杨倩教授治疗溃疡性结肠炎经验探析

溃疡性结肠炎(ulcerative colitis,UC)是一种慢性、非特异性炎症性肠炎,其主要表现为结肠和直肠的弥漫性黏膜炎症[1]。目前UC的发病机制尚不清楚,一般认为是遗传易感性、肠道菌群失调和免疫失衡共同作用的结果[2]。随着我国经济结构的调整、人民生活方式的改变,UC在我国的发病率逐年增高[3]。作为直结肠癌的危险因素之一,该病严重影响着UC患者的生活质量。5-氨基水杨酸、免疫抑制剂、皮质类固醇和生物制剂是控制UC患者炎症的主要治疗方案。     

NGAL通路关键因子与溃疡性结肠炎复发的相关性研究及临床应用

[目的]探究NGAL通路关键因子与溃疡性结肠炎复发的相关性研究及临床应用。[方法]随机收集我院收治的89例溃疡性结肠炎患者,根据其严重程度分为轻、中度UC组与重度UC组,分别检测患者体内的NGAL通路关键因子水平,并对比分析两组患者治疗缓解后的复发情况。[结果]治疗前重度UC组患者的血清NGAL水平明显高于轻、中度UC组患者,差异有统计学意义(P0.05)。治疗后重度UC组患者的血清NGAL水平与轻、中度UC组患者相比未见明显差异(P0.05)。治疗缓解患者重度UC组停药后3个月、停药后6个月的复发率明显高轻、中度UC组患者,差异有统计学意义(P0.05)。[结论]NGAL水平在溃疡性结肠炎患者中明显升高,且疾病活动程度越高,其NGAL水平升高越明显,患者的复发率也随之升高,控制患者NGAL水平,有利于预防疾病复发,具有重要临床意义。     

中药直肠滴注式灌肠法治疗溃疡性结肠炎30例

[目的]观察中药直肠滴注式灌肠法治疗溃疡性结肠炎（UC）的疗效优势。[方法]60例UC患者,随机分为2组,各30例,2组患者分别采用中药直肠滴注式灌肠法（观察组）和传统保留灌肠法（对照组）治疗。[结果]观察组中药在肠内存留时间、药物外溢情况、患者满意度、临床效果均优于对照组（P〈O．05）。[结论]UC病程长、易反复,采用中药直肠滴注式药物保留灌肠提高了临床疗效,增加了患者满意度,利于疾病恢复。     

复方青黛颗粒联合路优泰治疗溃疡性结肠炎的疗效观察

[目的]观察复方青黛颗粒联合路优泰治疗溃疡性结肠炎(UC)的疗效。[方法]选取我科近3年病房收治的UC伴焦虑患者,将其分为复方青黛颗粒联合路优泰治疗组和复方青黛颗粒对照组,比较2组的疗效。[结果]治疗组和对照组疗效比较,差异具有统计学意义(P<0.05)。[结论]对于伴有焦虑的UC患者在治疗时给予抗焦虑药物具有一定的临床治疗意义。     

miR-196b在溃疡性结肠炎缓解期肠易激样综合征肠黏膜中表达的意义

[目的]:研究溃疡性结肠炎(ulcerative colitis,UC)缓解期肠易激样综合征(IBLS)患者肠黏膜组织中miR-196b的表达水平,探讨其在溃疡性结肠炎缓解期肠易激样综合征[IBS(+)UC]中的意义。[方法]选取IBS(+)UC患者16例,并同时配对UC缓解期无肠易激样综合征[IBS(-)UC]患者及肠易激样综合征-腹泻型(IBS-D)患者各16例,采用qRT-PCR方法检测直肠黏膜组织中miR-196b的表达水平。[结果]IBS(+)UC患者直肠黏膜组织中miR-196b正常表达,水平为0.58±0.09,IBS(-)UC组直肠黏膜组织中miR-196b低表达,水平为0.41±0.07。2组比较差异有统计学意义(P0.05);IBS-D组miR-196b高表达,水平为0.64±0.11,与IBS(+)UC组比较差异无统计学意义(P0.05);与IBS(-)UC组比较,差异有统计学意义(P0.05)。[结论]直肠黏膜组织中miR-196b水平在IBS(+)UC表达上调,可以作为区分IBS(-)UC的关键指标。     

