从亚太地区炎性反应性肠病处理共识看亚太儿童炎性反应性肠病的诊治

亚太地区儿童炎性反应性肠病(IBD)的发生率呈上升趋势,需结合西方儿童IBD的诊治标准和亚太地区特点,摸索出适合亚太地区的儿童IBD的诊治方案.本研究从解读2006年亚太地区IBD处理共识入手,介绍IBD的诊断和治疗意见,并结合目前国内儿童IBD的患病、诊断和治疗现状作出分析.儿童IBD的诊断必须除外肠道感染性疾病,特别是肠结核.治疗应更多考虑到本地区患者的药物代谢特点和依从性.同时,建议使用简化儿童IBD疾病活动度评分标准.     

儿童炎症性肠病的临床管理及治疗

儿童炎症性肠病(IBD)活动期的治疗主要包括水杨酸制剂、糖皮质激素、免疫抑制剂、生物治疗和抗生素等药物疗法,近来营养治疗被认为对儿童IBD的诱导缓解有非常重要的意义,而加强临床管理对长期缓解及预防复发起关键作用.     

炎症性肠病24例

目的 总结儿童炎症性肠病(IBD)的临床特点和诊疗经验,提高儿童IBD的诊疗水平.方法 参照2001年中华医学会消化病学会制定的标准,2000年12月-2010年12月重庆医科大学附属儿童医院共确诊IBD患儿24例,通过调阅病例、随访获取资料,并对24例IBD患儿的临床、实验室检查、影像学、内窥镜、组织病理学检查,按照Sutherland指数和Harvey和Bradshow标准疾病活动性评分结果进行回顾性分析.结果 IBD 24例中溃疡性结肠炎(UC)组16例,克罗恩病(CD)组8例;男童略多于女童;IBD主要肠道表现有腹痛、腹泻、便血,主要肠外表现有发热、贫血、关节痛／炎、消瘦、生长发育迟缓;UC组与CD组临床表现差异无统计学意义,仅便血症状UC组占优势.病变侵犯部位:UC病变主要侵犯左半结肠(P =0.027);CD病变可侵犯全消化道任何部位,以回盲部及其周围肠管(P =0.002)和上消化道(P =0.028)受累最为多见.经过积极治疗IBD患儿疾病活动度显著下降,其中英夫利昔单抗对常规治疗无效的UC患儿可迅速控制临床症状.结论 儿童IBD的诊断需要对临床、实验室检查、影像学、内窥镜检查及组织病理学检查综合分析,尤其结肠镜和组织病理学检查.儿童IBD积极治疗仍可获得显著疗效.     

粪菌移植在儿科应用的研究进展北大核心CSCD

粪菌移植(FMT)可将健康人粪便中的各种肠道微生物、代谢产物和天然抗菌物质等移植到受者肠道内,可重建肠道菌群平衡、修复肠黏膜屏障、控制炎症反应、调节机体免疫,是治疗肠道菌群失调所致疾病的新方法。FMT治疗儿童复发性艰难梭菌感染已写入复发性艰难梭菌感染的诊疗指南。FMT治疗儿童炎症性肠病、孤独症谱系障碍的有效性及安全性较好。     

儿童炎症性肠病诊疗中心质量控制标准专家共识

儿童炎症性肠病(IBD)的诊断及治疗需要多学科参与, 且需要专业团队的长期随访管理。高质量IBD诊疗中心的管理在减少IBD并发症、降低致残率以及维持长期缓解方面起到重要作用。本共识旨在进一步规范儿童IBD诊疗中心的管理, 提高儿童IBD的诊治质量。     

不容忽视的炎症性肠病肠外表现

炎症性肠病(IBD)是一种严重的难治性肠道疾病,近年来发病率逐年升高。临床上对儿童IBD肠外表现(EIMs)认识不足,以致延误诊断。因此提高对IBD的EIMs认识不容忽视,对早期诊断及治疗有重要意义。EIMs肾脏病变以IgA肾病、间质性肾炎为主,儿科医师应加以重视。     

