Unravelling the pathogenesis of inflammatory bowel disease

外泌体是细胞分泌/衍生的囊泡状纳米颗粒,其介导了一种新型的细胞间通讯方式。细胞分泌型mRNA和microRNAs(miRNAs)可随着外泌体在细胞间进行功能转移,并被送入受体细胞作为内源性miRNAs发挥作用,同时调节多个目标基因或信号。外泌体等外囊泡介导的细胞间通讯以及肠道微生物群−宿主细胞通讯参与了炎症性肠病发生、发展相关的状况。本文回顾外泌体在细胞间通讯的方式作用,从细胞间通讯的角度讨论外泌体在炎症性肠病的发病机制、病情进展、治疗诊断中的作用及其临床应用前景。

     

外泌体miRNA介导的细胞间通讯在骨与软骨组织疾病中的作用研究进展

目的 外泌体是细胞间信息传递的重要载体,对骨科疾病发病机理的研究具有重要意义。本文对骨与软骨组织中功能细胞的外泌体miRNA介导的细胞间通讯作用及机制进行总结与归纳,期望为骨科疾病治疗提供参考。方法 以\     

外泌体在心肌疾病中的研究进展

外泌体是具有脂双层膜的细胞外囊泡,其通过携带丰富的微小RNA(miRNA)等生物分子传递信息,是细胞间通讯的关键介质。外泌体通过参与炎症反应、内皮细胞损伤、心肌纤维化等过程来影响各种心肌疾病的发生发展,在心肌的损伤和修复中起着非常重要的作用。本文主要就近几年发现的外泌体在各种心肌疾病中的机制、诊断及治疗等方面的作用展开综述。     

间充质干细胞外泌体在肝癌中作用的研究进展

肝细胞癌作为人类恶性肿瘤之一,具有侵袭性强、化疗敏感性差、复发率高、死亡率高等特点。因此,确定治疗肝癌的新靶点对于探索治疗新策略具有重要意义。外泌体是重要的物质运输载体,参与肝癌细胞增殖、分化、凋亡等过程,影响化疗药物敏感性,可能是治疗肝癌的理想途径。该文就间充质干细胞外泌体对肝癌的影响进行了综述。     

间充质干细胞在炎症性肠病治疗中的研究进展

现代医学研究表明炎症性肠病的发病机制与患者免疫失调具有密切关系。目前临床对于炎症性肠病治疗主要原则为消除活动性炎症以及改善免疫功能紊乱,比如氨基水杨酸制剂、免疫抑制剂以及糖皮质激素等均是临床治疗常用药物。间充质干细胞为具有自我复制以及多方向分化潜能的成体干细胞,对于组织修复以及免疫调节等均具有良好的治疗效果,目前在心肌梗死以及系统性红斑狼疮等疾病治疗中应用较为广泛。近些年很多专家将间充质干细胞应用于炎症性肠病的治疗中,取得了良好的效果。本文将这些新研究进展进行综述,以期为炎症性肠病的临床治疗提供借鉴。     

炎症性肠病的肠外表现及治疗

炎症性肠病(IBD)是一种系统性疾病,不仅累及肠道,亦可出现多种肠外表现(EIM),易造成误诊,及时诊断及合理治疗能够改善患者的功能状态和生活质量,现将IBD肠外表现及治疗方法作一综述。     