黏膜通透性相关因子CK8、S100、E-cadherin在溃疡性结肠炎中的表达及作用

[目的]探究黏膜通透性相关因子CK8、S100、E-cadherin在溃疡性结肠炎(UC)中的表达,以期为UC的生物学研究提供新的方向。[方法]利用免疫组织化学的方法比较观察组(UC患者或DSS模型小鼠)与对照组(正常人或正常小鼠)间结肠组织中上述3种因子的表达差异。[结果]与对照组比较,观察组肠组织中CK8和E-cadherin表达降低,S100蛋白则升高。[结论]CK8、S100、E-cadherin通过影响肠黏膜通透性参与UC的发生及发展,从而有望成为UC治疗新的生物靶点。     

P-糖蛋白在溃疡性结肠炎患者肠黏膜中表达的研究

[目的]探讨P-糖蛋白在溃疡性结肠炎(UC)患者肠黏膜中表达的水平及意义。[方法]以健康体检者作为对照组,对来自45例UC患者60份肠黏膜应用免疫组织化学的方法检测P-糖蛋白的表达。[结果]P-糖蛋白在UC肠黏膜的表达水平与疾病本身及疾病的病情轻重、疾病是否活动无直接相关性,但与是否为难治性UC有关。难治性UC患者的肠黏膜中P-糖蛋白表达水平较非难治性UC患者低(P0.05),但经治疗病情缓解后P-糖蛋白在肠黏膜的表达水平有显著提升(P0.05),与正常对照组比较差异无统计学意义。[结论]P-糖蛋白在难治性UC肠黏膜的表达降低,可能构成疾病难治的原因之一。中药治疗难治性UC有效的机制可能通过上调P-糖蛋白在肠黏膜中的表达而修复肠黏膜屏障功能来实现。     

同型半胱氨酸对丽珠肠乐维持治疗溃疡性结肠炎复发的影响

[目的]探讨和研究溃疡性结肠炎(UC)患者血清同型半胱氨酸(homocysteine,HCY)水平,明确HCY水平与UC复发的关系。[方法]对我院32例健康体检者及38例丽珠肠乐维持治疗的UC患者进行血清HCY水平的检测,对检测结果进行比较分析,并观察半年及1年疗程的UC患者缓解期与活动期血中HCY水平,比较HCY的水平差异对UC复发的影响。[结果]UC缓解期患者的血清HCY高于健康者,但是两者之间差异无统计学意义(P0.05);当病程2年,半年内及1年内疗程的UC患者活动期HCY水平较缓解期普遍升高,虽然两者差异无统计学意义,但是仍可提示UC复发跟高HCY血症存在正相关关系;而无论是半年疗程,还是1年疗程的UC患者,当病程2年的缓解期血清HCY水平显著低于活动期(P0.05)。[结论]在UC患者中无论是活动期还是缓解期,都存在着高HCY血症,且UC复发时HCY水平更高,故可通过监测UC缓解期患者血中HCY水平,提早干预,减少复发,这一结果可为今后防止UC复发提供了新的思路和方向。     

粪菌移植治疗溃疡性结肠炎疗效的Meta分析

[目的]系统评价粪菌移植治疗溃疡性结肠炎(UC)的有效性和安全性。[方法]系统检索PubMed、Embase、The Cochrane Library、Web of Science、Medline、WANFANG和CNKI数据库,查找关于粪菌移植治疗UC疗效评价随机对照试验,检索时间均从建库至2018年9月10日前发表的,文献检索及筛选、数据提取和文献偏倚评估均由2位研究者独立进行。应用RevMan 5.3软件进行Meta分析。[结果]共纳入4个研究,共计277例患者。Meta分析结果表示,结合临床缓解和内镜缓解,粪菌移植治疗UC的缓解率为28%(39/140),与安慰剂的缓解率9.5%(13/137)比较,差异有统计学意义[OR=3.67,95%CI(1.82,7.39),P0.01]。与安慰剂比较,在临床缓解方面[OR=2.41,95%CI(1.27,4.56),P0.01]和内镜缓解方面[OR=3.27,95%CI(1.62,6.59),P0.01]上,差异有统计学意义。[结论]粪菌移植能明显提高UC的治愈率,是一种治疗UC的有效手段。     

