炎症性肠病肠外表现的发病机制和处理原则

摘要/Abstract

摘要： 炎症性肠病（inflammatory bowel disease,IBD）是一类慢性复发性胃肠道炎症性疾病,包括克罗恩病（Crohn disease,CD）和溃疡性结肠炎（ulcerative colitis,UC）。30%~50% IBD患者可出现肠外表现（extraintestinal manifestation,EIM）,累及肌肉骨骼、皮肤、眼部和肝胆系统等多个器官。部分EIM的发生与IBD炎症活动平行,而另一些则可独立进展,其发病机制涉及遗传易感性、肠道菌群紊乱及免疫异常等多个因素。EIM的诊疗管理需多学科团队（multidisciplinary team,MDT）协作,与IBD活动相关的EIM可通过控制IBD本身来缓解,而独立进展的EIM则需针对其发病机制采取个体化治疗策略。除传统治疗外,肿瘤坏死因子（tumor necrosis factor,TNF）-α抑制剂是适用于大部分EIM治疗的核心生物制剂。未来,精准诊断、个体化治疗及多学科协作将是EIM研究的重点方向。

关键词: 炎症性肠病, 肠外表现, 多学科团队协作, 个体化诊疗

Abstract: Inflammatory bowel disease (IBD) is a group of chronic relapsing inflammatory gastrointestinal diseases, including Crohn′s disease (CD) and ulcerative colitis (UC). Approximately 30%-50% of IBD patients develop extraintestinal manifestations (EIMs), which affect multiple organs such as the musculoskeletal, skin, eyes, and hepatobiliary systems. The occurrence of some EIMs parallels the activity of IBD inflammation, while others may progress independently. The pathogenesis of EIMs involves multiple factors, including genetic susceptibility, dysbiosis of the gut microbiota, and immune dysregulation. The diagnosis and management of EIMs require multidisciplinary team (MDT) collaboration. EIMs associated with IBD activity can be alleviated by controlling the underlying IBD, while EIM with independent progression requires individualized treatment strategies according to its pathogenesis. In addition to conventional treatments, tumor necrosis factor (TNF)-α inhibitors are core biologics suitable for the treatment of most EIMs. In the future, precision diagnosis, personalized treatment, and multidisciplinary collaboration will be key directions in EIMs research.

Key words: Inflammatory bowel disease, Extraintestinal manifestation, multidisciplinary team collaboration, Personalized diagnosis and treatment

中图分类号:

R574

曹芝君, 陆君涛. 炎症性肠病肠外表现的发病机制和处理原则[J]. 内科理论与实践.

CAO Zhijun, LU Juntao. Pathogenesis and Management Principles of Extraintestinal Manifestations in Inflammatory Bowel Disease[J]. Journal of Internal Medicine Concepts & Practice.

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