炎症性肠病患儿对英夫利昔单克隆抗体治疗失应答的影响因素研究进展

炎症性肠病(IBD)是包括克罗恩病、溃疡性结肠炎和未定型结肠炎在内的一组病因不明的慢性非特异性胃肠道炎症性疾病。近年来儿童IBD的发病率逐年增加, 对患儿、家庭及社会造成了相当大的疾病负担。英夫利昔单克隆抗体(IFX)作为一种有效的重要治疗方法, 近年来临床上对其出现失应答的IBD患儿逐渐增多, 其原因复杂且不明确。本文将对可能导致IBD患儿对IFX治疗出现失应答的因素进行讨论和归纳, 以期寻找合适的方法提高IFX对IBD患儿的治疗效果。     

儿童炎症性肠病的研究现状及展望

儿童炎症性肠病(PIBD)是一组病因不明的慢性复发性非特异性肠道炎症性疾病,发病机制复杂,目前在诊断和治疗方面仍然面临挑战。近年来,儿童IBD在国内外的发病率呈现上升趋势,引起了儿科医师的广泛关注。文章在儿童IBD发病机制进展、最佳治疗目标的监测策略、治疗方法进展、青春期IBD管理及向成人转诊过渡衔接等方面进行了总结,旨在为我国儿科医师IBD的研究提供参考。     

炎症性肠病的生物学治疗进展及在儿童中的应用现状

炎症性肠病(IBD)是一类病因尚不十分明确的慢性非特异性肠道炎症性疾病,发病率在成人及儿童均有逐年增高的趋势,传统治疗效果欠佳.近年来,随着抗TNF-α单克隆抗体等生物制剂的问世,给IBD患者也带来更多新的有效的治疗选择.但随之也引发了对生物制剂近、远期不良反应,适应证选择,医疗成本等的争论.现就IBD的生物学治疗进展及在儿童中的应用现状作一介绍,并探讨以生物治疗为中心的“下阶梯”治疗模式.     

肠内营养在儿童克罗恩病治疗中的研究进展

克罗恩病(Crohn's disease,CD)是一种主要累及末端回肠及近端结肠的目前仍无法治愈的炎症性肠病(inflammatory bowel disease,IBD),其主要症状有腹痛、腹泻、发热,随着病情的进展可出现直肠出血、肠瘘、肠梗阻等.儿童患者可出现生长发育迟缓、青春期延迟.CD的治疗一直以来是临床医生的讨论热点,其药物治疗有诸多不良反应,手术治疗复发率高、并发症多.肠内营养疗法(enteral nutrition,EN)是指患儿经口或通过导管直接到胃或小肠的营养途径.目前研究发现EN可用于CD患儿的诱导缓解,维持缓解,并且可促进生长发育.EN已广泛运用于CD的临床治疗,特别是在儿童CD的治疗.该文通过分析近年来国内外学者对EN在CD临床治疗中的研究工作,对EN在CD治疗中的重要性、主要作用、作用机制、治疗方法及疗效影响因素等进行总结.     

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??The history of fecal microbiota transplantation ??FMT??can be traced back to more than 1700 years ago. However?? FMT has got unparalleled development only in the recent years. The recent studies report that FMT plays an important role in the treatment of Clostridium difficile infection??inflammatory bowel disease??irritablebowelsyndrome??allergic diseases??obesity??autism and other diseases. This article reviewed the history of FMT??and discussed its procedure and indications.     

粪便微生物移植治疗幼儿重症伪膜性肠炎1例并文献复习

目的探讨伪膜性肠炎患儿的诊断与治疗并介绍粪便微生物移植治疗。方法总结1例重症伪膜性肠炎患儿的临床表现、辅助检查、诊断及治疗,并对粪便微生物移植进行相关文献复习。 结果①患儿,男,13月龄,以肠道感染,继发肠梗阻起病,间断腹泻2个月,全身水肿1个月入院。病程中外院曾实施剖腹探查+双侧腹股沟斜疝疝囊高位结扎术。入我院后诊断为蛋白丢失性肠病,重症伪膜性肠炎,电解质紊乱,代谢性酸中毒,营养不良等,予以各种对症支持治疗,并甲硝唑及万古霉素联合用药,并最终给予粪便微生物移植治疗,好转出院。②文献复习国外报道的成人伪膜性肠炎、复发性艰难梭菌感染及抗生素相关性腹泻的粪便微生物移植共217例,首次治疗完全缓解为191例（88.0%）;复发9例,行第2次粪便微生物移植完全缓解为8例(88.9%)。回顾儿童粪便微生物移植1例,并结合本文病例了解粪便微生物移植流程及儿科应用。 结论及时诊断及加强伪膜性肠炎的临床管理,在未取得充分儿童粪便微生物移植的安全性与有效性证据之前,在经验治疗失败或无效的伪膜性肠炎患儿中应用该方法仍需谨慎。     

