gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2024-23-4-148-158gnck-1930Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWВоспалительные заболевания кишечника: эпидемиология и факторы риска (обзор литературы)Inflammatory bowel diseases: epidemiology and risk factors (review)https://orcid.org/0000-0002-0134-8856СтамболцянВ. Ш.StamboltsyanV. Sh.

Стамболцян Венера Шаеновна — аспирант 1-го года обучения по специальностям эпидемиология, внутренние болезни

ул. Кирочная, д. 41, г. Санкт-Петербург, 191015

Venera Sh. Stamboltsyan

Kirochnaya st., 41, St. Petersburg, 191015

Stamboltsyan95@mail.ruhttps://orcid.org/0000-0002-6151-2021БакулинИ. Г.BakulinI. G.

Бакулин Игорь Геннадьевич — д.м.н., профессор, заведующий кафедрой пропедевтики внутренних болезней, гастроэнтерологии и диетологии им. С.М. Рысса

ул. Кирочная, д. 41, г. Санкт-Петербург, 191015

Igor G. Bakulin

Kirochnaya st., 41, St. Petersburg, 191015

https://orcid.org/0000-0002-6890-8096АслановБ. И.AslanovB. I.

Асланов Батырбек Исмелович — д.м.н., доцент, заведующий кафедрой эпидемиологии, паразитологии и дезинфектологии

ул. Кирочная, д. 41, г. Санкт-Петербург, 191015

Batyrbek I. Aslanov

Kirochnaya st., 41, St. Petersburg, 191015

https://orcid.org/0009-0004-4213-5963КирилловаА. А.KirillovaA. A.

Кириллова Анна Александровна — студент

ул. Кирочная, д. 41, г. Санкт-Петербург, 191015

Anna A. Kirillova

Kirochnaya st., 41, St. Petersburg, 191015

ФГБОУ ВО «Северо-Западный ГМУ имени И.И. Мечникова» Минздрава РоссииРоссияMechnikov North-West State Medical UniversityRussian Federation202421122024234148158Copyright © Стамболцян В.Ш., Бакулин И.Г., Асланов Б.И., Кириллова А.А., 20242024Стамболцян В.Ш., Бакулин И.Г., Асланов Б.И., Кириллова А.А.Stamboltsyan V.S., Bakulin I.G., Aslanov B.I., Kirillova A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1930

В настоящее время неуклонно растет бремя хронических неинфекционных заболеваний (ХНИЗ), в том числе аутовоспалительных заболеваний, к которым относятся воспалительные заболевания кишечника (ВЗК) — болезнь Крона (БК) и язвенный колит (ЯК). ВЗК являются хроническими, прогрессирующими, иммунологически опосредованными заболеваниями, которые часто дебютируют в молодом возрасте и характеризуются чередованием периодов обострений и ремиссий. Глобальное распространение ВЗК, вероятно, связано с вестернизацией рациона питания и окружающей среды, что приводит к изменению микробиома кишечника и увеличивает риск заболевания у людей с генетической предрасположенностью. В свете увеличения заболеваемости ВЗК по всему миру, важной задачей является изучение факторов риска для разработки прогностических моделей риска развития ВЗК и различных вариантов течения ЯК и БК и методов борьбы с этими заболеваниями. В данной обзорной статье рассматриваются ключевые аспекты, касающиеся негативных и благоприятных воздействий различных факторов на развитие и течение ВЗК. Приведены данные, демонстрирующие, что курение (ОШ = 1,76; 95% ДИ: 1,40–2,22), ожирение II или III степени (ОШ = 1,86; 95% ДИ: 1,30–2,68 для БК и ОШ = 2,97; 95% ДИ: 1,75–5,17 для ЯК), прием антибиотиков за год до постановки диагноза (ОШ = 1,61; 95% ДИ: 1,26–2,05 при БК и ОШ = 1,20; 95% ДИ: 1,09–1,31 при ЯК), нестероидных противовоспалительных препаратов (ОР = 1,53; 95% ДИ: 1,08–2,16 для БК), каждый дополнительный месяц приема комбинированных оральных контрацептивов (при ЯК на 3,3%; 95% ДИ: 2,1–4,4 и при БК на 6,4%; 95% ДИ: 5,1–7,7), могут не только увеличивать риски обострений ВЗК, но и способствовать развитию данных состояний. Указанные факторы могут усугублять течение уже имеющегося заболевания: например, ожирение повышает частоту госпитализаций при БК (ОШ = 2,35; 95% ДИ: 1,56–3,52) и вероятность резистентности к генно-инженерным биологическим препаратам (ГИБП) (ОШ = 1,6; 95% ДИ: 1,39–1,83). Негативное воздействие могут оказывать диетические факторы, такие как ультра-обработанные продукты (ОР = 1,82; 95% ДИ: 1,22–2,72), кондитерские изделия (≥ 100 г/сутки) (ОР = 2,58; 95% ДИ: 1,44–4,62) увеличивая риск развития ВЗК, а применение транс-жиров может быть связано с тенденцией к увеличению заболеваемости ЯК (ОР = 1,34; 95% ДИ: 0,94–1,92). В качестве факторов, протективно влияющих на течение ВЗК, рассматриваются физическая активность, снижая частоту обострений БК (ОР = 0,72; 95% ДИ: 0,55–0,94) и ЯК (ОР = 0,78; 95% ДИ: 0,54–1,13). Пищевые волокна (24 г/ сутки) снижают риск развития БК (ОР = 0,59; 95% ДИ: 0,39–0,90), а большое количество фруктов в рационе снижает вероятность развития ЯК (ОШ = 0,69; 95% ДИ: 0,49–0,96) и БК (ОШ = 0,57; 95% ДИ: 0,44–0,74).

