类固醇激素依赖型溃疡性结肠炎缓解期IL-23表达的研究

目的 探讨IL-23在缓解期类固醇激素依赖型溃疡性结肠炎患者结肠组织中表达的病理意义.方法 采用Western blot分析及免疫组化SABC法检测15例缓解期激素依赖型溃疡性结肠炎患者炎症修复区结肠组织IL-23的蛋白表达情况,予统计学软件统计分析,并以30例缓解期的一般溃疡性结肠炎患者(15例SASP维持治疗,15例强的松维持治疗)炎症修复区结肠组织及10例正常结肠黏膜组织为对照组.结果 与正常对照组比较,SASP维持治疗及强的松维持治疗缓解期一般溃疡性结肠炎患者炎症修复区结肠组织IL-23的蛋白表达均轻度升高(P>0.05),而缓解期激素依赖型溃疡性结肠炎患者炎症修复区结肠组织IL-23的蛋白表达显著高于一般溃疡性结肠炎组(P<0.01).结论 IL-23的过度表达可能在溃疡性结肠炎类固醇激素依赖发病机制中起关键作用.     

类固醇激素依赖型溃疡性结肠炎缓解期IL-23表达的研究

目的 探讨IL-23在缓解期类固醇激素依赖型溃疡性结肠炎患者结肠组织中表达的病理意义.方法 采用Western blot分析及免疫组化SABC法检测15例缓解期激素依赖型溃疡性结肠炎患者炎症修复区结肠组织IL-23的蛋白表达情况,予统计学软件统计分析,并以30例缓解期的一般溃疡性结肠炎患者（15例SASP维持治疗,15例强的松维持治疗）炎症修复区结肠组织及10例正常结肠黏膜组织为对照组.结果 与正常对照组比较,SASP维持治疗及强的松维持治疗缓解期一般溃疡性结肠炎患者炎症修复区结肠组织IL-23的蛋白表达均轻度升高（P〉0.05）,而缓解期激素依赖型溃疡性结肠炎患者炎症修复区结肠组织IL-23的蛋白表达显著高于一般溃疡性结肠炎组（P〈0.01）.结论 IL-23的过度表达可能在溃疡性结肠炎类固醇激素依赖发病机制中起关键作用.     

溃疡性结肠炎患者炎症黏膜中IL-6、L-23的表达及其临床意义

研究显示促炎细胞因子在溃疡性结肠炎（UC）的发病机制中起重要作用。目的：探讨UC患者炎症黏膜中白细胞介素．6（IL-6）、IL．23的表达情况及其临床意义。方法：选取42例UC患者（轻、中、重度活动期分别为9例、10例和13例．缓解期10例）于内镜下取结直肠炎症黏膜活检标本．另取18名健康志愿者的结肠黏膜作为正常对照。以免疫组化方法检测黏膜细胞因子IL-6、IL-23表达。结果：轻、中、重度活动期UC患者IL-6、IL-23表达量依次增高,组间两两比较差异均有统计学意义（P〈O．05）,且均显著高于缓解期患者和正常对照组（P〈0．05）;缓解期患者仅IL-23表达量显著高于正常对照组（P〈O．05）,IL-6表达量与正常对照组无明显差异。结论：IL-6和IL-23在UC的发生、发展中起重要作用．两者的黏膜表达水平可反映UC疾病活动度。     

姜黄素对溃疡性结肠炎大鼠的抗炎作用及其对肠黏膜IL-23的影响

目的研究姜黄素对溃疡性结肠炎大鼠肠黏膜IL-23表达的影响,进一步探讨姜黄素对溃疡性结肠炎的抗炎作用机制。方法将80只雄性SD大鼠随机分为正常对照组、模型组、姜黄素组、柳氮磺吡啶(SASP)组,每组均为20只。模型组、姜黄素组、SASP组大鼠分别以100 mg/kg TNBS乙醇溶液灌肠制备大鼠结肠炎模型。正常对照组予相同剂量的0.9%氯化钠溶液灌肠;正常对照组、模型组每日予相同剂量的0.9%氯化钠溶液灌胃;姜黄素组、SASP组自造模第2天起每日分别予100 mg/kg姜黄素溶液及SASP溶液灌胃。造模第8天处死大鼠,采集大鼠结肠标本备检。评价各组大鼠的体质量变化,光镜下观察大鼠肠黏膜组织病理改变并进行病理学评分,评价各组大鼠的疾病活动指数(DAI)、肠黏膜损伤指数(CMDI)及组织学损伤情况(HS);采用RT-PCR方法测定肠黏膜组织IL-23 mRNA水平;Western blot测定肠组织IL-23蛋白表达水平。结果与模型组比较,姜黄素组DAI、CMDI、HS评分及IL-23蛋白、mRNA的表达均有明显降低(P均<0.05),与SASP组比较无统计学差异(P>0.05)。结论姜黄素能显著抑制IL-23的表达,对实验性大鼠结肠炎有明显的抑制作用。     

