Inflamm Bowel Dis：IBD患者发生淋巴瘤的危险因素

      目前应用免疫抑制剂如硫唑嘌呤、6-巯基嘌呤和抗肿瘤坏死因子-α抑制剂（TNF-α）如英夫利昔单抗、塞妥珠单抗等，是用于IBD诱导或者维持缓解的有效药物。虽然大多数研究都认为IBD本身并不会增加淋巴瘤的风险，但随这些药物使用的增加，出现一些恶性肿瘤的报道如淋巴瘤。因此为了解IBD患者淋巴瘤相关的危险因素，来自美国梅奥中心的Waqqa Afif等人进行了一项研究，该研究发表在2013年6月的《inflammatory bowel diseases》上，该研究认为年龄的增加、男性及免疫抑制剂的使用能增加IBD患者患淋巴瘤的风险。

      在这项研究中实验组和对照组的选择是通过梅奥中心的诊断指标来选取的，最后研究确定了从1980-2009年间确诊为淋巴瘤的80名成年IBD患者。每个实验对象都与2个对照病人在IBD亚型、地理位置及随访时间相匹配，通过应用条件回归分析危险因素与淋巴瘤的相关性。其中实验组有60名（75%）男性，对照组77名（48%）男性。实验组平均年龄为59岁，对照组42岁。实验组和对照组接受免疫抑制剂治疗的分别为20例（25%）和23例（14%），接受TNF-α抑制剂的分别为4例（5%）和6例（4%）。最后通过多元条件回归分析发现，年龄每增加10岁（OR，1.83；95%CI，1.37-2.43）、男性（OR，4.05,；95%CI，1.82-9.02）、免疫抑制剂（OR，4.2；95%，1.35-13.11）能显著增加淋巴瘤的风险。而疾病的严重程度和TNF-α的使用不是淋巴瘤发生的独立危险因素。研究还发现，使用免疫抑制剂或者TNF-α制剂的病人中有75%的人在治疗过程中EB病毒检测阳性，还需要进行一些前瞻性研究来说明EB病毒与淋巴瘤发生的相关性。

      研究认为年龄的增加、男性和免疫抑制剂是IBD患者淋巴瘤发生的危险因素，所以应用免疫抑制剂前要权衡利弊，特别是老年男性患者。

Risk Factors for Lymphoma in Patients with Inflammatory Bowel Disease: A Case-control Study
Background
Subgroups of patients with inflammatory bowel disease (IBD) may have an increased risk of developing lymphoma. We sought to identify factors that were associated with lymphoma in patients with IBD.
Methods
Cases and controls were identified through a centralized diagnostic index. We identified 80 adult patients with IBD who developed lymphoma between 1980 and 2009. For each case, 2 controls were matched for subtype of IBD, geographic location, and length of follow-up. Conditional logistical regression was used to assess associations between risk factors and the development of lymphoma.
Results
Sixty patients were males (75%) versus 77 controls (48%). Median age at index date was 59 years for cases and 42 years for controls. Twenty patients (25%) and 23 controls (14%) were receiving immunosuppressive medications at the index date. Four patients (5%) and 6 controls (4%) were receiving anti–tumor necrosis factor α agents at the index date. In multiple variable analysis, age per decade (odds ratio, 1.83; 95% confidence interval, 1.37–2.43), male gender (odds ratio, 4.05; 95% confidence interval, 1.82–9.02) and immunosuppressive exposure at the index date (odds ratio, 4.20; 95% confidence interval, 1.35–13.11) were significantly associated with increased odds of developing lymphoma. Disease severity and use of anti–tumor necrosis factor α agents were not independently associated with developing lymphoma. When testing was performed on patients exposed to immunosuppressive or anti–tumor necrosis factor α medications, Epstein–Barr virus was identified 75% of the time.
Conclusions
In this case–control study, increasing age, male gender, and use of immunosuppressive medications were associated with an increased risk of lymphoma in patients with IBD.