250例炎症性肠病住院病人临床分析

目的探讨炎症性肠病(Inflammatoryboweldisease,IBD)的临床特点。方法回顾性分析我院14年来确诊的IBD住院病人250例。结果161例溃疡性结肠炎(Ulcerativecolitis,UC)及89例克罗恩病(Crohn'sdisease,CD)中,均男多于女(1.3～1.9:1),各年龄段均有发病,发病高峰为20～50岁。1%CD有阳性家族史。70%～80%UC患者有腹痛、腹泻、血便和黏液便;UC病变范围分型为直肠炎27例(18%),直肠乙状结肠炎40例(26%),左半结肠炎29例(19%),全结肠炎52例(34%),区域性结肠炎4例(3%);病情轻、中、重度分别为67例(42%)、59例(37%)、35例(21%);临床类型为暴发型5例(3%),初发型68例(42%),慢性持续型35例(22%),慢性复发型53例(33%)。58%～80%CD患者有腹痛腹泻,28%CD病人有血便;CD病变范围分型为小肠型28例(31%)、结肠型30例(34%)、回结肠型27例(30%)、其他(食道、十二指肠)4例(5%);病情轻、中、重度分别为15例(17%)、28例(31%)、46例(52%);疾病表型为非狭窄非穿孔型25例(28%),狭窄型33例(37%),穿孔型31例(35%)。肠外表现多累及关节、口腔、皮肤和眼,UC及CD发病率分别为2%、0.6%、0、0和6%、5%、5%、1%。CD并发症较多,主要为肠梗阻、瘘管及穿孔。12例(7%)UC病人因内科治疗无效而行手术,42例(47%)CD病人是经手术确诊为CD,其中13例(15%)初诊为“阑尾炎”。结论IBD就诊人数逐年增加。IBD临床表现多样,CD肠外表现及并发症较UC多见,误诊率较高。     

炎症性肠病治疗药物研究进展

炎症性肠病（IBD）,IBD至少包括克罗恩病和溃疡性结肠炎两种独立疾病。IBD对人体健康带来极大的损害,严重影响了生活质量,加重患者的经济负担。本文主要对IBD的流行病学、致病因素以及临床治疗药物进行了总结,期望能为后续IBD的药物研发和治疗提供参考。     

A Review on Chemical-Induced Inflammatory Bowel Disease Models in Rodents

Ulcerative colitis and Crohn''s disease are a set of chronic, idiopathic, immunological and relapsing inflammatory disorders of the gastrointestinal tract referred to as inflammatory bowel disorder (IBD). Although the etiological factors involved in the perpetuation of IBD remain uncertain, development of various animal models provides new insights to unveil the onset and the progression of IBD. Various chemical-induced colitis models are widely used on laboratory scale. Furthermore, these models closely mimic morphological, histopathological and symptomatical features of human IBD. Among the chemical-induced colitis models, trinitrobenzene sulfonic acid (TNBS)-induced colitis, oxazolone induced-colitis and dextran sulphate sodium (DSS)-induced colitis models are most widely used. TNBS elicits Th-1 driven immune response, whereas oxazolone predominantly exhibits immune response of Th-2 phenotype. DSS-induced colitis model also induces changes in Th-1/Th-2 cytokine profile. The present review discusses the methodology and rationale of using various chemical-induced colitis models for evaluating the pathogenesis of IBD.     

Systematic Review of Recent Lipidomics Approaches Toward Inflammatory Bowel Disease

Researchers have endeavored to identify the etiology of inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis. Though the pathogenesis of inflammatory bowel diseases remains unknown, dysregulation of the immune system in the host gastrointestinal tract is believed to be the major causative factor. Omics is a powerful methodological tool that can reveal biochemical information stored in clinical samples. Lipidomics is a subset of omics that explores the lipid classes associated with inflammation. One objective of the present systematic review was to facilitate the identification of biochemical targets for use in future lipidomic studies on inflammatory bowel diseases. The use of high-resolution mass spectrometry to observe alterations in global lipidomics might help elucidate the immunoregulatory mechanisms involved in inflammatory bowel diseases and discover novel biomarkers for them. Assessment of the characteristics of previous clinical trials on inflammatory bowel diseases could help researchers design and establish patient selection and analytical method criteria for future studies on these conditions. In this study, we curated literature exclusively from four databases and extracted lipidomics-related data from literature, considering criteria. This paper suggests that the lipidomics approach toward research in inflammatory bowel diseases can clarify their pathogenesis and identify clinically valuable biomarkers to predict and monitor their progression.     