妊娠期溃疡性结肠炎治疗经验总结

[目的]有效地控制妊娠期UC患者的病情,减轻药物的毒副作用,帮助患者顺利度过孕产期;[方法]中西医结合、综合调治,包括孕前调理沟通、孕期合理用药、菌群调节、饮食调理、肠内营养以及口服中药等;[结果]已先后诊治妊娠期UC患者40余例,且均顺利生产,在对患者子女的长期随访中未见不良反应的发生。[结论]中西医结合、综合调治的方法治疗妊娠期UC具有一定的价值,可被临床借鉴使用。     

溃疡性结肠炎患者血小板计数及凝血功能检测的临床意义

目的探讨检测溃疡性结肠炎患者血小板计数和凝血功能的临床意义。方法检测68例溃疡性结肠炎患者及26例对照组血小板计数及凝血功能,分析两者对患者临床病情程度的影响及其相关性。结果活动期溃疡性结肠炎患者血小板计数及纤维蛋白原明显高于缓解期患者和对照组（P〈0．05）,凝血酶原时间明显低于缓解期患者和对照组（P〈0．05）。重度溃疡性结肠炎患者血小板计数及纤维蛋白原明显高于中、轻度患者（P〈0．05）,凝血酶原时间明显低于中、轻度溃疡性结肠炎患者（P〈0．05）。溃疡性结肠炎患者血小板计数与凝血酶原时间变化存负相关,与纤维蛋白原存在正相关。结论血小板计数及凝血功能检测对判断溃疡性结肠炎活动性及其严重程度具有重要临床价值。     

溃疡性结肠炎的肠外表现

目的：分析溃疡性结肠炎（UC）伴随的肠外表现,探讨其与病变部位和疾病程度之间的关系。方法：采用χ^2检验方法对392例UC患者进行回顾性分析。结果：392例UC患者中,82例（20．9％）有肠外表现,其中34例（8．7％）有1种以上肠外表现;全结肠型与左半结肠型UC患者肠外表现的发生率均较单纯直肠型者增高（P＜0．05）,其中全结肠型的发生率最高,左半结肠型次之,单纯直肠型最低,呈递减趋势,但前二者间差异无显著性（P＞0．05）;各种常见肠外表现的发生率在重度UC患者较轻度明显升高（P＜0．05）,从轻度、中度到重度呈递增趋势;除强直肠脊柱脊、原发性硬化性胆管炎等外,多数肠外表现的发生与UC活动性密切相关,经氨基水杨酸类和（或）皮质类固醇治疗后消失。结论：UC患者肠外表现发生率较高,累及的部位依次为关节、肝胆、皮肤、口腔和眼睛。UC肠外表现的发生与病变部位和炎症程度密切相关。多数肠外表现与UC活动性相关,但与UC预后无明显关系。     

活动期溃疡性结肠炎凝血功能分析

背景：血栓栓塞是溃疡性结肠炎（UC）较严重的并发症之一,了解活动期UC凝血状态,可为治疗提供参考依据。目的：分析UC活动期患者凝血功能的变化,探讨其与疾病活动性和严重程度的关系。方法：选取2006年1月～2012年11月上海中医药大学附属普陀医院收治的UC患者162例。检测患者血小板计数（PLT）、平均血小板体积（MPV）、凝血酶原时间（胛）、活化部分凝血活酶时间（APTr）、纤维蛋白原（FIB）、凝血酶时间（r丌）、D-二聚体（D-D）、红细胞沉降率（ESR）、C反应蛋白（CRP）,评估患者临床活动性指数（CAI）和Baron内镜下评分。比较PLT、MPV、PT、APTT、FIB、Tr、D-D在UC不同疾病活动性和不同严重程度间的差异,分析UC活动期PLT、MPV、PT、FIB、D-D与ESR、CRP、CAI、Baron评分的相关性。结果：UC活动期组与缓解期组、正常对照组的PLT、MPV、FIB、D-D相比差异有统计学意义（P〈0．05）。轻、中、重度UC间D-D相比差异有统计学意义（P〈0．05）。Spearman等级相关分析显示,UC活动期患者PLT和D-D与ESR、CAI、Baron评分呈正相关,MPV与ESR、Baron评分呈负相关,PT和D-D与CRP呈正相关,FIB与ESR、CRP、Baron评分呈正相关（P〈0．05）。多元回归分析结果显示,UC活动期患者MPV与Baron评分呈负相关,FIB与ESR和CRP呈正相关,D-D与ESR和CRP呈正相关（P〈0．05）。结论：PLT、MPV、PT、FIB、D-D可作为评价UC活动性的指标,D-D可作为评价UC严重程度的指标。     

Antibody testing for ulcerative colitis--more letters?

