寄生虫感染与炎症性肠病负相关的研究

炎症性肠病（inflammatory bowel disease,IBD）的流行病学研究显示,无论是溃疡性结肠炎（UC）还是克罗恩病（CD）的发病,均与寄生虫感染呈负相关。这一现象启迪人们运用动物实验、临床试验来探讨潜在的机制。寄生虫,尤其是蠕虫感染后,宿主胃肠道主要出现Th2型免疫应答反应。机体的免疫活性细胞活化并表达细胞因子,破毁和驱除寄生虫。肠道病变修复后的宿主具有抵御IBD发病和病变复发的能力。人工感染蠕虫的研究显示,IBD患者肠道病变程度显著减轻。以上研究结果有助于了解IBD胃肠道免疫损伤的机制,拓展新的治疗学研究。     

上虞市城郊人群肠道蠕虫病流行的影响因素

1990年和2005年2次对上虞市城郊人群肠道寄生虫感染和社会经济情况进行调查。结果显示,居民经济水平、劳作环境、卫生习惯、健康意识、农村改水改厕等均有明显改善,居民肠道蠕虫感染率明显下降,肠道蠕虫病流行已得到有效控制。     

肠道微生态重建在炎症性肠病治疗中的意义

尽管炎症性肠病(inflammatory bowel disease,IBD)的病因和发病机制尚未完全明确,但肠道中定植的大量微生物在肠道疾病发生中有着重要作用已是共识。既往的研究大多只关注细菌导致肠道炎症,而忽略了肠道中真菌、病毒、寄生虫等其他微生物对IBD的影响;并且饮食因素在改善肠道微生态环境和IBD症状上的重要作用也被很多研究者所忽略。近年来,"粪菌移植"作为一种整体的改善患者肠道微生态环境的方法也在IBD治疗过程中有良好的疗效。因此,本文就肠道微生态重建在IBD治疗中的意义作一概述。     

乌鲁木齐市哈萨克族中小学生肠道寄生虫感染情况的调查

了解乌鲁木齐市哈萨克族中小学生肠道寄生虫病感染情况与提供有效的防治措施。对乌鲁木齐仅有的二所哈萨克族中小学在校全体学生进行了肠道寄生虫感染情况的调查。通过本次调查共查出8种寄生虫,其中原虫4种,蠕虫3种及尘螨一种。人群总肠道寄生虫感染率6.39％,蛲虫感染率0.80％。小学生与中学生肠道寄生虫感染水平有显著性差异。肠道寄生虫感染率随着年龄的增加感染水平逐渐降低。     

蠕虫治疗炎症性肠病的研究进展

炎症性肠病(IBD)是一类病因不明的肠道慢性非特异性炎性疾病,包括溃疡性结肠炎(UC)和克罗恩病(CD)。已知与IBD发病相关的危险因素包括环境、遗传和免疫因素等。近年有关蠕虫治疗IBD的基础和临床研究逐渐增多,认为蠕虫对IBD有积极的治疗作用且安全性较高。本文就蠕虫治疗IBD的研究进展作一综述。     

江阴市肠道蠕虫病防治效果观察

江阴市位于江苏省南部长江三角洲，属肠道蠕虫病流行区。2004年根据全国重要人体寄生虫病调查方案要求，选择1988年全国人体寄生虫分布调查的镇、村完成了肠道蠕虫感染情况调查，结果如下。     

巨细胞病毒感染与炎症性肠病的关系

人巨细胞病毒(human cytomegalovirus,HCMV)是常见的机会性致病病毒,在免疫功能正常个体中常表现为隐性或潜伏感染,在免疫功能受损个体中常呈现显性感染.炎症性肠病(inflammatory bowel disease,IBD)是一种慢性、复发性的肠道炎症性疾病;IBD患者由于营养不良及使用免疫抑制剂等原因,感染HCMV的风险明显增加.IBD合并HCMV感染的患者逐渐增多,HCMV感染加重IBD病情的现象引起了临床医师的共同关注.研究表明HCMV感染可能在IBD病情发展变化中起重要作用,及时诊断IBD患者中HCMV的感染并正确治疗对患者的预后有很大改善作用.本文就巨细胞病毒感染与IBD中的关系及其治疗进展作一综述.     