激素依赖型溃疡性结肠炎的治疗进展

炎症性肠病主要包括克罗恩病和溃疡性结肠炎,是一组以反复发作为特征的慢性炎症性肠道疾病。大约20%的溃疡性结肠炎是一种慢性活动性疾病,为了维持缓解症状,常常需要几个疗程的激素治疗。尽管溃疡性结肠炎患者用激素治疗在短期内可以控制症状,但是在激素减量期间或停止应用激素时,溃疡性结肠炎的症状会复发,这种情况被定义为类固醇激素依赖。本文就激素依赖型溃疡性结肠炎的治疗进展作一综述。     

沙利度胺对溃疡性结肠炎大鼠结肠组织MMP-9、COX-2、IL-8水平的影响

[目的]探讨沙利度胺治疗溃疡性结肠炎大鼠的疗效及对结肠组织中基质金属蛋白酶-9（MMP-9）、环氧合酶-2（COX-2）、白介素-8（IL-8）表达水平的影响。[方法]将40只Wistar大鼠随机分为空白对照组、模型组、柳氮磺胺吡啶（SASP）组、沙利度胺组,每组10只。应用2,4,6三硝基苯磺酸与乙醇的混合物复制溃疡性结肠炎大鼠模型,除空白对照组和模型组正常饲养不进行药物治疗外,柳氮磺胺吡啶组给予SASP混悬液100mg/（kg·d）灌胃,沙利度胺组给予沙利度胺片混悬液200mg/（kg·d）灌胃。14d后处死全部大鼠,观察大鼠结肠组织大体形态、结肠炎症活动指数（DAI）评分和病理学的改变,并采用免疫组织化学法检测结肠组织中MMP-9、COX-2、IL-8的表达水平。[结果]沙利度胺能显著降低溃疡性结肠炎大鼠DAI评分和结肠组织中MMP-9、COX-2、IL-8的表达水平,并对损伤黏膜有较好的修复作用。[结论]沙利度胺对溃疡性结肠炎大鼠有较好的疗效,主要表现在促进黏膜愈合、降低组织中MMP-9、COX-2、IL-8的表达水平等方面。     

复方甘草酸苷对TNBS结肠炎大鼠肠道炎症的影响

背景:复方甘草酸苷的主要成分甘草酸具有抗炎和免疫调节作用。临床上复方甘草酸苷用于溃疡性结肠炎的治疗取得一定疗效。目的:观察复方甘草酸苷对实验性结肠炎大鼠肠道炎症的影响及其可能机制。方法:40只大鼠随机分为四组,三组以TNBS/乙醇诱导结肠炎,并分别予0.9%NaCl(模型对照组)、复方甘草酸苷和SASP灌肠14 d,正常对照组仅以0.9%NaCl灌肠14 d。实验期间评估疾病活动指数(DAI)。治疗结束后处死大鼠,行结肠黏膜大体和组织学损伤评分,免疫组化法检测结肠组织NF-κB p65、iNOS表达,ELISA法检测血清IL-8、IL-4水平。结果:模型对照组大鼠DAI、结肠黏膜大体和组织学损伤评分以及结肠组织NF-κB p65、iNOS表达和血清IL-8水平显著高于正常对照组(P<0.05),血清IL4水平显著低于正常对照组(P<0.05)。复方甘草酸苷组大鼠上述指标均较模型对照组显著好转(P<0.05),与SASP组相比无明显差异。结论:复方甘草酸苷对结肠炎的治疗作用可能与抑制NF-κB活化,进而下调iNOS以及促炎细胞因子如IL-8表达,上调抗炎细胞因子如IL4表达有关。     