炎性肠病药物治疗的循证医学研究进展

目的:从循证医学的角度解析炎性肠病药物治疗的相关进展。旨在提高对临床证据的认知,帮助临床医生评估新的治疗,从批判的视角重新看待以往的治疗。方法:收集国外近期相关文献进行评价。结果及结论:炎性肠病(IBD)的发病机制尚不清楚,众多的治疗方案可供选择。因此,循证医学研究结果有非常重要的临床指导意义。IBD的研究方面取得了可喜的进步。但是,有关CD活动指数(CDAI)和临床分型系统仍有待于改进。通过循证医学的研究证据有望确定安全和易于耐受的药物,并能发现目前诊治方面存在的缺陷和问题,更好地解决患者的病痛。     

Optimization of anti-TNF therapy in patients with Inflammatory Bowel Disease

After the introduction of anti-tumor necrosis factor (anti-TNF) agents, the clinical outcome of patients with Inflammatory Bowel Disease (IBD) has improved significantly. However, use of anti-TNF therapy is complicated by loss of response. In order to maintain remission, adequate serum levels are required. Hence, therapeutic drug monitoring (TDM) is important in order to optimize serum drug levels, especially in patients with loss of response to these agents. Optimization of anti-TNF therapy by applying TDM enables clinicians to regain response to TNF blockers in a significant proportion of patients. It is important to use anti-TNF agents in their most optimal way, since these therapeutic agents are expensive and the medical options after failing anti-TNF therapy are limited. Here, we will discuss how to optimize treatment with anti-TNF agents in IBD patients in order to improve treatment efficacy, prevent anti-drug antibody formation, reduce side effects, discontinue unnecessary treatment and manage costs.     

伊班磷酸钠联合钙剂和维生素D治疗炎症性肠病性骨质疏松的疗效观察

目的探讨伊班磷酸钠联合钙剂和维生素D治疗炎症性肠病性骨质疏松的疗效和安全性。方法来自河南科技大学第一附属医院经定量CT(QCT)诊断为炎症性肠病骨质疏松和骨量减少的49例患者,给予钙剂和维生素D治疗,另外静脉滴注伊班磷酸钠1mg,每3个月1次,在治疗前、后6个月和1年进行QCT扫描。结果治疗6个月、1年后腰椎骨密度较治疗前有明显增加(P<0.05、P<0.01)。结论静脉滴注伊班磷酸钠联合口服钙剂和维生素D治疗炎症性肠病引起的骨质疏松和骨量减少是一项耐受性较好的方案。     

糖皮质激素及嘌呤类似物在炎症性肠病治疗中的应用与评价

目的：合理应用糖皮质激素及嘌呤类似物治疗炎症性肠病。方法：复习文献,总结糖皮质激素及嘌呤类似物治疗炎症性肠病的适应证、用药时机、疗程、疗效及不良反应。结果及结论：糖皮质激素适用于氨基水杨酸制剂疗效不佳的轻、中型患者,尤其适用于重型活动期及暴发型患者;应根据患者炎症性肠病病变的程度和范围选择合适的剂量、给药方式,注意药品不良反应。嘌呤类似物主要适用于对糖皮质激素依赖的UC病例及维持缓解用药以及激素疗效不佳的轻、中度炎症、瘘管性病变以及激素依赖的CD病例。起效慢,不单独用于急性期的治疗;不良反应存在个体差异,用于维持缓解,宜长期用药。     

核受体作为炎症性肠疾病治疗靶点的研究进展

炎症性肠疾病是一种慢性肠道炎症疾病,其发病机制尚不明确,目前多认为与炎症和肠黏膜损伤有关。核受体是一种重要的转录调节因子,包括孕烷X受体(pregnane X receptor,PXR)、法尼酯X受体(farnesoid X receptor,FXR)和组成型雄甾烷受体(constitutive androstane receptor,CAR)等。近年深入研究发现,核受体可以通过抑制炎症信号通路、调节肠道紧密连接蛋白及代谢酶的表达减轻肠道炎症,并维持肠黏膜屏障功能,在炎症性肠疾病肠道保护方面发挥重要作用。因此,本文综述核受体PXR、FXR和CAR对炎症性肠疾病肠道的保护作用机制,为以核受体为靶点的炎症性肠疾病药物治疗提供新思路。