溃疡性结肠炎的肠外皮肤表现
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摘要
溃疡性结肠炎(UC)的发病率呈逐年上升趋势,其发病机制尚未完全明确。UC肠外表现(EIM)多样,可涉及骨关节、皮肤、肝胆、眼等全身多个器官系统,一种EIM的出现增加了其他EIM的发生风险。皮肤表现是UC重要的EIM,可分为反应性皮肤表现、免疫相关性皮肤表现、营养不良和治疗导致的皮肤表现。本文就UC肠外皮肤表现的临床症状、诊断、治疗等作一综述。
The incidence of ulcerative colitis( UC) is increasing in recent years,and its pathogenesis is not completely clear. The extraintestinal manifestations( EIM) of UC are diverse and can involve multiple organ systems such as bone and joint,skin,liver and gallbladder,eye,etc. The incidence of one EIM increases the risk of development of other EIM. Cutaneous manifestations are important EIM of UC,and are usually classified into reactive,immunityassociated,malnutrition and treatment-induced manifestations. This article reviewed the clinical symptoms,diagnosis and treatment of cutaneous extraintestinal manifestations of UC.
The incidence of ulcerative colitis( UC) is increasing in recent years,and its pathogenesis is not completely clear. The extraintestinal manifestations( EIM) of UC are diverse and can involve multiple organ systems such as bone and joint,skin,liver and gallbladder,eye,etc. The incidence of one EIM increases the risk of development of other EIM. Cutaneous manifestations are important EIM of UC,and are usually classified into reactive,immunityassociated,malnutrition and treatment-induced manifestations. This article reviewed the clinical symptoms,diagnosis and treatment of cutaneous extraintestinal manifestations of UC.
引文
1 Holleran G,Lopetuso LR,Ianiro G,et al. Gut microbiota and inflammatory bowel disease:so far so gut![J].Minerva Gastroenterol Dietol,2017,63(4):373-384.
2 Karmiris K, Avgerinos A, Tavernaraki A, et al.Prevalence and Characteristics of Extra-intestinal Manifestations in a Large Cohort of Greek Patients with Inflammatory Bowel Disease[J]. J Crohns Colitis,2016,10(4):429-436.
3 Vide J, Osório F, Costa-Silva M, et al. Cutaneous Morbidity Among Inflammatory Bowel Disease Patients:A Cohort Study[J]. J Crohns Colitis, 2018, 12(4):442-451.
4 Marzano AV,Borghi A,Stadnicki A,et al. Cutaneous manifestations in patients with inflammatory bowel diseases:pathophysiology, clinical features, and therapy[J].Inflamm Bowel Dis,2014,20(1):213-227.
5 Ott C,Sch9lmerich J. Extraintestinal manifestations and complications in IBD[J]. Nat Rev Gastroenterol Hepatol,2013,10(10):585-595.
6 Peyrin-Biroulet L,Van Assche G,Gómez-Ulloa D,et al.Systematic Review of Tumor Necrosis Factor Antagonists in Extraintestinal Manifestations in Inflammatory Bowel Disease[J]. Clin Gastroenterol Hepatol,2017,15(1):25 -36. e27.
7 Sagami S,Ueno Y,Tanaka S,et al. Successful Use of Adalimumab for Treating Pyoderma Gangrenosum with Ulcerative Colitis under Corticosteroid-tapering Conditions[J]. Intern Med,2015,54(17):2167-2172.
8 Baumgart DC, Wiedenmann B, Dignass AU. Rescue therapy with tacrolimus is effective in patients with severe and refractory inflammatory bowel disease[J]. Aliment Pharmacol Ther,2003,17(10):1273-1281.
9 Hindryckx P,Novak G,Costanzo A,et al. Disease-related and drug-induced skin manifestations in inflammatory bowel disease[J]. Expert Rev Gastroenterol Hepatol,2017,11(3):203-214.
10 Harbord M,Annese V,Vavricka SR,et al; European Crohn’s and Colitis Organisation. The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease[J]. J Crohns Colitis,2016,10(3):239-254.
11 Catalán-Serra I,Martín-Moraleda L,Navarro-López L,et al. Crohn’s disease and Sweet’s syndrome:an uncommon association[J]. Rev Esp Enferm Dig,2010,102(5):331-337.
12 Timani S, Mutasim DF. Skin manifestations of inflammatory bowel disease[J]. Clin Dermatol,2008,26(3):265-273.
13 Pellicer Z,Santiago JM,Rodriguez A,et al. Management of cutaneous disorders related to inflammatory bowel disease[J]. Ann Gastroenterol,2012,25(1):21-26.
14 Singh S, Graff LA, Bernstein CN. Do NSAIDs,antibiotics,infections,or stress trigger flares in IBD?[J].Am J Gastroenterol,2009,104(5):1298-1313.
15 Markiewicz M, Suresh L, Margarone J 3rd, et al.Pyostomatitis vegetans:A clinical marker of silent ulcerative colitis[J]. J Oral Maxillofac Surg,2007,65(2):346-348.