蠕虫对肠道菌群的影响及在宿主免疫中的作用

胃肠道寄生虫与共生菌群等其它有机体共享肠道栖息地。研究表明在脊椎动物感染的模型中,蠕虫和肠道微生物菌群之间存在大量的相互作用,对宿主免疫和代谢产生重要影响。本文将蠕虫-微生物群相互作用以及在宿主免疫中的作用进行综述,旨在为蠕虫-肠道菌群相互作用的研究提供理论依据。     

寄生虫感染与细胞因子

宿主在感染寄生虫后产生的免疫应答中,细胞因子作为介质起着关键作用。本文分别从原虫、血液和组织内蠕虫、肠道蠕虫感染以及寄生虫免疫逃避等四个方面阐述与细胞因子的关系。同一种细胞因子在不同寄生虫感染及不同的寄生期所起的作用可以完全不同,它们之间的关系甚为复杂。对细胞因子进行深入的研究,将进一步阐明寄生虫与宿主的相互关系。     

浦东新区人群肠道蠕虫感染状况调查

人体肠道寄生虫是一类危害人们身体健康的常见寄生虫。1988～ 1991年曾对本区 6 378名常住人群进行了肠道寄生虫感染情况的调查 ,结果显示其总感染率为 6 1.15 %。近年来 ,随着改革开放的深入 ,人民的物质生活水平不断提高 ,居民的自我保健意识逐渐增强 ,政府对粪、水等外环境的管理力度不断加强 ,人群中肠道寄生虫的感染随之也会发生变化。为了解本区肠道寄生虫的感染状况 ,为今后制订防治对策提供科学依据 ,作者于 1999年 10～ 12月对浦东新区的常住人群进行了肠道蠕虫感染状况的抽样调查。1　材料与方法1.1　调查对象　在 1988年所开展的…     

Current status and future perspectives of leukocytapheresis for inflammatory bowel disease

Ulcerative colitis (UC) and Crohn's disease (CD) comprise the idiopathic inflammatory bowel diseases (IBD) of the gut. The etiology of IBD is poorly understood, but an autoimmune disturbance has been suggested to play an important role in this incurable disease. Extracorporeal leukocytapheresis (CAP) is an additional adjunct for IBD patients refractory to other conventional therapies, including steroids. The primary aim of CAP should be to suppress such unwanted immunological response by removing circulating inflammatory cells from the blood stream. The first decade has been passed since CAP was approved by Japanese social health insurance policy. It is therefore now an appropriate opportunity to upgrade and summarize our current understandings and/or future perspectives of this unique non-pharmacological and non-surgical strategy for IBD patients. According to several clinical and basic research reports, an early introduction of CAP should produce higher efficacy as compared with CAP applied sometime after a clinical relapse. Likewise, CAP therapy adjusted to patients' body-weight as well as two treatment sessions per week (intensive regimen) should benefit the efficacy rate. The etiology of IBD is not fully elucidated yet. As a result, the major therapeutic strategies in the Western world have been immunosuppressive therapy, including biologics. CAP is an unusual treatment modality for IBD because it seems to have both effectiveness and safety, which should generally be balanced in this type of illness. We now have to develop future strategies with and without combining biologics to improve the quality of life of IBD patients.     

Advances in nutritional therapy in inflammatory bowel diseases: Review

Inflammatory bowel diseases(IBD), including ulcerative colitis and Crohn's disease are chronic, life-long, and relapsing diseases of the gastrointestinal tract. Currently, there are no complete cure possibilities, but combined pharmacological and nutritional therapy may induce remission of the disease. Malnutrition and specific nutritional deficiencies are frequent among IBD patients, so the majority of them need nutritional treatment, which not only improves the state of nutrition of the patients but has strong anti-inflammatory activity as well. Moreover, some nutrients, from early stages of life are suspected as triggering factors in the etiopathogenesis of IBD. Both parenteral and enteral nutrition is used in IBD therapy, but their practical utility in different populations and in different countries is not clearly established, and there are sometimes conflicting theories concerning the role of nutrition in IBD. This review presents the actual data from research studies on the influence of nutrition on the etiopathogenesis of IBD and the latest findings regarding its mechanisms of action. The use of both parenteral and enteral nutrition as therapeutic methods in induction and maintenance therapy in IBD treatment is also extensively discussed. Comparison of the latest research data, scientific theories concerning the role of nutrition in IBD, and different opinions about them are also presented and discussed. Additionally, some potential future perspectives for nutritional therapy are highlighted.     