The global spread of IBD is likely due to the westernization of the diet and the environment, which leads to changes in the gut microbiome and increases the risk of disease in people with a genetic predisposition. In light of the increasing incidence of IBD worldwide, it is important to evaluate risk factors in order to develop prognostic risk models for IBD and various variants of the course of UC and CD and methods to combat these diseases. This review article examines key aspects related to the negative and beneficial effects of various factors on the development and course of IBD. The data shows that smoking (OR = 1.76; 95% CI: 1.40–2.22), obesity class II or III (OR = 1.86; 95% CI: 1.30–2.68 for CD and OR = 2.97; 95% CI: 1.75–5.17), taking antibiotics one year before the diagnosis (OR = 1.61;95% CI: 1.26–2.05 for UC and OR = 1.20; 95% CI: 1.09–1.31 for CD), nonsteroidal anti-inflammatory drugs (Relative Risk (RR) = 1.53; 95% CI: 1.08–2.16 for UC), combined oral contraceptives (UC by 3.3%; 95% ДИ: 2.1–4.4 and CD by 6.4%; 95% ДИ: 5.1–7.7), can not only increase the risks of exacerbations of IBD, but also contribute to the development of these conditions. These factors can aggravate the course of an existing disease: for example, the frequency of hospitalizations (OR = 2.35; 95% CI: 1.56–3.52) and the probability of resistance to genetically engineered biological drugs (GEBD) (OR = 1.6; 95% CI: 1.39–1.83). Dietary factors such as ultra-processed foods (RR = 1.82; 95% CI: 1.22–2.72), confectionery (≥ 100 g/day) (RR = 2.58; 95% CI: 1.44–4.62) and trans fats (RR = 1.34; 95% CI: 0.94–1.92) can have a negative impact, increasing the risk of developing IBD. Physical activity is considered as factors that have a protective effect on the course of IBD, reducing the frequency of exacerbations (RR = 0.78; 95% CI: 0.54–1.13 for UC and RR = 0.72; 95% CI: 0.55–0.94 for CD). Dietary fiber (24 g/day) reduces the risk of developing CD (RR = 0.59; 95% CI:0.39–0.90), and a large number of fruits in the diet reduces the risk of developing both UC (OR = 0.69; 95% CI: 0.49–0.96) and CD (OR = 0.57; 95% CI: 0.44–0.74).

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The authors declare that there are no conflicts of interest present.