炎症性肠病858例临床分析

目的总结分析炎症性肠病（IBD）的临床特点,探讨诊治策略。方法对1998年1月至2009年7月354例炎症性肠病住院患者和2003年1月至2009年7月504例炎症性肠病门诊患者资料进行回顾性分析。结果本组资料显示我院近12年来IBD发病呈逐年上升趋势,溃疡性结肠炎（UC）明显多于克罗恩病（CD）。本组IBD患者中男女之比为1.28∶1。IBD平均发病年龄（41.07±16.07）岁。UC发病高峰年龄为30～49岁,CD发病高峰年龄为20～39岁。本组住院患者中UC和CD两组民族构成比较无统计学差异。肠镜检查中UC以直肠和乙状结肠病变为主,CD以回盲部及回肠末端病变为主。本组患者IBD病理组织学检出率为41.5%,UC误诊率为17.0%,CD误诊率为25.0%。治疗以氨基水杨酸类及类固醇激素为主。结论炎症性肠发病数呈逐年上升趋势;IBD诊断主要依靠内镜及病理。IBD呈慢性复发性发作过程,应长期维持治疗。     

487例溃疡性结肠炎住院患者临床特征分析

[目的]回顾性调查沈阳军区总医院住院溃疡性结肠炎（UC）患者,分析近年住院UC患者的临床特征.[方法]收集2000年1月～2013年12月期间在沈阳军区总医院住院的487例UC患者的临床资料,统计患者的临床特征,内镜及病理特点,治疗及预后情况.[结果]近14年该院UC住院患者呈上升趋势,发病高峰年龄20～40岁.临床症状主要有腹泻（91.03％）、血便（71.08％）、腹痛（75.34％）等,肠外表现（3.49％）及并发症（6.57％）少见.病情以中度（32.65％）、重度（37.44％）为主.病变范围以广泛型或全结肠型（37.22％）为主,临床类型以慢性复发型（40.14％）、初发型（37.41％）为主.中医证型以湿热内蕴型（44.78％）、脾胃气虚型（25.59％）为主.治疗上以西医（86.65％）为主,氨基水杨酸类药物（86.02％）和糖皮质激素（86.02％）、中药（52.36％）广泛使用.单纯内科治疗总有效率达89.22％,手术率1.02％,死亡3例（0.65％）.[结论]近年来该院UC患者呈增加趋势,病程较短,以中、重度为主,慢性复发型及初发型多见,肠外表现及并发症少.中医证型以湿热内蕴型、脾胃气虚型多见.内科保守治疗效果较好,手术病例少,死亡率低.     

327例溃疡性结肠炎临床特征分析

背景：近年我国溃疡性结肠炎（UC）患病率有逐渐增加的趋势。目的：探讨我国UC的发病特点，指导临床治疗。方法：对1978年4月～2006年6月在北京军区总医院消化内科内镜中心确诊为UC的病例进行回顾性分析。结果：327例患者中。男女之比为1．7：1，中位年龄为40岁，平均病程3．1年。UC患者的黏液血便发生率最高（71.3％）．其次为腹泻（53．8％）和腹痛（52.3％）。病变以直乙结肠炎（29．1％）和直肠炎（21．1％）为主。临床分型以初发型（44．4％）和慢性复发型（36．4％）为主，其次为慢性持续型（16．4％），暴发型仅占2．8％。病情以轻度（33．6％）和中度（48.3％）为主，重度仅占18．0％。治疗药物主要为单纯5-氨基水杨酸类药物（41．5％）和5-氨基水杨酸类药物联用糖皮质激素（37．0％）．单纯内科治疗的有效率为94．1％，无效7例（5．2％），死亡1例（0．7％）。结论：我国UC患者的特点与国外报道存在一定的差异，主要表现是以直乙结肠炎为主，轻中度病变居多，肠外表现和并发症较少。大多数轻中度UC患者以局部病变为主，且局部治疗效果较好，重度UC患者多为全结肠炎，以全身治疗为主；需行结肠切除、癌变和死亡病例少见．     

炎症性肠病临床表现的东西方差异

炎症性肠病（IBD）在西方国家相当常见。据报道溃疡性结肠炎（UC）的发病率为10／10^5-20/10^5，克罗恩病（CD）约为5／10^5-10/10^5：UC的患病率约为100／10^5-200/10^5，CD约为50/10^5-100／10^5。亚洲国家IBD较少见．但近20年我国IBD相关报道异常增多。Jiang等综合分析10 218例国内文献报道的UC患者，发现近10年该病报道病例数上升3．1倍。一项基于住院病例的回顾调查研究显示我国IBD住院患者呈逐渐增加的趋势，2003年UC住院例数和内镜检出例数分别是1990年的3．4倍和4．1倍；2003年住院消化病患者中CD患者的构成比为1990年的3．4倍：2003年住院总患者中CD患者的构成比为1990年的2～倍。     