Nutritional status and nutritional therapy in inflammatory bowel diseases

Underweight and specific nutrient deficiencies are frequent in adult patients with inflammatory bowel disease （IBD）. In addition, a significant number of children with IBD, especially Crohn＇s disease （CD） have impaired linear growth. Nutrition has an important role in the management of IBD. In adults with CD, enteral nutrition （EN） is effective in inducing clinical remission of IBD, although it is less efficient than corticosteroids. Exclusive EN is an established primary therapy for pediatric CD. Limited data suggests that EN is as efficient as corticosteroids for induction of remission. Additional advantages of nutritional therapy are control of inflammation, mucosal healing, positive benefits to growth and overall nutritional status with minimal adverse effects. The available evidence suggests that supplementary EN may be effective also for maintenance of remission in CD. More studies are needed to confirm these findings. However, EN supplementation could be considered as an alternative or as an adjunct to maintenance drug therapy in CD. EN does not have a primary therapeutic role in ulcerative colitis. Specific compositions of enteral diets-elemental diets or diets containing specific components-were not shown to have any advantage over standard polymeric diets and their place in the treatment of CD or UC need further evaluation. Recent theories suggest that diet may be implicated in the etiology of IBD, however there are no proven dietary approaches to reduce the risk of developing IBD.     

白介素-10与炎症性肠病

炎症性肠病(inflammatory bowel disease,IBD)是一种慢性、复发性的肠道炎症疾病,其明确病因目前仍不清楚.肠道免疫功能异常导致过量炎症因子释放损伤肠道黏膜在IBD发病中起着关键作用,应用免疫抑制剂减少炎症因子的释放也被应用于IBD的治疗.近年来利用细胞因子调节机体免疫功能以治疗IBD的研究日渐...     

Management of the pregnant inflammatory bowel disease patient on antitumour necrosis factor therapy: State of the art and future directions

Antitumour necrosis factor (anti-TNF) therapy has been a major advance in the treatment of inflammatory bowel disease (IBD) by improving rates of mucosal healing, steroid-free remission, and decreasing rates of hospitalization and surgery. Because IBD affects women in their reproductive years, clinicians have and will continue to be asked in the future about the safety profile of these agents and their potential impact on pregnancy, the developing fetus and newborn. Immunoglobulin G transfer from the mother to fetus begins in the second trimester, with an elevation starting at 22 weeks of gestation and the largest amount transferred in the third trimester. Although research investigating the long-term outcomes of children exposed to anti-TNF therapy in utero is limited, there is no known adverse effect on either pregnancy or newborn outcomes including infectious complications with this class of drugs. The World Congress of Gastroenterology consensus statement on biological therapy for IBD considered infliximab and adalimumab to be low risk and compatible with use during conception and during pregnancy in at least the first two trimesters. Based on a clinical algorithm used at the University of Calgary Pregnancy and IBD clinic (Calgary, Alberta), recommendations have been provided on the management of pregnant patients on anti-TNF therapy, particularly with regard to third-trimester dosing, taking into account disease characteristics of individual patients. When educated about the safety of anti-TNF therapy during pregnancy, patients often choose to continue on therapy during the third trimester.     