活动期溃疡性结肠炎患者体内血小板激活状态的评价

目的 探讨血小板激活和活动期溃疡性结肠炎的关系。方法 对32例活动期溃疡性结肠炎、11例缓解期溃疡性结肠炎、30例肠易激综合征（IBS）患者和正常对照组27例用SH－93智能血液凝聚仪检测血小板聚集率，用酶联免疫法检测P－选择素和血栓素B2（TXB2）。同时评价43例溃疡性结肠炎内镜下表现和结肠黏膜活检情况。结果 32例活动期溃疡性结肠炎患者平均1min血小板聚集率和最大血小板聚集率均明显高于IBS组和正常对照组（P＜0．01）；32例活动期溃疡性结肠炎P－选择素和TXB2明显高于IBS组和正常对照组，差异有显著性（P＜0．01或P＜0．05）。缓解期溃疡性结肠炎的P－选择素也高于正常对照组。结论 活动期溃疡性结肠炎患者体内存在血小板激活，血小板可能直接参与结肠黏膜的急性炎症反应。其中P－选择素是溃疡性结肠炎的特异性指标，而血小板聚集率和TXB2与疾病的活动度有关。抗血小板药物可能对溃疡性结肠炎有一定的治疗效果。     

乌梅丸对溃疡性结肠炎大鼠结肠组织白细胞介素8及13含量的影响

[目的]观察乌梅丸对溃疡性结肠炎大鼠结肠组织白细胞介素(IL)-8、IL-13的影响.[方法]84只SD大鼠随机分为正常对照组,模型组,柳氮磺胺吡啶( SASP)组,乌梅丸大、中、小剂量组,每组14只;除正常组外,其他各组大鼠采用2.4-二硝基氯苯(DNCB)加醋酸复合法制备溃疡性结肠炎模型;采用双抗体夹心ELISA法检测各组大鼠结肠组织IL-8、IL-13的含量.[结果]模型组大鼠结肠组织中IL-8含量较正常组显著增高(P＜0.01),乌梅丸各剂量组、SASP组则较模型组明显降低(P＜0.01或P＜0.05);模型组大鼠结肠组织IL-13含量较正常组显著降低(P＜0.01),乌梅丸各剂量组、SASP组较模型组明显升高(P＜0.01或P＜0.05).乌梅丸大剂量组降低IL-8、升高IL-13的效果最显著,其IL-8、IL-13的含量与正常组比较差异无统计学意义.[结论]IL-8、IL-13参与了UC的发生、发展,乌梅丸能通过降低溃疡性结肠炎大鼠结肠组织IL-8的含量、升高IL-13的含量,从而起到治疗UC的作用.     

慢性溃疡性结肠炎合并严重肺问质性纤维化一例

间质性肺纤维化可能代表溃疡性结肠炎一种很少报道的的结肠外表现。本文报道1例慢性溃疡性结肠炎病人长期服用柳氮磺胺吡啶(salicylazosulfapyridine简称SASP)和强的松治疗后发生严重限制性肺疾患,全结肠切除后病情加剧。     

Compared azathioprine efficacy in ulcerative colitis and in Crohn's disease

AIM: To compare the 6-month efficacy and tolerance of azathioprine in 68 patients with steroid-resistant or steroid-dependent chronic ulcerative colitis (n=30) or Crohn's disease (n=38).METHODS: Clinical remission was defined as a Crohn's Disease Activity Index<150 for Crohn's disease and number of non-bloody stools<=3/day for ulcerative colitis, associated with prednisone requirement<=10 mg/day.RESULTS: Seventy-three per cent of patients with ulcerative colitis had distal or left-sided colitis and 84% of patients with Crohn's disease had pancolitis. Azathioprine was discontinued early for side-effect in 8 (26.7%) patients with ulcerative colitis and in 8 (21.1%) patients with Crohn's disease (NS). In patients treated at least 6 months by azathioprine, clinical remission rates were 77.3% and 70% for chronic ulcerative colitis and Crohn's disease (NS). Complete corticosteroids weaning was obtained significantly more often in ulcerative colitis patients than in Crohn's disease patients (59.1% vs 30%; P<0.05).CONCLUSION: Azathioprine seems to be at least as effective and equally tolerated in steroid-resistant or steroid-dependent chronic ulcerative colitis or Crohn's disease patients.     

Increased incidence of faecal coliforms with in vitro adhesive and invasive properties in patients with ulcerative colitis.