重型溃疡性结肠炎的临床特点与治疗转归

目的评价重型溃疡性结肠炎（UC）的临床疗效及治疗转归,寻找提示疗效及预后的相关因素.方法回顾性分析41例住院重型UC患者的病例资料.记录临床表现及诊疗经过,对柳氮磺胺吡啶（SASP）/5氨基水杨酸（5-ASA）、皮质激素、免疫抑制剂等药物疗效进行评价,并对手术病例进行分析.结果重型UC患者占同期住院UC患者的28.5%（41/144）,其中17.1%（7/41）伴肠道外表现;92.7%（38/41）为全结肠型病变,初发型、慢性持续型及慢性复发型分别占36.9%（15/41）、36.9%（15/41）和26.8%（11/41）;控制急性发作主要药物为激素,占61.0%（25/41）;31例（75.6%）重型UC经药物治疗缓解,7例（17.1%）最终手术治疗.发病年龄轻、全结肠病变、低血红蛋白、低血清白蛋白是提示药物疗效差、需手术治疗的相关因素.结论对于重型UC,除积极系统的药物治疗外,应及时评估药物疗效及手术需求.     

溃疡性结肠炎患者手术治疗预测因素分析

手术是溃疡性结肠炎（UC）内科治疗无效或发生严重并发症者的治疗选择.目的：分析UC患者行手术治疗的可能预测因素.方法：纳入1998年8月～2009年9月北京协和医院住院UC患者312例,其中34例接受手术治疗,278例接受非手术治疗,回顾性分析、比较两组患者的各类临床资料.结果：住院UC患者手术率为10.9%,手术死亡率为5.9%,重度UC患者手术率为23.9%.手术组13例患者为激素抵抗,8例为激素依赖,9例发生严重并发症,4例激素治疗有效者主动要求手术治疗.手术组平均住院次数显著多于非手术组（P〈0.05）,术前Hb、白蛋白显著低于非手术组（P〈0.05）,CRP显著高于非手术组（P〈0.05）,重度结肠炎、全结肠炎患者比例显著高于非手术组（P〈0.05）.结论：疾病严重程度高、病变范围广、对激素抵抗的UC患者,手术需求增加.     

初发型与慢性复发型溃疡性结肠炎患者临床特点及诊疗比较分析

目的探讨初发型与慢性复发型溃疡性结肠炎(ulcerative colitis,UC)患者在发病危险因素、临床表现、疾病严重程度、实验室指标、内镜特点、病理特征、诱导缓解方法等方面的差异。方法收集2017年1月1日至2019年11月1日于武汉大学人民医院住院的137例UC患者的相关病例资料、辅助检查结果及药物治疗方法;依据患者既往史分为初发型组和慢性复发型组,对相关数据整理后采用SPSS 23.0统计软件进行统计学分析。结果初发型组61例,慢性复发型组76例;慢性复发型组饮酒史比率(28.9%)高于初发型组患者(13.1%)(P0.05),在诱发因素比率上慢性复发型组比率(35.5%)也高于初发型(16.4%)(P0.05);具体诱发原因中以停药(27.0%)、不洁饮食(16.2%)、刺激饮食(10.8%)为主;初发型组腹泻比率(60.7%)高于慢性复发型组(43.4%)(P0.05);病变范围上慢性复发型组E1、E2比率(47.4%)高于初发型组(26.2%),E3比率(52.6%)低于初发型组(73.8%)(P0.05);病理表现上初发型组隐窝脓肿、腺体萎缩比率(66.7%)高于慢性复发型组(39.4%)(P0.05);药物治疗方面初发型组单用水杨酸制剂比率(73.8%)明显高于慢性复发型组(40.8%)(P0.001),全身应用类固醇激素比率(21.3%)明显低于慢性复发型组(51.3%)(P0.001)。两组在性别、年龄、腹痛、血便、体质量减轻、发热、疾病严重程度和病情活动度、WBC、Hb、CRP、ESR、贫血程度等实验室指标及内镜表现和免疫抑制应用上比较,差异均无统计学意义(P0.05)。结论慢性复发型UC患者相对于初发型UC患者往往发病具有明显诱发原因,饮酒既可能是其危险因素,也可是诱发原因之一;初发型患者腹泻比率高于慢性复发型患者,可能与这里患者病变范围多位于降结肠以上部分相关;初发型患者隐窝脓肿比率较高,提示病情进展变化可能。慢性复发型患者类固醇激素应用明显高于初发型患者,对于复发型患者药物诱导缓解治疗可考虑水杨酸制剂加量(轻、中度患者)或水杨酸制剂、类固醇激素、免疫抑制剂联合治疗(重度患者)。     

