肠道菌群与溃疡性结肠炎

溃疡性结肠炎(UC)是一组病因和发病机制不明的肠道慢性非特异性炎症性疾病。近年来研究认为UC可能主要由遗传基因易感个体决定,免疫反应增强是关键的直接发病机制;并且许多研究都表明肠道菌群在UC的发病机制中起到了重要的启动作用,环境、饮食、精神心理等因素可能是发病的重要诱因。基于此理论,微生态制剂在治疗炎症性肠病中得到广泛的     

肠道微生态改变在炎症性肠病中的作用

炎症性肠病（IBD）主要包括溃疡性结肠炎（UC）和克罗恩病（CD），其病因和发病机制尚未明确。目前认为IBD的病因为肠道微环境（肠道菌群）、宿主遗传易感性和黏膜免疫因素三者间的相互作用。近年来．随着微生态学的发展，肠道菌群与IBD发病的关系日益受到关注。本文就IBD时肠道菌群的变化、肠道微生态改变对IBD的影响以及微生态制剂对IBD的治疗作用作一综述。     

溃疡性结肠炎与肠道菌群

溃疡性结肠炎（UC）的病因和发病机制目前尚未完全清楚,近年来随着微生态学的发展,多项证据表明UC患者存在肠道菌群紊乱。此文就UC患者肠道菌群的变化、肠道菌群的检查方法以及益生菌制剂对UC的疗效和可能的作用机制作一综述。     

微生态制剂与溃疡性结肠炎

溃疡性结肠炎（ulcerative colitis，UC）是一种病因未明的非特异性肠道炎症，目前多认为与感染、免疫、遗传等因素相关。传统上以氨基水杨酸（ASA）制剂、糖皮质激素和免疫抑制剂治疗为主，但存在易复发、不良反应较多等问题。近年有关微生态制剂在维持UC缓解、防止复发等方面的研究日益增多，微生态制剂亦被认为是UC传统疗法的有益补充。为此，本文对微生态制剂与UC的关系作一综述。     

炎症性肠病与肠道细菌研究进展

炎症性肠病(inflammatory bowel disease,IBD)包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn's disease,CD).其发病机制至今仍不清楚,可能的病因包括由基因决定的宿主易感性、黏膜免疫和肠道微生态环境三者的相互作用.近年来随着微生态学的发展,肠道菌群与IBD发病的关系日益受到关注.关于肠道病原微生物在IBD发病机制及其引起的一系列免疫学、微生态学、病理生理等方面的变化出现了研究和报道,同时微生态制剂在肠道免疫调节、控制炎症反应等方面的优点已有许多动物实验及临床应用证明,其中微生态制剂之一益生菌在IBD应用较普遍,本文就IBD与肠道菌群研究进展及益生菌制剂治疗IBD作一综述.     

慢性肾功能衰竭患者肠道微生态变化及微生态制剂疗效观察

目的 :探讨慢性肾功能衰竭 (CRF)患者肠道微生态的变化及其与肾功能的关系 ,观察微生态制剂 (回春生 )治疗CRF的可行性。方法 :对CRF患者主要肠道菌群 (肠杆菌、肠球菌等需氧菌 ,双歧杆菌、类杆菌、乳杆菌等厌氧菌 )行定量培养 ,并检测肾功能 ;比较治疗前后肠道菌群、临床表现以及肾功能的变化。结果 :CRF患者普遍存在肠道微生态平衡的紊乱 ,主要体现在需氧菌群过度增殖 ,厌氧菌群明显受抑 ,且与肾功能状况明显相关 ;微生态制剂有助于改善此种失衡 ,促进临床表现与肾功能的改善。结论 :肠道微生态失衡参与了CRF的发展、恶化过程 ,微生态制剂可能为CRF的治疗提供一条新的途径。     

肠易激综合征的肠道菌群干预

肠道菌群是人体的重要组成部分,并在肠易激综合征的发病过程中起到重要作用。近年来的研究表明,多种 类型的微生态制剂能够对肠易激综合征起到治疗作用。文章总结了肠道菌群调节在肠易激综合征方面的循证医学 证据,结合临床实践经验进行归纳,并提出肠道菌群干预应遵循“先破后立”的原则。     

