炎症性肠病中的银屑病：一项系统评价与荟萃分析

Psoriasis in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

摘要: 背景：银屑病是炎症性肠病最常见的免疫介导的皮肤表现。目前关于共存的银屑病对炎症性肠病自然史的影响的数据很少且相互矛盾。本研究旨在确定炎症性肠病患者中银屑病的临床特征和相关风险因素。方法：对电子数据库(PubMed和Embase)进行了搜索，从开始到2022年3月12日，以确定报告炎症性肠病患者中银屑病的研究。从纳入的研究中提取了相关数据，包括无法进行荟萃分析的数据。采用随机和固定效应模型来总结临床信息。本研究遵循流行病学观察研究的Meta分析指南。结果：这项荟萃分析包括34项研究。在累计453,917名IBD患者中，总共有9487例银屑病患者。斑块状银屑病占总数的60.4% (95% CI 0.544~0.665)。50.7%的银屑病患者(95% CI 0.489~0.525)发生在被诊断为炎症性肠病之前。在荟萃分析中，银屑病与女性(RR = 1.145, 95% CI 1.110~1.180)、克罗恩病(RR = 1.128, 95% CI 1.056~1.205)、吸烟者(RR = 1.280, 95% CI 1.130~1.450)、其他肠外表现(RR = 1.907, 95% CI 1.588~2.290)和IBD相关手术史(RR = 2.083, 95% CI 1.203~3.607)有关。结论：大约一半的银屑病在炎症性肠病诊断前出现，抗肿瘤坏死因子治疗诱发的矛盾性银屑病不是停药的指征。临床医生应针对这一特殊人群制定个性化的治疗方案。

Abstract: Background: Psoriasis is the most common immune-mediated cutaneous manifestation of inflam-matory bowel disease. The current data on the impact of coexistent psoriasis on natural history of inflammatory bowel diseases are scarce and contradictory. This study aimed to identify the clinical features and associated risk factors of psoriasis in patients with inflammatory bowel disease. Methods: The search of electronic databases (PubMed and Embase) was conducted from inception to March 12, 2022 to identify studies reporting psoriasis among inflammatory bowel disease pa-tients. We extracted relevant data from included studies, including data not able to be me-ta-analysis. Random and fixed effect models were used to summarize clinical information. This study followed meta-analysis of Observational Studies in Epidemiology guidelines. Results: This meta-analysis included 34 studies. In total, there were 9487 cases of psoriasis in the cumulative 453,917 IBD patients. Plaque psoriasis accounted for 60.4% of the total (95% CI 0.544~0.665). 50.7% of patients with psoriasis (95% CI 0.489~0.525) occurred before they were diagnosed with inflam-matory bowel disease. In meta-analysis, psoriasis was associated with female (RR = 1.145, 95% CI 1.110~1.180), Crohn’s disease (RR = 1.128, 95% CI 1.056~1.205), smokers (RR = 1.280, 95% CI 1.130~1.450), other extraintestinal manifestations (RR = 1.907, 95% CI 1.588~2.290), and IBD-related surgery history (RR = 2.083, 95% CI 1.203~3.607). Conclusions: About half of psoriasis appear before inflammatory bowel disease diagnosis, and gastroenterology consultation may be required when a patients with psoriasis present with intestinal symptoms. Clinicians should make personalized treatment plans for this specific population.