Interaction of obesity and inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of unknown etiology that is thought to result from a combination of genetic, immunologic and environmental factors. The incidence of IBD has been increasing in recent decades, especially in developing and developed nations, and this is hypothesized to be in part related to the change in dietary and lifestyle factors associated with modernization. The prevalence of obesity has risen in parallel with the rise in IBD, suggesting a possible shared environmental link between these two conditions. Studies have shown that obesity impacts disease development and response to therapy in patients with IBD and other autoimmune conditions. The observation that adipose tissue produces pro-inflammatory adipokines provides a potential mechanism for the observed epidemiologic links between obesity and IBD, and this has developed into an active area of investigative inquiry. Additionally, emerging evidence highlights a role for the intestinal microbiota in the development of both obesity and IBD, representing another potential mechanistic connection between the two conditions. In this review we discuss the epidemiology of obesity and IBD, possible pathophysiologic links, and the clinical impact of obesity on IBD disease course and implications for management.     

造血干细胞移植治疗炎症性肠病进展

炎症性肠病(IBD)是胃肠道慢性炎性肉芽肿性疾病,其发病与环境、遗传因素相关,传统治疗包括抗炎和抑制免疫等治疗.新近的研究提示造血干细胞移植(HSCT)治疗IBD有效,此文就HSCT治疗IBD的研究现状和存在的问题进行概述.     

Importance of nutrition in inflammatory bowel disease

Inflammatory bowel disease （IBD） results from the interaction between an individual＇s immune response and precipitant environmental factors, which generatean anomalous chronic inflammatory response in thosewho are genetically predisposed. Various feeding practices have been implicated in the origin of IBD based on epidemiological observations in developed countries, but we do not have solid evidence for the etiological role played by specific food types. IBD is associated with frequent nutritional deficiencies, thepattern and severity of which depends on the extent,duration and activity of the inflammation. Nutritional support allows these deficiencies in calories, macro and micronutrients to be rectified. Enteral nutrition is also aprimary therapy for IBD, especially for Crohn＇s disease,as it allows the inflammatory activity to be controlled,kept in remission, and Drevents or delays the need forsurgery. Nutritional support is especially important in childhood IBD as an alternative to pharmacological treatment. This report discusses the complex relationship between diet and IBD.     

Promises and paradoxes of regulatory T cells in inflammatory bowel disease

Since their discovery two decades ago,CD4+CD25+Foxp3+ regulatory T cells(Tregs) have become the subject of intense investigation by immunologists. Unlike other T cells,which promote an immune response,Tregs actively inhibit inflammation when activated by their cognate antigen,thus raising hope that these cells could be engineered into a highly targeted,antigenspecific,immunosuppressant therapy. Although Tregs represent less than 10% of circulating CD4+T cells,they have been shown to play an essential role in preventing or limiting inflammation in a variety of animal models and human diseases. In particular,spontaneous intestinal inflammation has been shown to occur in the absence of Tregs,suggesting that there may be a Treg defect central to the pathogenesis of human inflammatory bowel disease(IBD). However,over the past decade,multiple groups have reported no qualitative or quantitative deficits in Tregs from the intestines and blood of IBD patients to explain why these cells fail to regulate inflammation in Crohn's disease and ulcerative colitis. In this review,we will discuss the history of Tregs,what is known about them in IBD,and what progress and obstacles have been seen with efforts to employ them for therapeutic benefit.     

Therapy with stem cells in inflammatory bowel disease

Inflammatory bowel disease(IBD) affects a part of the young population and has a strong impact upon quality of life. The underlying etiology is not known, and the existing treatments are not curative. Furthermore, a significant percentage of patients are refractory to therapy. In recent years there have been great advances in our knowledge of stem cells and their therapeutic applications. In this context, autologous hematopoietic stem cell transplantation(HSCT) has been used in application to severe refractory Crohn’s disease(CD), with encouraging results. Allogenic HSCT would correct the genetic defects of the immune system, but is currently not accepted for the treatment of IBD because of its considerable risks. Mesenchymal stem cells(MSCs) have immune regulatory and regenerative properties, and low immunogenicity(both autologous and allogenic MSCs). Based on these properties, MSCs have been used via the systemic route in IBD with promising results, though it is still too soon to draw firm conclusions. Their local administration in perianal CD is the field where most progress has been made in recent years, with encouraging results. The next few years will be decisive for defining the role of such therapy in the management of IBD.