Faecal samples were collected from 23 patients with active ulcerative colitis, 15 patients with established ulcerative colitis in remission, 20 patients with active colitis of cause other than ulcerative colitis, and 20 normal control subjects. Ten coliform colonies were randomly selected from the faecal sample cultures and serotyped before the testing of each different serotype from each sample for adhesive or invasive properties on HeLa cell monolayers. In the patients with both active ulcerative colitis and ulcerative colitis in remission and those with other types of colitis one serotype tended to dominate the faecal coliform flora. In normal controls more variety was encountered. Thirty-five per cent of the patients with active ulcerative colitis and 27% of the patients with ulcerative colitis in remission had at least one adhesive or invasive faecal coliform as compared with 5% of the patients with other types of colitis and 5% of the normal controls. These findings are significant (P < 0.05) and may have aetiological and therapeutic significance.     

6-mercaptopurine or methotrexate added to prednisone induces and maintains remission in steroid-dependent inflammatory bowel disease

BACKGROUND: As treatment of steroid-dependent patients with inflammatory bowel disease (IBD) is controversial, we analysed the efficacy and tolerance of 6-mercaptopurine (6-MP) and methotrexate (MTX) added to prednisone in increasing and maintaining the disease remission rate. METHODS: Seventy-two steroid-dependent IBD patients, 34 with ulcerative colitis (UC) and 38 with Crohn's disease (CD), receiving treatment with prednisone were randomly assigned in a 2:2:1 ratio to additionally receive, orally, over a period of 30 weeks 1.5 mg/kg/day of 6-MP (group A) or 15 mg/week of MTX (group B), or 3 g/day of 5-aminosalicylic acid (5-ASA) (group C). All patients who achieved remission were included in a maintaining remission study for 76 weeks. Remission was defined after stopping prednisone as a CD activity index of <150 and normal serum orosomucoid concentration for CD patients and a Mayo Clinic score <7 for UC patients. RESULTS: With regard to achieved remission, a significantly higher (P< 0.05) rate existed for UC patients in group A (78.6%) than in group C (25%), with no statistical differences in group B (58.3%) versus C. For CD patients, the rates were significantly higher (P< 0.001 and 0.01, respectively) in groups A (93.7%) and B (80%) versus C (14%). With regard to maintaining remission, UC patients in group A (63.6%) presented significantly higher rates (P < 0.0015 and P < 0.001, respectively) versus 14.3% in group B and none in group C. For CD patients, statistical differences (P < 0.001) existed when comparing rates in groups A (53.3%) and B (66.6%) versus none in group C. Noticeable side effects appeared in 13.3% of patients from group A and 11.5% from group B. CONCLUSIONS: These results suggest that 6-MP or MTX added to prednisone could be effective in steroid sparing, as well as in achieving and maintaining remission in steroid-dependent IBD patients. MTX was less effective in maintaining remission in UC patients.     

溃疡性结肠炎患者核因子-κB活化与细胞因子基因表达

目的　探讨溃疡性结肠炎 (UC)患者肠黏膜活检组织细胞因子mRNA的表达及其与NF κB活化的关系 ,以及抗炎药物 (柳氮磺吡啶和糖皮质激素 )对其的影响。方法　 31例来自四川大学华西医院的UC患者 (符合 1993年太原会议制定的UC诊断标准 )被纳入本研究。其中 17例使用过药物 (柳氮磺吡啶或柳氮磺吡啶 +糖皮质激素 )治疗 ,14例未用过任何与UC治疗相关的药物 ,11例同期结肠癌患者 (取其癌旁正常组织 )作为对照。采用 :(1)凝胶电泳迁移率改变分析检测核因子 (NF) κBDNA结合活性 ;(2 )逆转录聚合酶链反应检测白细胞介素 (IL) 1βmRNA和IL 8mRNA的表达。 结果　 (1)UC患者肠黏膜活检组织IL 1βmRNA和IL 8mRNA表达与对照组相比明显升高 (P <0 0 5 ) ,且与NF κBDNA结合活性呈显著正相关 (IL 1β :r=0 836 3,P <0 0 5 ;IL 8:r=0 6 0 2 4 ,P <0 0 5 )。 (2 )糖皮质激素和柳氮磺吡啶明显抑制NF κB的活性 ,降低IL 1βmRNA和IL 8mRNA的表达。结论　 (1)NF κB是UC细胞因子释放的关键调控因素 ,在UC的发生和发展中起着十分重要的作用。 (2 )糖皮质激素和柳氮磺吡啶可能通过抑制NF κB的活性 ,减少细胞因子的表达而起到抗炎作用。     

