炎症性肠病患者树突状细胞免疫功能亢进

树突状细胞(Dendritic cell,DC)因其独特的免疫学功能在调节机体免疫状态中起关键作用,而DC免疫功能与其表面免疫分子表达密切相关。DC免疫功能异常将导致机体免疫功能紊乱。过去研究发现,炎症性肠病(inflammatory bowel disease,IBD)患者免疫功能异常,但未见有关IBD患者DC免疫功能的研究。本文在检测IBD患者DC表面免疫分子HLA-DR及目B7-1表达水平及DC诱导自体混合T淋巴细胞增殖能力基础上探讨DC免疫功能与IBD相关性。     

雷公藤内酯醇抑制炎症性肠病患者树突状细胞免疫功能

雷公藤制剂在调节机体免疫状态中有重要作用,但仍不清楚雷公藤是否通过调节DC免疫功能而发挥药理作用。本实验将研究雷公藤内酪醇对炎症性肠病患者DC表面人白细胞抗原-DR(HLA-DR,为MHC-Ⅱ主要成份之一)和免疫分子B7表达水平及DC免疫功能的影响,并进一步探讨该影响在雷公藤制剂调节机体免疫状态中的可能作用及其机制。     

雷公藤内酯醇抑制炎症性肠病患者树突状细胞免疫功能

雷公藤制剂在调节机体免疫状态中有重要作用,但仍不清楚雷公藤是否通过调节DC免疫功能而发挥药理作用。本实验将研究雷公藤内酯醇对炎症性肠病患DC表面人白细胞抗原-DR(HLA-DR,为MHC-Ⅱ主要成份之一)和免疫分子B7表达水平及DC免疫功能的影响,并进一步探讨该影响在雷公藤制剂调节机体免疫状态中的可能作用及其机制。     

炎症性肠病的治疗

炎症性肠病(IBD)的病因致今未明,因此缺乏特效治疗。溃疡性结肠炎(UC)与克隆病(CD)的治疗原则基本相同,但二者在近期疗效与防止复发方面则有区别,一般在UC优于CD.本病应以内科治疗为主,手术仅适用于UC有中毒性巨结肠经积     

树突状细胞与炎症性肠病

树突状细胞(DC)是体内功能最强的专职抗原提呈细胞,既能启动免疫应答,又能诱导免疫耐受。炎症性肠病可能是遗传和环境因素共同作用导致肠道黏膜对肠道正常菌群免疫反应失常引起的慢性非特异性炎症。DC可能参与了IBD的发生,对DC功能的进一步深入研究,有助于发现新的IBD治疗靶点。     

炎症性肠病与免疫研究的进展

炎症性肠病(Inflammatory bowel disease，IBD)是一种原因不明的慢性非特异性肠道炎症性疾病．包括克罗恩病(Crohn’s Disease．CD)和溃疡性结肠炎(Ulcerative Colitis，UC)。IBD发生以欧美国家为最高，亚洲国家相对较低，全球均有逐渐增高的趋势。近年来，随着我国人民生活方式的改变．本病的发病率也在上升。黏膜免疫是IBD研究的热点之一，人们已认识到免疫功能紊乱并非IBD伴随情况，而是其重要致病因素，本文就这方面的研究进展作一综述。     

011 炎症性肠病患者是否接受了最佳治疗

对于炎症性肠病（IBD）患者的诊断、治疗以及监测已有相关指南发表，尽管如此，仍有部分患者未得到最佳治疗。迄今尚未见研究综合评价IBD患者接受的治疗是否符合治疗指南的规定。本研究旨在评价有症状的IBD患者是否得到了符合指南规定的最佳治疗。     

炎症性肠病的临床表现及诊断

溃疡性结肠炎(溃结)与克隆病(Crohn病)共称为炎症性肠病(IBD),均可见于儿童及成年人,以20～40岁为多见.IBD的起病多缓渐、隐匿、病史常数月或数年,活动期与缓解期交替出现,亦有持续活动而不缓解者.少数急性起病。     

炎症性肠病患者NK细胞激活和效应应答

炎症性肠病与肠道黏膜免疫系统对肠腔内细茵和食物抗原等异常免疫应答有密切关系,在炎症肠黏膜组织内有大量激活的单个核淋巴细胞浸润,表达高水平的促炎症细胞因子和辅助刺激信号分子等.NK细胞是先天性和获得性免疫应答的重要淋巴细胞,主要通过分泌细胞毒杀伤蛋白质对靶细胞进行直接杀伤,并分泌促炎症介质.在炎症性肠病患者炎症肠黏膜组织内有大量NK细胞浸润,表达高水平激活分子,并分泌促炎症细胞因子,参与肠黏膜炎症损伤.     

