清肠化湿方对实验性结肠炎小鼠IL-6反式信号转导的影响＊

目的：观察清肠化湿方对实验性结肠炎小鼠白介素6（IL-6）反式信号转导trans-signaling的影响,初步探讨该方治疗溃疡性结肠炎（UC）作用机制是否与调控IL-6 trans-signaling有关。方法： TNBS法制备小鼠结肠炎模型,药物干预后,ELISA法检测可溶性白细胞介素6受体（sIL-6R）含量,实时荧光定量PCR法检测IL-6、糖蛋白130（gp130）mRNA相对表达水平,Western Blot法观察结肠黏膜IL-6、gp130蛋白的表达情况。结果：模型组小鼠sIL-6含量、IL-6及gp130 mRNA和蛋白表达水平较正常小鼠明显增高。清肠化湿方可以降低实验性结肠炎小鼠结肠sIL-6水平（P<0.01）,降低IL-6及gp130mRNA和蛋白表达水平（P<0.01）。结论：清肠化湿方对小鼠实验性结肠炎发挥良好抗炎效应,可能与调控IL-6 trans-signaling有关。     

中药免煎颗粒联合美莎拉嗪灌肠液治疗溃疡性结肠炎38例

目的:观察中药免煎颗粒联合美莎拉嗪灌肠液治疗溃疡性结肠炎的临床疗效。方法:将73例溃疡性结肠炎患者随机分为治疗组38例和对照组35例,治疗组给予中药免煎颗粒口服联合美莎拉嗪灌肠液灌肠治疗,对照组给予柳氮磺吡啶治疗。结果:对照组有效率为74.2%,治疗组有效率为86.8%,治疗组有效率明显优于对照组(P<0.05)。结论:中药免煎颗粒联合美莎拉嗪灌肠液治疗溃疡性结肠炎具有较好的临床疗效。     

Effects of electroacupuncture at lower he-sea points on interleukin-1β and high mobility group box 1 in model rats with ulcerative colitis

ObjectiveTo comparatively observe the effect of electroacupuncture at digestive system-related lower he-sea points on the expressions of serum interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) of colon tissues and high mobility group box 1 protein (HMGB 1) of ulcerative colitis (UC) model rats, and to explore whether there is relative specificity of electroacupuncture at Shàngjùxū (

ST 37), one of lower he-sea points of large intestine, in treatment of bowel diseases.MethodA total of 60 SD rats were randomly divided into control group, model group, ST 37 group, Zúsānlľ (

ST 36) group, Xiàjùxū (

ST 39) group and Yánglíngquán (

GB 34) group. There were ten rats in each group; five were males, and five were females. UC models were established by clysis with 2, 4, 6-trinitrobenzene sulfonic acid/alcohol solution. After modeling, treatment was conducted for ten days, specimens were collected, colonic ulcers and inflammation were inspected visually and scored. The content of serum IL-1β and the expressions of TNF-α and HMGB 1 in colon were detected through ELISA.Results

Compared with control group, the scores of colonic ulcers and inflammation, the content of serum IL-1β and the expressions of TNF-α (except ST 37 group) and HMGB 1 were all higher (P<0.05, P<0.01);

compared with model group, the scores of colonic ulcers in ST 36 group and ST 37 group were lower obviously (P<0.05, P<0.01); the expressions of IL-1β, TNF-α and HMGB 1 in the four treatment groups were lower obviously (P<0.01);

compared with ST 37 group, the expressions of IL-1β, TNF-α and HMGB 1 in other three treatment groups were higher obviously (P<0.05, P<0.01); and the scores of colonic ulcers in ST 39 group and GB 34 group were higher obviously (P<0.05).Conclusion

The score of colonic ulcers can be reduced through electroacupuncture at ST 37, ST 36, ST 39 and GB 34, which can also reduce the content of serum IL-1β and the expressions of TNF-α and HMGB 1, and effectively inhibit inflammatory response of colon caused by UC;

the effect trend of the four acupoints in treatment of UC is: ST 37>ST 36>ST 39>GB 34, and electroacupuncture at ST 37 has the best effect with relative specificity.     

