10.3969/j.issn.1001-5256.2020.07.002

炎症性肠病与慢性肝脏疾病的关系及其管理策略

DOI: 10.3969/j.issn.1001-5256.2020.07.002

王江滨

吉林大学白求恩第三医院/中日联谊医院消化内科

详细信息

中图分类号: R575;R574
计量
- 文章访问数: 1486
- HTML全文浏览量: 50
- PDF下载量: 234
- 被引次数: 0
出版历程
- 出版日期: 2020-07-20

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

Wang JiangBin

Department of Gastroenterology, Bethune Third Hospital/China-Japan Union Hospital of Jilin University, Changchun 130033, China

摘要

摘要:
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。
- 炎症性肠病 /
- 肝疾病 /
- 诊断 /
- 治疗学
Abstract:
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.
- inflammatory bowel disease /
- liver diseases /
- diagnosis /
- therapeutics

HTML全文

参考文献(39)

[1]BOONSTRA K,van ERPECUM KJ,van NIEUWKERK KM,et al.Primary sclerosing cholangitis is associated with a distinct phenotype of inflammatory bowel disease[J].Inflamm Bowel Dis,2012,18(12):2270-2276．

[2]PARK SH,YANG SK,LIM YS,et al.Clinical courses of chronic hepatitis B virus infection and inflammatory bowel disease in patients with both diseases[J].Inflamm Bowel Dis,2012,18(11):2004-2010．

[3]HORN TL,REYNOLDS J,DE VILLIERS W,et al.Hepatitis C virus and inflammatory bowel disease[J].Dig Dis Sci,2009,54(6):1171-1177．

[4]SHU HJ,LI J,YANG H,et al.Risk of hepatitis B virus reactivation in patients with inflammatory bowel disease combined with positive hepatitis B surface antigen after immunosuppressive therapies[J].Chin J Gastroenterol Hepatol,2016,25(10):1127-1131.(in Chinese)舒慧君，李骥，杨红，等．免疫抑制治疗对HBs Ag阳性炎症性肠病患者HBV再活动的影响[J]．胃肠病学和肝病学杂志，2016,25(10):1127-1131．

[5]PAPA A,FELICE C,MARZO M,et al.Prevalence and natural history of hepatitis B and C infections in a large population of IBD patients treated with anti-tumor necrosis factor-αagents[J].JCrohns Colitis,2013,7(2):113-119．

[6]Drug-induced Liver Disease Study Group,Chinese Society of Hepatology,Chinese Medical Association.Guidelines for the management of drug-induced liver injury[J].J Clin Hepatol,2015,31(11):1752-1769.(in Chinese)中华医学会肝病学分会药物性肝病学组．药物性肝损伤诊治指南[J]．临床肝胆病杂志，2015,31(11):1752-1769．

[7]ROJAS-FERIA M,CASTRO M,SUREZ E,et al.Hepatobiliary manifestations in inflammatory bowel disease:The gut,the drugs and the liver[J].World J Gastroenterol,2013,19(42):7327-7340．

[8]MAGRS,PADUANO D,CHICCO F,et al.Nonalcoholic fatty liver disease in patients with inflammatory bowel disease:Beyond the natural history[J].World J Gastroenterol,2019,25(37):5676-5686．

[9]de VRIES AB,JANSE M,BLOKZIJL H,et al.Distinctive inflammatory bowel disease phenotype in primary sclerosing cholangitis[J].World J Gastroenterol,2015,21(6):1956-1971．

[10]HIRSCHFIELD GM,KARLSEN TH,LINDOR KD,et al.Primary sclerosing cholangitis[J]Lancet,2013,382(9904):1587-1599．

[11]LINDOR KD,KOWDLEY KV,HARRISON ME,et al.ACG Clinical Guideline:Primary sclerosing cholangitis[J]Am J Gastroenterol,2015,110(5):646-659;quiz 660．

[12]LYNCH KD,KESHAV S,CHAPMAN RW.The use of biologics in patients with inflammatory bowel disease and primary sclerosing cholangitis[J].Curr Hepatol Rep,2019,18(1):115-126．

[13]SEIBOLD F,WEBER P,KLEIN R,et al.Clinical significance of antibodies against neutrophils in patients with inflammatory bowel disease and primary sclerosing cholangitis[J].Gut,1992,33(5):657-662．

[14]ALTWEGG R,COMBES R,LAHARIE D,et al.Effectiveness and safety of anti-TNF therapy for inflammatory bowel disease in liver transplant recipients for primary sclerosing cholangitis:A nationwide case series[J].Dig Liver Dis,2018,50(7):668-674．

[15]ARAI O,IKEDA H,MOURI H,et al.Two cases of inflammatory bowel disease diagnosed in the course of primary biliary cirrhosis[J].Nihon Shokakibyo Gakkai Zasshi,2010,107(6):900-908．

[16]MATTNER J.Impact of microbes on the pathogenesis of primary biliary cirrhosis(PBC)and primary sclerosing cholangitis(PSC)[J].Int J Mol Sci,2016,17(11):1864．

[17]LIBERAL R,GASPAR R,LOPES S,et al.Primary biliary cholangitis in patients with inflammatory bowel disease[J].Clin Res Hepatol Gastroenterol,2020,44(1):e5-e9．

[18]TANAKA A.Autoimmune hepatitis:2019 update[J].Gut Liver,2020.[Online ahead of print]