16 Hegarty AM,Barrett AW,Scully C. Pyostomatitis vegetans[J]. Clin Exp Dermatol,2004,29(1):1-7.
17 Knapp N,Khan Z,Albuquerque R,et al. Pyostomatitis Vegetans in Ulcerative Colitis; Management with Topical Tacrolimus and Systemic Azathioprine in a 10-year-old Boy(Case Report and Review of the Literature)[J]. J Int Oral Health,2016,8(1):132-136.
18 Calobrisi SD,Mutasim DF,McDonald JS. Pyostomatitis vegetans associated with ulcerative colitis. Temporary clearance with fluocinonide gel and complete remission after colectomy[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod,1995,79(4):452-454.
19 Marinea爫A,Rezu爧E,Mihai C,et al. Extra intestinal manifestations and complications in inflammatory bowel disease[J]. Rev Med Chir Soc Med Nat Iasi,2014,118(2):279-288.
20 Farhi D,Cosnes J,Zizi N,et al. Significance of erythema nodosum and pyoderma gangrenosum in inflammatory bowel diseases:a cohort study of 2402 patients[J]. Medicine(Baltimore),2008,87(5):281-293.
21 Blake T,Manahan M,Rodins K. Erythema nodosum-a review of an uncommon panniculitis[J]. Dermatol Online J,2014,20(4):22376.
22 Georgiou G,Pasmatzi E,Monastirli A,et al. Cutaneous manifestations of inammatory bowel disease[J]. Hosp Chron,2006,1(9):158-168.
23 Vavricka SR,Brun L,Ballabeni P,et al. Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort[J]. Am J Gastroenterol,2011,106(1):110-119.
24 中华口腔医学会口腔黏膜病专业委员会,中华口腔医学会中西医结合专业委员会.复发性阿弗他溃疡诊疗指南(试行)[J].中华口腔医学杂志,2012,47(7):402-404.
25 邓维,于瑞星,张晓艳.银屑病与慢性炎症性肠病的相关性研究进展[J].国际皮肤性病学杂志,2017,43(5):285-288.
26 Denadai R,Teixeira FV,Steinwurz F,et al. Induction or exacerbation of psoriatic lesions during anti-TNF-αtherapy for inflammatory bowel disease:a systematic literature review based on 222 cases[J]. J Crohns Colitis,2013,7(7):517-524.
27 Tillack C,Ehmann LM,Friedrich M,et al. Anti-TNF antibody-induced psoriasiform skin lesions in patients with inflammatory bowel disease are characterised by interferon-γ-expressing Th1 cells and IL-17A/IL-22-expressing Th17cells and respond to anti-IL-12/IL-23 antibody treatment[J]. Gut,2014,63(4):567-577.
28 Shipman AR, Reddy H, Wojnarowska F. Association between the subepidermal autoimmune blistering diseases linear Ig A disease and the pemphigoid group and inflammatory bowel disease:two case reports and literature review[J]. Clin Exp Dermatol,2012,37(5):461-468.
29 Cleynen I,Vermeire S. Paradoxical inflammation induced by anti-TNF agents in patients with IBD[J]. Nat Rev Gastroenterol Hepatol,2012,9(9):496-503.
30 Ariyaratnam J, Subramanian V. Association between thiopurine use and nonmelanoma skin cancers in patients with inflammatory bowel disease:a meta-analysis[J]. Am J Gastroenterol,2014,109(2):163-169.
31 田原,李俊霞,王化虹,等.溃疡性结肠炎患者皮肤表现及影响因素分析[J].中华内科杂志,2016,55(7):505-509.
2 Karmiris K, Avgerinos A, Tavernaraki A, et al.Prevalence and Characteristics of Extra-intestinal Manifestations in a Large Cohort of Greek Patients with Inflammatory Bowel Disease[J]. J Crohns Colitis,2016,10(4):429-436.
3 Vide J, Osório F, Costa-Silva M, et al. Cutaneous Morbidity Among Inflammatory Bowel Disease Patients:A Cohort Study[J]. J Crohns Colitis, 2018, 12(4):442-451.
4 Marzano AV,Borghi A,Stadnicki A,et al. Cutaneous manifestations in patients with inflammatory bowel diseases:pathophysiology, clinical features, and therapy[J].Inflamm Bowel Dis,2014,20(1):213-227.
5 Ott C,Sch9lmerich J. Extraintestinal manifestations and complications in IBD[J]. Nat Rev Gastroenterol Hepatol,2013,10(10):585-595.
6 Peyrin-Biroulet L,Van Assche G,Gómez-Ulloa D,et al.Systematic Review of Tumor Necrosis Factor Antagonists in Extraintestinal Manifestations in Inflammatory Bowel Disease[J]. Clin Gastroenterol Hepatol,2017,15(1):25 -36. e27.
7 Sagami S,Ueno Y,Tanaka S,et al. Successful Use of Adalimumab for Treating Pyoderma Gangrenosum with Ulcerative Colitis under Corticosteroid-tapering Conditions[J]. Intern Med,2015,54(17):2167-2172.