The presence of perinuclear antineutrophil cytoplasmic antibodies (P-ANCAs) and antibodies against cathepsin G, a target antigen for P-ANCAs, was determined in the sera of patients with ulcerative colitis (UC), relative to endoscopic severity and disease activity. P-ANCAs were detected by indirect immunofluorescent assay on ethanol-fixed human neutrophils. Antibodies to cathepsin G were detected by ELISA and Western blotting. P-ANCAs were detected by immunofluorescent assay in 62.5% of 32 patients with active UC. Anti–cathepsin G antibodies were detected in 40.6% of 32 patients with active UC, and their prevalence was significantly higher in patients with severe colitis, as determined by endoscopy, than in those with mild or moderate colitis. The prevalence and titers of anti–cathepsin G antibodies were significantly higher during the active phase of the disease than during the inactive phase.     

细胞免疫指标与溃疡性结肠炎严重程度的关系

背景：CD4、CD8阳性T淋巴细胞和可溶性白细胞介素—2受体(SIL—2B)作为细胞免疫的主要指标被认为与溃疡性结肠炎(UC)的严重程度有关，但其相关关系各学者意见不一。目的：观察外周血CD4、CD8阳性T淋巴细胞和SIL—2B水平与UC严重程度的关系及其在疾病缓解后的变化情况，以评估上述指标在UC临床诊治中的价值。方法：测定24例活动期UC患者的外周血CD4、CD8阳性T淋巴细胞和SIL—2B水平，其中10例患者的SIL—2B水平作治疗前后比较。结果：活动期UC患者的SIL—2B水平显著高于健康对照组(P＜0．05)，且与疾病严重程度有关；CD4、CD8阳性T淋巴细胞水平则与健康对照组无显著差异，与疾病严重程度亦无关。经类固醇激素治疗症状缓解后，患者的SIL—2B水平显著下降(P＜0．05)。结论：外周血SIL—2B水平与UC的严重程度和缓解密切相关，CD4、CD8阳性T淋巴细胞水平则无参考价值。     

The role of Budesonide-MMX in active ulcerative colitis

Traditional corticosteroids represent a well-established and effective treatment for active ulcerative colitis (UC). However, the severity of their systemic side effects, led in recent years to look for new steroid molecules that could reduce them, maximizing the anti-inflammatory activity. Budesonide has been one of the most studied steroid compounds and it has been approved for the treatment of mild to moderate active Crohn's disease (CD). In order to extend the release until the distally located inflammation, budesonide has been coupled with a controlled delivery system, called Multi-Matrix system (MMX^®), already successfully tested with oral mesalazine for the treatment of distal UC. After in vitro and in vivo models, the efficacy of Budesonide-MMX has been investigated in active UC with a first small phase II study, and partially encouraging results. This article will review the evidences on the use of budesonide in inflammatory bowel diseases and will discuss the role of Budesonide-MMX in active UC nowadays.     

EUS IN THE DIAGNOSIS OF ULCERATIVE COLITIS

The ultrasonograms of ulcerative colitis (UC) in active stage show hypoechoic changes of the colorectal wall from the mucosal layer to the deeper layers. These endoscopic ultrasound (EUS) changes of the wall recognized in active stage disappear or normalize in the stage of remission. When the stage of UC is exacerbated, the hypoechoic changes of the wall extend from the mucosal layer to the deeper layers with the increase of wall thickness. These EUS images of active UC are classified into the following types: UC‐M, thickening of the whole wall with the structure preserved; UC‐SM, hypoechoic changes reach the superficial portion of third layer with the thickening of whole wall; UC‐SM deep, hypoechoic changes reach the deeper portion of third layer with the thickening of whole wall; UC‐MP, hypoechoic changes reach the fourth layer with the thickening of whole wall; UC‐SS/SE, hypoechoic changes penetrate through the fourth layer with the thickening of whole wall. With the help of EUS we can demonstrate the severity of inflammation in UC. Moreover, in severe cases of UC, the treatment strategy including emergency surgery can be determined. EUS is a valuable method in the management of UC.     