老年性便秘与肠道菌群失调的相关性及药物干预性研究

目的研究老年性便秘与肠道菌群失调的相关性,以及老年便秘患者服用微生态制剂干预后肠道菌群改善的情况。方法从肠道菌群失调的角度,采用横断面调查研究老年性便秘及非便秘老年人群的肠道菌群的差异,并应用队列研究试验设计方案,用微生态制剂进行生物学干预试验。结果老年便秘人群肠道中肠杆菌、肠球菌、梭杆菌数量增多,乳酸杆菌、双歧杆菌、类杆菌数量减少。经过微生态制剂治疗后肠杆菌、肠球菌、梭杆菌数量有所下降,乳酸杆菌、双歧杆菌、类杆菌数量有所增高。结论老年性便秘患者肠道菌群分布与非便秘者比较有差异,且微生态制剂干预对便秘患者肠道菌群失调有一定疗效。     

基于肠道菌群的慢性便秘治疗进展

<正>慢性便秘主要表现为排便困难和(或)排便次数减少、粪便干硬、排便时肛门直肠梗阻或阻塞感、排便不尽感等症状,且病程超过6个月^[1]。对于慢性便秘的确切机制,目前的研究尚不清楚,但近年来大量的证据表明肠道菌群与慢性便秘的发病存在密切联系。肠道微生态治疗通过采用微生态制剂(益生菌、益生元、合生元)以及菌群移植等措施来调节肠道菌群结构和功能,改善宿主健康状态。     

肠道微生态失衡与肝性脑病发病的研究进展

肝性脑病(hepatic encephalopathy,HE)是肝硬化并发症之一,发病率、死亡率高。目前其确切的发病机制尚未完全明确,且尚无特效的防治措施。近年来研究发现,肠道微生态失衡与HE发病相关。肠道微生态失衡导致小肠细菌过度生长、肠道黏膜受损、菌群易位、高血氨症、炎症反应、氧化应激,最终导致HE的发生。因此,改善肠道微生态失衡成为防治HE的新突破。本文旨在对近年来肠道菌群失衡与HE发生、发展的研究新进展及微生态制剂用于HE治疗进行内容总结,为临床防治HE提供有效信息。     

呼吸系统微生态演替与人类健康

呼吸系统微生态是人体微生态重要组成部分。呼吸道正常菌群相当于机体的天然屏障,这些固有的微生物群在抵御外籍菌入侵方面具有重要的作用,同时还发挥着局部免疫功能。正常情况下,呼吸道各部位的微生物种类和数量相对稳定。对呼吸道正常菌群演替次序和变化特征的深入研究是认识呼吸系统炎症本质、开发呼吸道益生菌的理论基础。     

Prebiotics, probiotics, and dietary fiber in gastrointestinal disease

Microecology of the gastrointestinal tract is the physiologic basis for the effect of dietary fiber, prebiotics and probiotics on the host. The ecology consists of the gastrointestinal tract, primarily the intestines, the foods that are fed into the tract, and the flora living within. Within this ecology, normal flora and probiotics, ferment dietary fiber and prebiotics to produce short chain fatty acids and substances that are absorbed and effect the host at the intestinal level and systemically. In this review, we will discuss the effects of prebiotics, probiotics and dietary fiber in gastrointestinal disorders and diseases.     

Importance of antineutrophil cytoplasmic antibodies in primary sclerosing cholangitis and ulcerative colitis: prevalence,titre, and IgG subclass.