[19]WU XR,LAN N,MUKEWAR S,et al.Autoimmune hepatitis is associated with a high prevalence of gut inflammatory disorders[J].Am J Gastroenterol,2012,107(Suppl 1):A1668．

[20]LIANG X,BI S,YANG W,et al.Epidemiological serosurvey of hepatitis B in China-declining HBV prevalence due to hepatitis B vaccination[J].Vaccine,2009,27(47):6550-6557．

[21]Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:a 2015 update[J].J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会，中华医学会感染病学分会．慢性乙型肝炎防治指南(2015年更新版)[J]．临床肝胆病杂志，2015,31(12):1941-1960．

[22]LIU XQ,QIN L.Treatment strategy of inflammatory bowel disease associated with viral hepatitis[J].Chin J Gastroenterol Hepatol,2016,25(10):1091-1093.(in Chinese)刘晓清，秦岭．炎症性肠病合并病毒性肝炎治疗策略[J]．胃肠病学和肝病学杂志，2016,25(10):1091-1093．

[23]HE Y,XU P,CHEN Y,et al.Prevalence and influences of hepatitis B virus infection on inflammatory bowel disease:A retrospective study in southern China[J].Int J Clin Exp Med,2015,8(5):8078-8085．

[24]KIM ES,CHO KB,PARK KS,et al.Prevalence of hepatitis-B viral markers in patients with inflammatory bowel disease in a hepatitis-B-endemic area:Inadequate protective antibody levels in young patients[J].J Clin Gastroenterol,2014,48(6):553-558．

[25]TOLENTINO YF,FOGACA HS,ZALTMAN C,et al.Hepatitis B virus prevalence and transmission risk factors in inflammatory bowel disease patients at Clementino Fraga Filho university hospital[J].World J Gastroenterol,2008,14(20):3201-3206．

[26]LONGO F,HEBUTERNE X,TRAN A,et al.Prevalence of hepatitis C in patients with chronic inflammatory bowel disease in the region of Nice and evaluation of risk factors[J].Gastroenterol Clin Biol,2000,24(1):77-81．

[27]BIANCONE L,PAVIA M,del VECCHIO BLANCO G,et al.Hepatitis B and C virus infection in Crohn's disease[J].Inflamm Bowel Dis,2001,7(4):287-294．

[28]LORAS C,GISBERT JP,MNGUEZ M,et al.Liver dysfunction related to hepatitis B and C in patients with inflammatory bowel disease treated with immunosuppressive therapy[J].Gut,2010,59(10):1340-1346．

[29]REDDY KR,BEAVERS KL,HAMMOND SP,et al.American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy[J].Gastroenterology,2015,148(1):215-219;quiz e16-e17．

[30]BASTIDA G,NOS P,AGUAS M,et al.Incidence,risk factors and clinical course of thiopurine-induced liver injury in patients with inflammatory bowel disease[J].Aliment Pharmacol Ther,2005,22(9):775-782．

[31]Study Group of Inflammatory Bowel Disease,Chinese Society of Gastroenterology,Chinese Medical Association.Expert consensus on therapeutic drug monitoring for inflammatory bowel disease in China[J].Chin J Dig,2018,38(11):721-727.(in Chinese)中华医学会消化病学分会炎症性肠病学组．中国炎症性肠病治疗药物监测专家共识意见[J]．中华消化杂志，2018,38(11):721-727．

[32]WORLAND T,CHIN KL,van LANGENBERG D,et al.Retrospective study of idiosyncratic drug-induced liver injury from infliximab in an inflammatory bowel disease cohort:The IDLE study[J].Ann Gastroenterol,2020,33(2):162-169．

[33]KOLLER T,GALAMBOSOVA M,FILAKOVSKA S,et al.Druginduced liver injury in inflammatory bowel disease:1-year prospective observational study[J].World J Gastroenterol,2017,23(22):4102-4111．

[34]GIZARD E,FORD AC,BRONOWICKI JP,et al.Systematic review:The epidemiology of the hepatobiliary manifestations in patients with inflammatory bowel disease[J].Aliment Pharmacol Ther,2014,40(1):3-15．

[35]RIEGLER G,D'INCR,STURNIOLO GC,et al.Hepatobiliary alterations in patients with inflammatory bowel disease:A multicenter study.Caprilli&Gruppo Italiano Studio Colon-Retto[J].Scand JGastroenterol,1998,33(1):93-98．

[36]BARGIGGIA S,MACONI G,ELLI M,et al.Sonographic prevalence of liver steatosis and biliary tract stones in patients with inflammatory bowel disease:Study of 511 subjects at a single center[J].J Clin Gastroenterol,2003,36(5):417-420．

[37]SOURIANARAYANANE A,GARG G,SMITH TH,et al.Risk factors of non-alcoholic fatty liver disease in patients with inflammatory bowel disease[J].J Crohns Colitis,2013,7(8):e279-e285．

[38]SAROLI PALUMBO C,RESTELLINI S,CHAO CY,et al.Screening for nonalcoholic fatty liver disease in inflammatory bowel diseases:Acohort study using transient elastography[J].Inflamm Bowel Dis,2019,25(1):124-133．

[39]BARBUIO R,MILANSKI M,BERTOLO MB,et al.Infliximab reverses steatosis and improves insulin signal transduction in liver of rats fed a high-fat diet[J].J Endocrinol,2007,194(3):539-550.

施引文献

资源附件(0)

访问统计