药物代谢遗传学检测在硫唑嘌呤治疗炎症性肠病中的应用

炎症性肠病（IBD）包括溃疡性结肠炎（UC）和克罗恩病（CD）.目前治疗该病的药物主要有氨基水杨酸、激素、免疫抑制剂及近年推出的生物制剂.其中的免疫抑制剂如硫唑嘌呤（AZA）和6-巯基嘌呤（6-MP）能够诱导和维持IBD缓解并减少激素依赖和耐药;但其疗效有明显的个体差异,约2/3患者有效,15%的患者无效,另有9%～25%的患者产生严重的骨髓抑制或肝毒性甚至危及生命.AZA治疗IBD在国外较普遍.近20年来,国人IBD患病率呈大幅增加,因此如何安全有效地用AZA治疗IBD具有重要的临床意义.     

选择性白细胞分离法联合药物治疗对溃疡性结肠炎诱导缓解和维持治疗的荟萃分析

不同研究显示选择性白细胞分离法对溃疡性结肠炎（UC）的疗效差异很大.目的：系统性评价选择性白细胞分离法联合药物治疗对UC诱导缓解和维持治疗的作用.方法：检索PubMed、EMBASE、Cochrane Central Register of Controlled Trials、Science Citation Index和中文科技期刊数据库.纳入所有比较选择性白细胞分离法联合药物治疗与传统药物治疗对UC诱导缓解和维持治疗疗效的随机对照试验（RCTs）.采用RevMan 5.0软件分析两者的诱导缓解率、维持缓解率和不良反应发生率.结果：共9项RCTs、685例患者符合人选标准,7项评估诱导缓解率,2项评估维持缓解率.选择性白细胞分离法联合药物治疗组的诱导缓解率显著高于传统药物治疗组（40.7%对29.1%,OR值为2.19,P〈0.0001）,维持缓解率亦显著高于传统药物治疗组（70.4%对25.0%,OR值为8.14,P=0.002）.选择性白细胞分离法联合药物治疗组的轻中度不良反应发生率明显低于传统药物治疗组（44.7%对65.3%,OR值为0.16,P=0.003）.结论：与传统药物治疗相比,选择性白细胞分离法联合药物治疗能明显提高UC患者的诱导缓解率和维持缓解率,并能降低不良反应发生率.     

118例溃疡性结肠炎临床、内镜与直肠动力分析

目的了解溃疡性结肠炎(UC)的临床、内镜和直肠动力特点。方法分析1982年2002年我院确诊118倒UC的临床、内镜、直肠动力特点。结果①UC症状以腹泻、粘液、粘液血便、腹痛为主,肠外表现少见;病程通常较短;病变范围以左半结肠为主;IgG、IgM升高;②肠镜下充血水肿最多见,其次是糜烂、溃疡;③腹压增加时肛门内外括约肌净增压降低(P<0.05),直肠最低敏感量、最大耐受性、最大顺应性明显降低(P<0.01);④大多数患者以柳氮磺胺吡啶治疗有效。结论了解UC的临床、内镜和直肠动力特点,有助于理解UC的发病规律、病理生理和更有效地治疗该病。     

溃疡性结肠炎360例临床特征分析

近年溃疡性结肠炎（UC）的发病率明显升高,明确临床特征有助于其诊断。目的：探讨UC的临床特征。方法：收集2008年7月-2011年7月西京医院收治并确诊的活动期UC患者的临床资料,回顾性分析其临床特征。结果：共收治活动期UC患者360例,男女之比1．25：1;平均就诊年龄40．5岁。疾病严重程度以轻中度UC多见（84．4％）。病变累及以左半结肠和直肠、乙状结肠多见;18例病变呈节段性分布,其余均为连续分布。本组患者以腹泻、黏液脓血便、腹痛为主要临床表现,内镜下黏膜弥漫性充血、水肿、糜烂和溃疡,44例伴有肠外表现。多数患者的白细胞、ESR和CRP水平增高。52例患者合并并发症。349例患者接受内科治疗,病情明显缓解。结论：UC患者以中青年男性多见,内镜下病变以左半结肠和直肠、乙状结肠多见,常见并发症为结肠假性息肉。UC确诊主要根据临床表现、结肠镜检查、病理学检查,其中结肠镜检查可明确病变部位、范围、程度以及肠腔有无狭窄或癌变,有助于临床病情分期,对指导临床治疗方案的选择具有重要意义。     