清肠栓对大鼠溃疡性结肠炎急性期模型CXCR2的影响

[目的]观察清肠栓对大鼠溃疡性结肠炎（UC）急性期模型结肠黏膜CXCR2的影响.[方法]SD大鼠48只,分为正常组、模型组、清肠栓组和SASP组,每组12只.用三硝基苯磺酸（TNBs）诱导大鼠UC急性期模型.造模后第3天开始给药,连续给药7d后处死.Elisa、免疫组化检测病变部位结肠组织中的CXCR2含量及蛋白表达.[结果]模型组CXCR2含量及蛋白表达较正常组明显升高（P＜0.05）,清肠栓及SASP组较模型组均降低（P＜0.05）.[结论]清肠栓通过调节结肠黏膜CXCR2蛋白含量,减少中性粒细胞向病变局部黏膜组织的趋化和激活,从而起到缓解病变部位炎症的作用.     

Evaluation of 5 versus 10 granulocyteaphaeresis sessions in steroid-dependent ulcerative colitis： A pilot, prospective, multicenter, randomized study

AIM： To evaluate the efficacy of 5 compared to ：tO granulocyteaphaeresis sessions in patients with active steroid-dependent ulcerative colitis.
METHODS： In this pilot, prospective, multicenter randomized trial, 20 patients with moderately active steroid-dependent ulcerative colitis were randomized to 5 or 10 granulocyteaphaeresis sessions. The primary objective was clinical remission at wk 17. Secondary measures included endoscopic remission and steroid consumption.
RESULTS： Nine patients were randomized to 5 granulocyteaphaeresis sessions （group 1） and 11 patients to 10 granulocyteaphaeresis sessions （group 2）. At wk 17, 37.5% of patients in group 1 and 45.45% of patients in group 2 were in clinical remission. Clinical remission was accompanied by endoscopic remission in all cases. Eighty-six percent of patients achieving remission were steroid-free at wk 17. Daily steroid requirements were significantly lower in group 2. Eighty-nine per cent of patients remained in remission during a one year follow-up. One serious adverse event, not related to the study therapy, was reported.
CONCLUSION： Granulocyteaphaeresis is safe and effective for the treatment of steroid-dependent ulcerative colitis. In this population, increasing the number of aphaeresis sessions is not associated with higher remission rates, but affords a significant steroid-sparing effect.     

Clinical evaluation of granulocyte/monocyte apheresis therapy for active ulcerative colitis

BACKGROUND: Recent evidence suggests that peripheral blood granulocytes and monocytes/macrophages have a major role in the exacerbation of ulcerative colitis. AIMS: Our objective was to investigate if selective granulocyte and monocyte adsorptive apheresis with Adacolumn promotes remission of active ulcerative colitis and spares corticosteroid. SUBJECTS: Sixty patients with active ulcerative colitis were studied, of whom 39 had relapsing-remitting ulcerative colitis, 15 had chronic continuous and 6 had their first episode of ulcerative colitis. METHODS: Granulocytapheresis was done with an Adacolumn filled with cellulose acetate beads as apheresis carriers that adsorb FcgammaR and complement receptors bearing leucocytes (granulocytes, monocytes and a small fraction of lymphocytes). Patients received up to 10 Adacolumn sessions over 12 weeks, one session was 60-90 min at 30 mL/min. No additional medication was given. Efficacy was assessed with Seo's activity index (AI) [Seo M, Okada M, Yao T. An index of disease activity in patients with ulcerative colitis. Am J Gastroenterol 1992;87:971-6]. The mean AL was 197.5 and range 154.4-277.7. AI < 150 was considered significant improvement and AI < 100 was considered clinical remission. RESULTS: Of 60 patients, 50 (83.3 %) improved, 14 achieved remission, granulocytapheresis was most effective in steroid-dependent patients. At entry, the mean dose of prednisolone was 15.3 mg/day per patient and was reduced to 3.6 mg/day after 10 sessions. Granulocytapheresis was well tolerated and no serious side-effects were observed. CONCLUSION: Based on our experience in patients with diverse ulcerative colitis disease expression and long-term exposure to conventional drug therapy, we believe that granulocytapheresis is an effective adjunct to conventional medication for promoting remission and sparing steroids in patients with active ulcerative colitis.