浊毒论治溃疡性结肠炎临证举隅

胡根和从浊毒方面论治溃疡性结肠炎的经验。认为浊毒贯穿本病的始末,并运用解毒化浊方法结合临床病案治疗该病,取得不错的疗效。     

美沙拉嗪栓联合穴位贴治疗溃疡性结肠炎中期效果探讨

目的:探讨美沙拉嗪栓联合穴位贴治疗溃疡性结肠炎中期临床效果。方法:将溃疡性结肠炎中期患者86例随机分为2组,各43例,其中对照组在常规治疗的基础上使用美沙拉嗪栓每日1~2次治疗,1枚/次,观察组在对照组治疗的基础上使用穴位贴,以中脘、足三里、大肠俞及上巨虚四穴进行贴敷,1贴/d,连续治疗3个月为1个疗程,治疗1个疗程后比较2组患者临床症状积分,临床症状缓解时间及1年后随访患者临床症状复发情况。结果:治疗后1周开始观察组临床症状积分显著低于治疗前及同期对照组(P0.05),治疗后观察组腹泻、腹痛腹胀及黏液脓血便消失时间均短于对照组(P0.05),治疗后1年观察组中发生腹痛、腹泻及脓血便的比率低于对照组(P0.05)。结论:美沙拉嗪栓联合穴位贴治疗溃疡性结肠炎,能较快改善临床症状,且维持时间长。     

葛仙汤治疗大鼠溃疡性结肠炎

目的:探讨葛仙汤对大鼠溃疡性结肠炎的治疗作用及其机制.方法:将SD大鼠按均衡随机原则分为正常对照组、模型对照组和葛仙汤低、中、高剂量组,采用大肠杆菌加乙酸免疫复合法造成大鼠溃疡性结肠炎模型.连续给药21 d,观察动物的一般情况,进行疾病活动指数(DAI)评估、结肠病理学评分(HS),检测血清中IL-6、IL-10含量.结果:葛仙汤低、中、高剂量3个治疗组DAI和HS均明显低于模型对照组(P<0.05或P<0.01),IL-6含量与模型对照组比较均明显减少(P<0.01);中剂量组IL-6含量明显低于高、低剂量组(P<0.05).3个治疗组IL-10均较模型对照组明显升高(P<0.01);中、低剂量组IL-10明显高于高剂量组(P<0.05).结论:低、中、高剂量葛仙汤均能缓解溃疡性结肠炎大鼠的症状,减轻其结肠病理损伤,促进溃疡面愈合,其中以中剂量效果为更好.     

The diagnostic accuracy of chromoendoscopy for dysplasia in ulcerative colitis: meta‐analysis of six randomized controlled trials

Aim The diagnostic accuracy of chromoendoscopy for dysplasia in ulcerative colitis (UC) was systematically evaluated. Method Original studies in any language were searched from PubMed and Embase. Meta‐analysis of prospective studies that compared chromoendoscopy with histological diagnosis was carried out. Sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for each study and pooled together; summary receiver operating characteristic (ROC) and subgroup analyses were performed, while the quality of the study and heterogeneity were assessed. Results Six randomized controlled trials were included, which used methylene blue or indigo carmine dye spray. The meta‐analysis demonstrated a pooled sensitivity of 83.3% (95% confidence interval (CI), 35.9–99.6%), specificity of 91.3% (95% CI, 43.8–100%), and DOR of 17.544 (95% CI, 1.245–247.14). Subgroup analyses revealed that both the methylene blue dye spray subgroup and the unspecified endoscopist subgroup include the same studies, and their pooled sensitivity and specificity were 0.737 and 0.917, respectively. The other subgroup, which used indigo carmine dye spray, had overall higher sensitivity (0.930) and lower specificity (0.910). Conclusion Chromoendoscopy has medium to high sensitivity and a high diagnostic accuracy for dysplastic lesions in UC.     

Low complication rate after stoma closure. Consultants attended 90% of the operations

Aim To evaluate complications after stoma closure. Method Using a retrospective review of 997 medical records, data were collected from all patients undergoing stoma closure at the Department of Surgery P, Aarhus University Hospital, Denmark, from 1996 to 2010. Patient data after Hartmann reversal and loop‐ileostomy closure were compared. Data regarding the grade of the operating surgeon and assistant were extracted. Results Out of 997 patients, 700 (70.6%) had a loop‐ileostomy closure and 172 (17.4%) had a Hartmann reversal. Postoperative mortality was 0.5%. Seven patients required re‐operation (0.7%). Morbidity was registered in 31.9% of the patients, with 131 (13.1%) having early complications and 187 (18.8%) having late complications. Wound infection was the most frequent early complication, which occurred in 31 patients (3.1%). Only 10 patients (1%) had an anastomotic leak. Incisional hernia was the most frequent late complication, occurring in 92 patients (9.3%). A consultant attended 90% of the operations. Junior surgeons never performed stoma closure without supervision. Body mass index was significantly associated with the development of incisional hernia. Hartmann reversal was associated with higher rates of complications compared with loop‐ileostomy closure. In patients with Hartmann reversal, stapled anastomosis was associated with stricture in 12 out of 95 cases (12.6%), whereas hand‐sewn anastomosis was not associated with stricture (0 out of 64 patients; 0%; P < 0.05). Conclusion Stoma closure is associated with low rates of leakage. A favourable case mix and high degree of consultant attendance may explain the good results.