Long term G‐CSF‐induced remission of ulcerative colitis‐like inflammatory bowel disease in a patient with glycogen storage disease Ib and evaluation of associated neutrophil function

We present a 23‐year‐old female with Glycogen storage disease Ib (GSD Ib) who was diagnosed with ulcerative colitis‐like inflammatory bowel disease (IBD) at 7 years of age. G‐CSF therapy reversed the IBD, was required to maintain IBD remission and was well tolerated. Neutrophil functions at time of diagnosis showed impaired chemotaxis but normal superoxide anion production and bactericidal activity. Ulcerative colitis‐like IBD may also be seen in GSD Ib and is responsive to G‐CSF therapy. Neutrophil dysfunction is variable among patients with GSD Ib. Pediatr Blood Cancer. 2010;55:1410–1413. © 2010 Wiley‐Liss, Inc.     

Epidemiologie und klinische Besonderheiten der pädiatrischen CED

The “pediatric peak age” for inflammatory bowel diseases (IBD) is 12–14 years. Approximately 60% of patients are diagnosed with Crohn’s disease, with males being more commonly affected by a factor of 1.4–1.6. The gender difference, however, is balanced out in ulcerative colitis, which is found in 30% of pediatric IBD patients. Indeterminate colitis is more frequently diagnosed in pediatrics than in “adult medicine”, with the numbers increasing the younger the patients are. Current IBD incidence rates range between four and ten new illnesses per year in 100,000 persons under 18 years. Thus it appears that there is still a slow but ongoing increase. The application of the Montreal classification contributes to increased comparability of studies and a deeper understanding of IBD in order to finally develop effective therapy and perhaps also prevention strategies. IBD registries represent an important source of data.     

Nutrition support for pediatric patients with inflammatory bowel disease: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology And Nutrition

Impairment of growth and malnutrition are significant complications of inflammatory bowel disease (IBD) in pediatric patients. Since this topic was last reviewed in these pages (), a number of studies have further explored the epidemiology and pathogenesis of these nutritional complications of IBD in an effort to provide more effective interventions to prevent the long-term consequences of chronic nutrient deficiencies in childhood. In addition, during the past 15 years, the use of selected nutrients and microorganisms (probiotics) as primary or adjunctive therapy for the treatment of IBD has become an emerging area of great interest. The following is a Clinical Report from the Nutrition and Inflammatory Bowel Disease Committees of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.     

Fecal microbiota transplantation in a toddler after heart transplant was a safe and effective treatment for recurrent Clostridiodes difficile infection: A case report

Pediatric recipients of SOT have a significantly increased risk of Clostridiodes (formerly Clostridium) difficile infection (CDI), which is associated with adverse outcomes after SOT. Alterations to the intestinal microbiota community structure increase the risk of CDI. FMT is a safe and effective treatment for recurrent CDI in immunocompetent children and adults. While there are increasing data that FMT in immunosuppressed patients is safe and effective without increased risk of infection, data regarding safety and efficacy of FMT in children after SOT are limited. To our knowledge, we report the youngest immunocompromised patient to undergo FMT and the third overall case of FMT in a child after HTx. Our patient presented with five episodes of rCDI in 6 months, and 16S rRNA genetic analysis revealed significant loss of overall microbiota community structure and diversity prior to FMT compared with a donor and a healthy, age‐matched control. After FMT, marked and prolonged (at least 16 months) shifts in the recipient microbiota community structure and diversity were evident, approaching that of donor and healthy, age‐matched control. FMT was well tolerated, restored microbial diversity without any graft or transplant complications, and prevented further rCDI episodes after more than 4 years of follow‐up.     