炎症性肠病的病因与发病机制

炎症性肠病(Inflammatory bowel dise-ase,下称IBD)主要包括克隆(Crohn)病(下称(CD)及溃疡性结肠炎(Ulcerative Colitis,下称UC).UC在国外常见,自50年代以来,年发病率为5/10万,在发展中国家有增加趋势.国内于     

炎性肠病患者服用硫唑嘌呤的不良反应及处理

目的评估炎性肠病患者使用硫唑嘌呤后因不良反应引起停药的比例及原因。方法对1995至2005年期间北京协和医院和中日友好医院住院病例中使用硫唑嘌呤的31例炎性肠病患者进行回顾性分析。结果7例患者因为出现不良反应而终止治疗,其中6例(19.4%)不良反应发生在用药4周内。结论早期不良反应是引起炎性肠病患者停止硫唑嘌呤治疗的主要原因。     

Bone Density and Bone Metabolism in Patients with Inflammatory Bowel Disease

Background/Aims:

Patients with inflammatory bowel disease (IBD) are at high risk for low bone mineral density (BMD). This study aimed to evaluate BMD in IBD patients and its relationship with bone metabolism in a group of Iranian patients.

Patients and Methods:

A cross-sectional study was conducted on patients with IBD to assess BMD status and serum biochemical factors. After getting the demographic data from 200 patients, they were screened using dual-energy X-ray absorptiometry of the lumbar spine (L2–L4) and femoral neck for BMD status. Serum levels of calcium, phosphate, alkaline phosphatase (ALP), and 25-hydroxyvitamin D (25-OH vitamin D) were measured to assess the bone metabolism status.

Results:

Two hundred patients with IBD were enrolled in the study. One hundred and eighty three (91.5%) patients were identified as having ulcerative colitis (UC) and 17 (8.5%) as having Crohn''s disease (CD). Based on the lumbar and femoral neck bone mass densitometry, 148 (74.4%) patients had low BMD at either lumbar spine or femoral neck. Of these, 100 patients (50.3%) were osteopenic and 48 patients (24.1%) were osteoporotic. A 58.6% and 61% of patients with UC had low BMD in the lumbar and femoral neck, respectively. These results for those with CD were 76.5% and 70.6%, respectively. The mean of femoral neck and lumbar T-scores in patients with UC were -1.14 and -1.38, and in patients with CD were -1.24 and -1.47, respectively (P > 0.05). The mean (±SD) levels for calcium (Ca) in UC and CD were in the normal range. The mean (±SD) levels of ALP and 25-OH vitamin D in both the groups were in the normal range, and in comparison between groups (UC and CD), no significant differences were observed (P = 0.20 for ALP and P = 0.44 for 25-OH vitamin D). In the assessment of correlation between biochemical markers and BMD, an inverse correlation between lumbar T-score and ALP or 25-OH vitamin D only in patients with UC was observed.

Conclusions:

The high prevalence of low BMD in the Iranian population with IBD needs attention. The subclinical vitamin D deficiency may contribute to bone loss in IBD patients, which is more pronounced in patients with UC in this study because of the small population of patients with CD.     

Disposition of Mesalazine from Mesalazine-Delivering Drugs in Patients with Inflammatory Bowel Disease,with and without Diarrhoea

Rijk MCM, van Schaik A, van Tongeren JHM. Disposition of mesalazine from mesalazine-delivering drugs in patients with inflammatory bowel disease, with and without diarrhoea. Scand J Gastroenterol 1992;27:863-868.

The disposition of mesalazine from the azo compounds sulphasalazine and olsalazine (Dipentum^®) and from the slow-release mesalazine drugs Pentasa^®, Asacol^®, and Salofalk^® was studied in 20 patients with inflammatory bowel disease. Ten of them had diarrhoea, and 10 had normal stools. On the last 2 days of a 7-day maintenance treatment with each of the study drugs urine and faeces were collected for determination of mesalazine, acetyl-mesalazine, and unsplit azo compound. In patients with and without diarrhoea the urinary and the faecal excretion of acetyl-mesalazine was lowest during treatment with olsalazine. The proportion of acetyl-mesalazine in faeces was highest during treatment with Pentasa in both groups. The presence of diarrhoea was associated with a decrease in the proportion of acetyl-mesalazine in faeces during treatment with all drugs, not significant only for Pentasa. The proportion of unsplit azo compound in faeces increased in the case of diarrhoea to almost 50%. It is concluded that in patients with inflammatory bowel disease diarrhoea substantially influences the disposition from ail these drugs except Pentasa.     