An analysis of 10218 ulcerative colitis cases in China

AIM: To analyze the characteristics of ulcerative colitis(UC) in China. METHODS: From 1981 to 2000, a total of 10218 patients of UC reported in Chinese medical literature and including our cases diagnosed were analyzed according to the diagnostic criteria of Lennard-Jones. RESULTS: The number of cases increased by 3.08 times over the past 10 years (2506 patients were diagnosed from 1981 to 1990 while 7512 patients were diagnosed from 1991 to 2000).Lesion range were described in 7966 patients, 5592 (70.20%) were proctosigmoiditis or proctitis, 1792(22.50%) left-sided colitis, 582(7.30%) pancolitis. Among the 8122 patients, 2826 (34.8%) had first episode, 4272 (52.6%) had chronic relapse, 869 (10.7%) were of chronic persist type, 154 (1.9%) were of acute fulminant type. The course of the illness were described in 5867 patients, 4427(75.5%) were less than 5 years, 910 (15.5%) between 5 and 10 years,530 (9.1%) more than 10 years. Six hundred and sixteen patients 618 patients(6.1%) had extraintestinal manifestations.The mean age at the diagnosis was 40.7 years( range 6-80 years, and the peak ages 30-49 years). The male to female ratio was 1.09. Among 270 patients diagnosed in our hospital,36 had histories of smoking, there was no negative association between the severity of UC and smoking(P>0.05), 21 smokers were followed up for one year, 15 of them had given up smoking when the disease were diagnosed, and one year later, 7 patients relapsed, another 6 patients continued smoking, and one year later,2 patients relapsed. Among 270 UC patients diagnosed in our hospital, 4 patients(1.48%) from 2 families had familial history of UC. Treatment was mentioned in 6859 patients, only 5-ASA and/or corticosteroid only in 1276 patients(18.6%), only Chinese herbs in 1377 patients(20.1%), combined Chinese and western medicine in 4056 patients(59.1%), surgery was performed in 87 patients(1.3%),other treatments in 63 patients(0.9%). CONCLUSIONS: In China, number of UC patients increased significantly in the past 10 years. Lesions are commonly located to left side colon. The course is short with rare extraintestinal manifestations. The age of onset is relatively high.Males and females are nearly equally affected. No negative relation was found between smoking and severity of the disease. Familial relatives are rarely involved Traditional Chinese medicine(TCM) is widely used in the treatment of UC.     

Sternocostal involvement in chronic recurrent multifocal osteomyelitis associated with ulcerative colitis

Chronic recurrent multifocal osteomyelitis (CRMO) is a chronic, relapsing, inflammatory, non-infectious disorder of the skeletal system and is of unknown origin. Early diagnosis of the disease is essential to exact treatment. The relationship between inflammatory bowel disease and CRMO is understood as extraintestinal rheumatic manifestations. CRMO associated with ulcerative colitis (UC) is very rarely reported. This case is first report of sternocostal involvement in CRMO associated with UC.     

Clinical manifestations of inflammatory bowel disease: East and West differences

Inflammatory bowel disease (IBD) is very common in developed countries, while it is relatively uncommon in Asian countries. However, the incidence of IBD has been increasing in some Asian countries in recent years. Most cases of ulcerative colitis (UC) in Asia are of the chronic relapsing type, run a milder course, and the fulminant type is rarely seen. There is no difference in clinical manifestations between Asian and developed countries. The incidence of Crohn's Disease (CD) is mainly in males in Asia, while it is mainly in females in developed countries. The clinical manifestations of CD are similar between both sets of countries. In China there are less fistulae and perianal diseases, and extraintestinal manifestations of CD are uncommon. In China, 5.6% of patients with UC have a family history, which is lower than 10-20% in developed countries. NOD2/CARD15 variants in the locus of 16q112 (IBD1) are significantly associated with the susceptibility of CD in developed countries, but NOD2/CARD15 variants have not been found in Asian CD patients.     