Repeated fecal microbiota transplantation in a child with ulcerative colitis

We report the case of an 11‐year‐old girl with ulcerative colitis refractory to conventional therapy, who was subsequently treated successfully with repeated fecal microbiota transplantation (FMT). The patient was steroid dependent despite several infliximab treatments, and colectomy was proposed to improve quality of life. After repeated FMT, she was able to maintain remission with on minimal dose of steroid. Although her fecal microbiota was dysbiotic before FMT, it was restored to a similar pattern as the donor after repeated FMT.     

The role of pro-inflammatory cytokines in inflammatory bowel disease growth retardation

Childhood inflammatory bowel disease (IBD) especially those with Crohn disease is commonly complicated by faltering growth and pubertal delay. Pro-inflammatory cytokines are often elevated in IBD and may affect linear growth and puberty either systemically or at the level of the growth plate. Further study of the underlying mechanisms of the deleterious effects of cytokines on the growth plate may improve management of faltering growth in childhood IBD. Well-controlled clinical studies of the respective effect of nutritional support, immunomodulatory therapy, biological agents and growth and puberty promoting agents on managing faltering growth also require further attention.     

Safety of infliximab treatment in pediatric patients with inflammatory bowel disease

BACKGROUND: Infliximab appears to be efficacious in the treatment of pediatric Crohn disease (CD). There are few large-scale pediatric studies on the complications of infliximab therapy. METHODS: A retrospective review of all infliximab infusions administered to IBD patients at a tertiary children's hospital was undertaken. Data was obtained from an infliximab infusion database maintained in the section of Pediatric Gastroenterology, pharmacy records and patient charts. RESULTS: 594 infusions were administered to 111 IBD patients (88 CD and 23 UC; 55 male and 56 female; ages 4 to 20 years; mean age, 13.4 years). The number of infusions ranged from 1 to 24 with a mean of 5.4/patient. Infusion reactions occurred in 8.1% of patients (seven early and two delayed) and in 1.5% of all infusions. Reactions occurred more frequently in female patients (14% versus 2%; P = 0.03). All reactions were mild and responded rapidly to treatment. Four patients had infections deemed unusual, including three cutaneous tinea infections and one case of shingles. CONCLUSION: Infliximab is safe in pediatric IBD patients with a low incidence of generally mild reactions that respond rapidly to intervention. Infusion reactions are more common in female patients. Our patients had no serious infectious complications, although cutaneous tinea infection may represent a newly reported associated complication.     

氧诱导对新生大鼠视网膜单核细胞趋化蛋白-1表达的影响

目的 探讨单核细胞趋化蛋白-1(MCP-1)与新生大鼠视网膜病变的关系.方法 清洁级新生SD大鼠36只,雌雄不限,与母鼠共同饲养,随机分为实验及对照组各18只.实验组大鼠在50和10 mL/L氧环境中循环饲养14 d后转入空气饲养,建立新生大鼠视网膜病变模型,对照组仅置于空气中.在视网膜病变模型结束后即刻(生后14 d,P14)、72 h(P17)及1周(P21)3个时点每组处死6只大鼠,取眼球制成石蜡标本,组织学观察其视网膜毛细血管密度指数(RCDI)的改变,免疫组织化学技术评估视网膜MCP-1的表达情况.结果 新生大鼠视网膜RCDI相同时点二组间差异有显著性[t(P14)=6.69 P=0.001,t(P17)=3.43 P=0.006,t(P21)=2.37 P=0.039)].而在同一组不同时点的比较显示随着时间的延长,实验组RCDI值逐渐减少,3个时点间差异存在显著性(F=17.74 P=0.0001);对照组3个时间点间差异无显著性(F=0.016 P=0.984).MCP-1的表达情况:相同时点二组间差异有显著性[t(P14)=40.45,t(P17)=43.44,t(P21)=17.45 Pa=0)].同一组内的不同时点比较随着时间的延长,实验组MCP-1值逐渐减少,3个时点间差异存在显著性(F=421.5 P=0);对照组3个时间点间差异无显著性(F=0.006 P=0.994).实验组MCP-1表达与RCDI水平呈正相关(r=0.822 P=0).结论 MCP-1的表达在氧诱导新生大鼠视网膜病中显著增强,随病程的延长而逐渐减少;视网膜MCP-1的表达与新生血管的发生相关.