活动期溃疡性结肠炎与蛋白质和脂质代谢的相关性分析

背景：溃疡性结肠炎（UC）已成为我国常见的慢性消化系统疾病之一,尽早对疾病活动性和严重度作出准确评估,有助于及时、正确的治疗。目的：分析活动期UC患者蛋白质和脂质代谢指标与疾病活动性和严重度之间的关系。方法：收集2006年1月～2012年11月上海市普陀区中心医院97例活动期UC患者和100名正常对照者,检测总蛋白（TP）、白蛋白（ALB）、球蛋白（GLB）、总胆固醇（TC）、三酰甘油（TG）、载脂蛋白A（ApoA）、载脂蛋白B（ApoB）、脂蛋白a（LPa）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（CDL-C）,并分析与疾病活动性、严重度的关系。结果：活动期UC患者BMI、TP、ALB和TC均显著低于正常对照组（P〈0．05）。与轻度活动期UC患者相比,重度和中度活动期UC患者ALB明显降低（P〈0．05）,重度活动期TG明显降低（P〈0．05）,中度活动期ApoA明显降低（P〈0．05）。相关性分析表明TP与ESR相关（P〈0．05）,ALB与ESR、CRP、CAI评分和Baron评分相关（P〈0．05）,TC与Baron评分相关（P〈0．05）。结论：活动期UC患者易出现蛋白质和脂质代谢紊乱,TP、ALB、TC与疾病活动性相关;ALB与疾病严重度有关,可作为UC疾病严重度评价的客观指标之一。     

Anti-cathepsin G antibodies in the sera of patients with ulcerative colitis

The presence of perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCAs) and that of antibodies against cathepsin G, a target antigen for P-ANCAs, was determined in the sera of patients with ulcerative colitis (UC), relative to the endoscopic severity and disease activity. P-ANCAs were detected by indirect immunofluorescent assay (IIF) on ethanol-fixed human neutrophils. Antibodies to cathepsin G were detected by an enzyme-linked immunosorbent assay (ELISA) and Western blotting. P-ANCAs were detected by IIF in 62.5% of 32 patients with active UC. Anti-cathepsin G antibodies were detected in 40.6% of 32 patients with active UC, and their prevalence was significantly higher in patients with severe colitis, as determined by endoscopy, than in those with mild or moderate colitis (P < 0.05). The prevalence and titers of anti-cathepsin G antibodies were significantly higher during the active than the inactive phase of the disease (P < 0.05). Measurement of titers of anti-cathepsin G antibodies by ELISA in the serum is useful for evaluating the activity of UC. Received: June 21, 1999 / Accepted: March 24, 2000     

Expression of interleukin-22/STAT3 signaling pathway in ulcerative colitis and related carcinogenesis

AIM:To investigate the expression of interleukin (IL)-22 and its related proteins in biopsy specimens from patients with ulcerative colitis (UC) and UC-related carcinogenesis. METHODS:Biopsy specimens were obtained from patients with inactive (n = 10), mild-to-moderately active (n = 30), severely active (n = 34), initial (n = 30), and chronic UC (n = 44), as well as UC patients with dysplasia (n = 10). Specimens from patients without colonic abnormalities (n = 20) served as controls. Chronic colitis in experimental mice was induced by 2.5% dextran sodium sulfate. The expression levels of IL-22, IL-23, IL-22R1 and phosphorylated STAT3 (p- STAT3) were determined by immunohistochemistry. Bcl-2, cyclin D1 and survivin expression was detected by Western blotting. RESULTS:Patients with active UC had significantly more IL-22, IL-23, IL-22R1 and p-STAT3-positive cells than the patients with inactive UC and normal controls. Furthermore, IL-22 and related proteins were closely related to the severity of the colitis. The expression of IL-22 and IL-22R1 in the tissue of initial UC was stronger than in that of chronic UC, whereas the expression of p-STAT3 was significantly increased in chronic UC tissues. In dysplasia tissues, the expression level of IL-22 and related proteins was higher compared with controls. Mouse colitis model showed that expression of IL-22, IL-22R1 and IL-23 was increased with time, p-STAT3 and the downstream gene were also remarkably upregulated.CONCLUSION:IL-22/STAT3 signaling pathway may be related to UC and UC-induced carcinogenesis and IL-22 can be used as a biomarker in judging the severity of UC.