Antineutrophil cytoplasmic antibodies (ANCA) have been reported in up to 87% of patients with primary sclerosing cholangitis with or without ulcerative colitis (PSC +/- UC) and in 68% of those with UC only. Compared with other liver and diarrhoeal diseases, ANCA have high specificity for PSC (+/- UC) and UC only. This study aimed to determine the prevalence and significance of ANCA in these two diseases and whether the ANCA titre or IgG subclass, or both, could distinguish between PSC + UC and UC only. Subjects included 63 patients with PSC, 85 with UC, 17 with coeliac disease, and 10 with dermatitis herpeteformis and 36 normal subjects. ANCA was detected using the immunoalkaline phosphatase method. The IgG subclass of ANCA was determined in 27 PSC + UC and 30 UC only patients using a panel of mouse monoclonal antibodies specific for the IgG subclasses. At a serum dilution of 1:5, ANCA had a diagnostic sensitivity of 65% for all PSC and 45% for UC only. For PSC + UC the sensitivity was 70% at 1:5 (p = 0.004 v UC only). At 1:50, the sensitivity values were 54% and 25% respectively for PSC + UC and UC only (p = 0.0006). In PSC, ANCA positivity was significantly associated with extensive involvement of the biliary tree but not with other clinical parameters. In UC only, the median disease duration was significantly greater in ANCA positive patients. The PSC + UC ANCA showed increased IgG3 compared with UC only ANCA (p < 0.05), together with increased IgG2 and IgG4 (p = NS). ANCA is a diagnostic marker in PSC and UC. While the higher titres and different IgG subclass distribution of ANCA in PSC + UC patients compared with those with UC only may reflect differences in underlying immune regulation, determination of the ANCA titre and IgG subclass is unlikely to have a role in distinguishing between PSC + UC and UC only ANCA. Future identification of the antigen(s) for ANCA should allow the development of a more sensitive and specific test for the diagnosis of these two conditions and also determine if ANCA is associated with UC or PSC.     

Management of elderly ulcerative colitis in Japan

Japan has the largest aging society, where many elderly people have intractable diseases including ulcerative colitis (UC). Along with the increasing total number of UC patients, the number of elderly UC patients has also been increasing and will continue to do so in the future. Although the clinical features and natural history of UC in the elderly have many similarities with UC in the non-elderly population, age-specific concerns including comorbidities, immunological dysfunction, and polypharmacy make the diagnosis and management of elderly UC challenging compared to UC in non-elderly patients. Based on increasing data related to elderly UC patients from Japan, as well as other countries, we reviewed the epidemiology, clinical course, differential diagnosis, management of comorbidities, surveillance, medical therapy, and surgery of UC in the elderly.

     

胰岛素样生长因子在UC临床特征评估中的价值

溃疡性结肠炎（UC）临床诊治有时较为困难,目前尚缺乏可反映本病临床特征的特异性生物学指标。目的：探讨胰岛素样生长因子（IGF）在评估UC临床特征中的价值。方法：采用酶标化学发光免疫分析法检测124例UC患者和50例健康对照者的外周血IGF-I和胰岛素样生长因子结合蛋白3（IGFBP3）的表达．并探讨两者与UC病情严重程度、治疗效果和癌变的相关性。结果：UC患者外周血IGF-I和IGFBP3水平较正常对照组明显下降．且随病情加重呈进行性下降,以中重度UC为著（P〈0．05）。UC治疗有效者IGF-I和IGFBP3水平较治疗前明显升高．以中重度UC为著（P〈0．05）。UC癌变时IGF．I和IGFBP3较正常对照组明显升高（P〈0．05）。结论：IGF-I和IGFBP3可有助于评估UC的病情严重程度和治疗效果．且在预On,0UC癌变中有重要价值．     

Value of colonoscopy for prediction of prognosis in patients with ulcerative colitis

Ulcerative colitis （UC） is a chronic inflammatory bowel disorder characterized by exacerbations and remissions. Some UC patients remain refractory to conventional medical treatment while, in others, the effectiveness of drugs is limited by side-effects. Recently, cyclosporine and leukocyte removal therapy have been used for refractory UC patients. To predict the efficacy of these therapies is important for appropriate selection of treatment options and for preparation for colectomy. Endoscopy is the cornerstone for diagnosis and evaluation of UC. Endoscopic parameters in patients with severe or refractory UC may predict a clinical response to therapies, such as cyclosporine or leukocyte removal therapy. As for the patients with quiescent UC, relapse of UC is difficult to predict by routine colonoscopy. Even when routine colonoscopy suggests remission and a normal mucosal appearance, microscopic abnormalities may persist and relapse may occur later. To more accurately identify disease activity and to predict exacerbations in UC patients with clinically inactive disease is important for deciding whether medical treatment should be maintained. Magnifying colonoscopy is useful for the evaluation of disease activity and for predicting relapse in patients with UC.     