Clinical epidemiology of ulcerative colitis in Arabs based on the Montréal classification

AIM: To determine the clinical, epidemiological and phenotypic characteristics of ulcerative colitis (UC) in Saudi Arabia by studying the largest cohort of Arab UC patients.METHODS: Data from UC patients attending gastroenterology clinics in four tertiary care centers in three cities between September 2009 and September 2013 were entered into a validated web-based registry, inflammatory bowel disease information system (IBDIS). The IBDIS database covers numerous aspects of inflammatory bowel disease. Patient characteristics, disease phenotype and behavior, age at diagnosis, course of the disease, and extraintestinal manifestations were recorded.RESULTS: Among 394 UC patients, males comprised 51.0% and females 49.0%. According to the Montréal classification of age, the major chunk of our patients belonged to the A2 category for age of diagnosis at 17-40 years (68.4%), while 24.2% belonged to the A3 category for age of diagnosis at > 40 years. According to the same classification, a majority of patients had extensive UC (42.7%), 35.3% had left-sided colitis and 29.2% had only proctitis. Moreover, 51.3% were in remission, 16.6% had mild UC, 23.4% had moderate UC and 8.6% had severe UC. Frequent relapse occurred in 17.4% patients, infrequent relapse in 77% and 4.8% had chronic disease. A majority (85.2%) of patients was steroid responsive. With regard to extraintestinal manifestations, arthritis was present in 16.4%, osteopenia in 31.4%, osteoporosis in 17.1% and cutaneous involvement in 7.0%.CONCLUSION: The majority of UC cases were young people (17-40 years), with a male preponderance. While the disease course was found to be similar to that reported in Western countries, more similarities were found with Asian countries with regards to the extent of the disease and response to steroid therapy.     

中国溃疡性结肠炎10218例的特点

目的分析中国溃疡性结肠炎患者的特点.方法对从1981年到2000年20年间中国医学文献报告及我院确诊的1021 8例患者进行分析结果①病例数目20年间,中国医学文献报告及我院确诊的患者共10218例,其中最近10年报告的病例数目是前10年3.8倍.②病变范围直肠乙状结肠炎和直肠炎占70.20%,左半结肠炎占22.50%,广泛性或全结肠炎占7.30%.③病变类型初发型34.8%,慢性反复发作型52.6%,慢性持续性10.7%,急性暴发性1.9%.④病程75.5%患者小于5年,15.5%患者在5年和10年之间,只有9.1%患者大于10年.⑤肠外表现6.1%患者有肠外表现.⑥年龄发病的平均年龄是40.7岁(范围从6岁～80岁,高峰年龄段是30岁～49岁).⑦性别男女比是1.09.⑧吸烟病情严重程度和吸烟之间无负相关(P＞0.05),⑨家族遗传性270例患者中有4例有家族史.⑩治疗单纯采用西药(氨基水杨酸类或/和皮质激素)治疗的占18.6%,单纯采用中医治疗的占20.1%,采用中西医结合治疗的占59.1%,手术1.3%,其他治疗占0.9%.结论中国溃疡性结肠炎的病例数目在过去10年中显著增加,病变主要以左半结肠为主,病程短,肠外表现少见,发病年龄相对较大,男女比例数目大致相等,家族遗传少见,吸烟与病情轻重之间无显著相关,中医药治疗在中国广泛应用.     

Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003-2005: a population-based study from the Danish Crohn colitis database

OBJECTIVES: A continuous increase in the incidence of inflammatory bowel disease (IBD), Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC) has been suggested. Since Denmark provides excellent conditions for epidemiological research, we aimed to describe contemporary IBD incidence rates and patient characteristics in Copenhagen County and City. METHODS: All patients diagnosed with IBD during 2003-2005 were followed prospectively. Demographic and clinical characteristics, such as disease extent, extraintestinal manifestations, smoking habits, medical treatment, surgical interventions, cancer, and death, were registered. RESULTS: Five-hundred sixty-two patients were diagnosed with IBD, resulting in mean annual incidences of 8.6/10(5) for CD, 13.4/10(5) for UC, and 1.1/10(5) for IC. Time from onset to diagnosis was 8.3 months in CD and 4.5 months in UC patients. A family history of IBD, smoking, and extraintestinal manifestations was significantly more common in CD than in UC patients. Only 0.6% of UC patients had primary sclerosing cholangitis. In CD, old age at diagnosis was related to pure colonic disease, whereas children significantly more often had proximal and extensive involvement. Twelve percent of CD patients and 6% of UC patients underwent surgery during the year of diagnosis, significantly less than earlier reported. CONCLUSIONS: The incidence of IBD in Copenhagen increased noticeably during the last decades. Time from onset of symptoms until diagnosis decreased markedly, extent of CD was related to age at diagnosis, and the risk of surgery was low in UC.