Osteoporosis in Inflammatory Bowel Disease

Osteoporosis commonly afflicts patients with inflammatory bowel disease, and many factors link the 2 states together. A literature review was conducted about the pathophysiology of osteoporosis in relation to inflammatory bowel disease. Screening guidelines for osteoporosis in general as well as those directed at patients with inflammatory bowel disease are reviewed, as are currently available treatment options. The purpose of this article is to increase physician awareness about osteopenia and osteoporosis occurring in patients with inflammatory bowel disease and to provide basic, clinically relevant information about the pathophysiology and guidelines to help them treat these patients in a cost-effective manner.     

Insufficient Knowledge of Korean Gastroenterologists Regarding the Vaccination of Patients with Inflammatory Bowel Disease

Background/Aims

There is an increased risk for inflammatory bowel disease (IBD) patients to develop infections due to the use of immunomodulators and biologics. Several infections are preventable by immunizations. This study investigated the knowledge and awareness of Korean gastroenterologists regarding the vaccination of patients with IBD.

Methods

A self-reported questionnaire was sent by e-mail to the faculty members of tertiary hospitals. Gastroenterologists were asked ten questions regarding the immunization of patients with IBD. A total of 56 gastroenterologists completed the questionnaire.

Results

A majority of gastroenterologists (>60%) had rarely or never recorded an immunization history from their patients with IBD. Moreover, 50% to 70% of the gastroenterologists did not know that live vaccines should be avoided in immunosuppressed patients. The most commonly mentioned resistance to vaccinations was "the lack of concern and knowledge regarding vaccination." Gastroenterologists more frequently asked about the immunization history of influenza, pneumococcal, hepatitis A, and hepatitis B vaccines and recommended these vaccines more often than others.

Conclusions

Korean gastroenterologists'' awareness and knowledge regarding the vaccination of patients with IBD were very poor. Intensive educational programs on immunization guidelines directed toward gastroenterologists who care for patients with IBD are required to ensure that these patients receive the necessary vaccinations.     

Prevalence of Macrocreatinkinase Type 1 in Patients with Inflammatory Bowel Disease

Macro-creatine-kinases are isoenzymes of creatinine-kinases (CK). They have been classified in two types: type 1 (CK bound to an immunoglobulin) and type 2 (an oligomeric mitochondrial CK). CK type 1 has been found in patients with ulcerative colitis (UC) but not in Crohn’s disease (CD). However, there are no studies evaluating macro-creatinkinase prevalence in inflammatory bowel disease (IBD). We included 159 consecutive patients (72 UC, 85 CD; 2 indeterminate colitis). Creatin-kinase total activity and isoenzymes activities were determined. Twelve (16.7%) patients with UC and one of the two patients with indeterminate colitis had serum macro-creatinkinase type 1 while no CD patients displayed this macromolecule (P < 0,001). Sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio were calculated for ulcerative colitis versus Crohn’s disease diagnosis, being 16.7, 98.9, 92.3, 59, 14.5, and 0.84% respectively. There was no correlation with age, gender, time from diagnosis, associated diseases, concomitant medication or disease activity. In conclusion our data suggests that the presence of macro-CK in IBD favors the diagnosis of ulcerative colitis. Further studies are necessary to understand the significance of this finding in a subset of patients with IBD.     

炎症性肠病患者巯基嘌啉甲基转移酶基因型检测与硫唑嘌啉安全性分析

目的初步探讨炎症性肠病(IBD)患者巯基嘌啉甲基转移酶(TPMT)基因突变情况,了解硫唑嘌啉的不良反应。方法对30例我院住院IBD患者TPMT*3C基因型通过基因PCR扩增、基因测序的方法进行检测,其中10例患者给予硫唑嘌啉1～2 mg/kg.d-1剂量口服。结果 30例患者TPMT*3C基因型均为野生型,未发现基因突变,2例发生不良反应。结论 TPMT*3C在IBD中突变率较低;应用硫唑嘌啉需严密观察其不良反应。