重视溃疡性结肠炎的规范化外科治疗

我国溃疡性结肠炎(ulcerative colitis,UC)的发病率近20年来呈现快速上升趋势,但由于既往的低发病率以及结直肠外科亚专业化在我国的发展不足,国内对溃疡性结直肠炎的诊断治疗在相当程度上还存在一定盲区。与国外新的治疗理念相比,我国还存在诸多问题,如对内科治疗的过度依赖,对外科手术指征的过严把控,手术方式的选择上存在明显差异、对癌变的监控及早期处理严重不足等。因此迫切需要提高相关科室人员对UC诊断治疗标准的知晓,强化区域炎症性肠病(inflamatory bowel diseases,IBD)诊治中心的建设,大力推动UC诊治指南的宣传与应用,是提高我国UC治疗水平的关键。     

Effects of sulfasalazine on biopsy mucosal pathologies and histological grading of patients with active ulcerative colitis

AIM: To investigate the mechanisms of sulfasalazine (SASP) in the treatment of ulcerative colitis (UC). METHODS: Changes of pathological signs and histological grading of 106 patients with active UC were observed before and after the treatment with SASP, 1 g, thrice daily for 6 wk. RESULTS: The effect of SASP on the vasculitis in lamina propria was 48.2% and 17.4% in the mild active UC (P<0.001) and 68% and 26.7% in the moderate active UC (P<0.001) before and after treatment. Fibroid necrosis of vessel wall was found in one case of mild UC and two cases of moderate UC before treatment and was not found after treatment. No thrombosis was found in mild UC before and after treatment, while thrombosis was found in one case of moderate UC before treatment. The effect on mucosal glandular abnormality was 30.4% and 13.0% in mild UC (P<0.05), and 42% and 40% in moderate UC (P>0.05) before and after treatment. The rate of eosinophil infiltration was 98.2% and 80.4% in mild UC (P<0.01), and 100% and 91.1% in moderate UC (P<0.05) before and after treatment. The effect on crypt abscess was 21.4% and 4.4% in mild UC (P<0.05), and 48% and 13.3% in moderate UC (P<0.001) before and after treatment. The effect on mucosal pathohistological grading was 2.00+/-0.84 and 0.91+/-0.46 in mild UC (P<0.001), and 2.49+/-0.84 and 1.31+/-0.75 in moderate UC (P<0.001) before and after treatment. CONCLUSION: SASP can improve small vessel lesions and crypt abscesses and reduce neutrophilic and eosinophilic leukocyte infiltration in inflammatory mucosa of UC.     

溃疡性结肠炎患者血栓前状态分子标志物的变化及其临床意义

目的探讨溃疡性结肠炎（UC）患者凝血、抗凝及纤溶指标的变化与溃疡性结肠炎的活动性及病变范围的关系。方法采用ELISA法检测32例活动期UC患者,20例缓解期UC患者及45例健康对照组的血小板颗粒膜蛋白-140（GMP-140）,血管性假性血友病因子（vWF：Ag）,血栓调节蛋白（TM）,D-二聚体（DD）的含量,采用发色底物法测定抗凝血酶-Ⅲ：活性（AT-Ⅲ：A）并进行分析。结果活动期UC患者GMP-140,vWF：Ag,TM,D-D的含量均明显高于缓解期患者及对照组,缓解期UC患者血栓前状态分子标志物水平明显高于对照组,而AT-Ⅲ：A在活动期UC患者明显低于缓解期患者及对照组。不同病变部位的活动期UC患者血栓前状态标志物水平有明显差异,活动期与缓解期UC患者各指标之间呈显著相关。结论UC患者处于明显的血栓前状态,血栓前状态分子标志物水平与病变活动性及病变范围有关,持续的高凝状态可能与UC患者的临床进展有关。