8 Baumgart DC, Wiedenmann B, Dignass AU. Rescue therapy with tacrolimus is effective in patients with severe and refractory inflammatory bowel disease[J]. Aliment Pharmacol Ther,2003,17(10):1273-1281.
9 Hindryckx P,Novak G,Costanzo A,et al. Disease-related and drug-induced skin manifestations in inflammatory bowel disease[J]. Expert Rev Gastroenterol Hepatol,2017,11(3):203-214.
10 Harbord M,Annese V,Vavricka SR,et al; European Crohn’s and Colitis Organisation. The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease[J]. J Crohns Colitis,2016,10(3):239-254.
11 Catalán-Serra I,Martín-Moraleda L,Navarro-López L,et al. Crohn’s disease and Sweet’s syndrome:an uncommon association[J]. Rev Esp Enferm Dig,2010,102(5):331-337.
12 Timani S, Mutasim DF. Skin manifestations of inflammatory bowel disease[J]. Clin Dermatol,2008,26(3):265-273.
13 Pellicer Z,Santiago JM,Rodriguez A,et al. Management of cutaneous disorders related to inflammatory bowel disease[J]. Ann Gastroenterol,2012,25(1):21-26.
14 Singh S, Graff LA, Bernstein CN. Do NSAIDs,antibiotics,infections,or stress trigger flares in IBD?[J].Am J Gastroenterol,2009,104(5):1298-1313.
15 Markiewicz M, Suresh L, Margarone J 3rd, et al.Pyostomatitis vegetans:A clinical marker of silent ulcerative colitis[J]. J Oral Maxillofac Surg,2007,65(2):346-348.
16 Hegarty AM,Barrett AW,Scully C. Pyostomatitis vegetans[J]. Clin Exp Dermatol,2004,29(1):1-7.
17 Knapp N,Khan Z,Albuquerque R,et al. Pyostomatitis Vegetans in Ulcerative Colitis; Management with Topical Tacrolimus and Systemic Azathioprine in a 10-year-old Boy(Case Report and Review of the Literature)[J]. J Int Oral Health,2016,8(1):132-136.
18 Calobrisi SD,Mutasim DF,McDonald JS. Pyostomatitis vegetans associated with ulcerative colitis. Temporary clearance with fluocinonide gel and complete remission after colectomy[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod,1995,79(4):452-454.
19 Marinea爫A,Rezu爧E,Mihai C,et al. Extra intestinal manifestations and complications in inflammatory bowel disease[J]. Rev Med Chir Soc Med Nat Iasi,2014,118(2):279-288.
20 Farhi D,Cosnes J,Zizi N,et al. Significance of erythema nodosum and pyoderma gangrenosum in inflammatory bowel diseases:a cohort study of 2402 patients[J]. Medicine(Baltimore),2008,87(5):281-293.
21 Blake T,Manahan M,Rodins K. Erythema nodosum-a review of an uncommon panniculitis[J]. Dermatol Online J,2014,20(4):22376.
22 Georgiou G,Pasmatzi E,Monastirli A,et al. Cutaneous manifestations of inammatory bowel disease[J]. Hosp Chron,2006,1(9):158-168.
23 Vavricka SR,Brun L,Ballabeni P,et al. Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort[J]. Am J Gastroenterol,2011,106(1):110-119.
24 中华口腔医学会口腔黏膜病专业委员会,中华口腔医学会中西医结合专业委员会.复发性阿弗他溃疡诊疗指南(试行)[J].中华口腔医学杂志,2012,47(7):402-404.
25 邓维,于瑞星,张晓艳.银屑病与慢性炎症性肠病的相关性研究进展[J].国际皮肤性病学杂志,2017,43(5):285-288.
26 Denadai R,Teixeira FV,Steinwurz F,et al. Induction or exacerbation of psoriatic lesions during anti-TNF-αtherapy for inflammatory bowel disease:a systematic literature review based on 222 cases[J]. J Crohns Colitis,2013,7(7):517-524.
27 Tillack C,Ehmann LM,Friedrich M,et al. Anti-TNF antibody-induced psoriasiform skin lesions in patients with inflammatory bowel disease are characterised by interferon-γ-expressing Th1 cells and IL-17A/IL-22-expressing Th17cells and respond to anti-IL-12/IL-23 antibody treatment[J]. Gut,2014,63(4):567-577.
28 Shipman AR, Reddy H, Wojnarowska F. Association between the subepidermal autoimmune blistering diseases linear Ig A disease and the pemphigoid group and inflammatory bowel disease:two case reports and literature review[J]. Clin Exp Dermatol,2012,37(5):461-468.
29 Cleynen I,Vermeire S. Paradoxical inflammation induced by anti-TNF agents in patients with IBD[J]. Nat Rev Gastroenterol Hepatol,2012,9(9):496-503.
30 Ariyaratnam J, Subramanian V. Association between thiopurine use and nonmelanoma skin cancers in patients with inflammatory bowel disease:a meta-analysis[J]. Am J Gastroenterol,2014,109(2):163-169.
31 田原,李俊霞,王化虹,等.溃疡性结肠炎患者皮肤表现及影响因素分析[J].中华内科杂志,2016,55(7):505-509.