溃疡性结肠炎患者血清蛋白电泳结果分析

溃疡性结肠炎（UC）是一种原因不明、容易复发、个体特异性强的炎性肠病。溃疡性结肠炎近10a来比20世纪50年代增加约10倍^[1]。UC的诊断缺乏特异性,本文对50例UC患者的血清进行了血清蛋白电泳测定分析,旨在探讨血清蛋白电泳分析对UC的诊断价值。     

抗中性粒细胞胞浆抗体对溃疡性结肠炎诊断的意义

炎症性肠病(IBD)包括溃疡性结肠炎(UC)和克罗恩病(CD),目前发病率呈上升趋势,但病因和性病机制尚未明确,因此没有一个特异性的诊断标准.     

抗中性粒细胞胞浆抗体及抗酿酒酵母抗体在溃疡性结肠炎诊断中的应用

目的探讨抗中性粒细胞胞浆抗体（pANCA）、抗酿酒酵母抗体（ASCA）在溃疡性结肠炎（UC）诊断、鉴别诊断中的意义及pANCA与UC活动性的关系。方法采用间接免疫荧光法测定血清pANCA和ASCA水平。结果 pANCA诊断UC的敏感性、特异性分别为62.5%、96.1%,联合监测pANCA＋/ASCA-诊断UC的敏感性、特异性分别为52.5%、100%。pANCA阳性率高低与UC活动状态、严重程度、病变范围无关。结论 pAN-CA是UC较特异血清抗体,可用于鉴别UC和克罗恩病（CD）。联合监测pANCA/ASCA可进一步提高诊断UC的特异性。但pANCA与UC活动性、病情轻重程度、病变范围无关。     

感染性结肠炎误诊为溃疡性结肠炎9例分析

目的：探讨感染性结肠炎（IC）误诊为溃疡性结肠炎（UC）的原因。方法：选择9例IC误诊为UC的临床资料进行回顾性分析。结果：9例初诊为UC的患者,后根据病史、临床表现、血常规及病理报告等相关临床资料予以否定,按IC给予诊断性治疗,全部治愈。结论：IC误诊为UC原因较多,提高肠镜医师及临床医师的诊断水平是减少误诊的关键。     

儿童溃疡性结肠炎8例分析

溃疡性结肠炎的病因较为复杂。与感染、免疫异常、环境因素及遗传等多种因索有关。对我院1995～2004结肠镜检查诊断溃疡性结肠炎（UC）8例分析如下。     

溃疡性结肠炎与结肠克罗恩病病理诊断的鉴别要点

溃疡性结肠炎（UC）和克罗恩病（Crohn病，CD）的鉴别诊断一直是一大难题，随着对结肠镜窥视下和活检病理形态改变的认识不断加深，人们开始重视肠黏膜活检病理诊断在UC和CD鉴别中的应用价值。本文分别从病变的分布，大体表现，组织学特征三方面对UC和CD的病理鉴别诊断要点进行分析总结，并对国外目前内镜下活检取材的要求做一简要介绍。     

溃疡性结肠炎七例误诊分析

我院于1991～2001年收治溃疡性结肠炎(UC)38例,其中初诊误诊7例,误诊率18.4%.现就此作一临床分析,以提高UC的诊断水平.     

儿童溃疡性结肠炎

溃疡性结肠炎（ulcerative colitis,UC）是一种原因不明的慢性直肠和结肠炎性疾病。儿童UC在流行病学、病因、临床表现及治疗等方面有一些特点,现综述如下。     

免疫组织化学在溃疡性结肠炎诊断中作用研究进展

溃疡性结肠炎是一种病因尚未明确的非特异性肠道炎症性疾病,是我国消化系统常见病.溃疡性结肠炎临床缺乏特异性诊断及鉴别诊断指标,在组织病理诊断方面也缺乏特异的诊断及鉴别诊断标准,而免疫组织化学是协助组织病理诊断的有效办法.本文就与溃疡性结肠炎诊断、严重程度分级、病程、鉴别诊断和癌变风险相关的免疫组织化学项目作一综述.     

炎症性肠病的影像学诊断

炎症性肠病（inflammatory bowel disease,IBD）是一种病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）。影像学检查是诊断IBD的重要手段,目前主要包括X线钡剂检查和CT、MRI,其不仅可确诊IBD、鉴别CD与UC,还能评价病变的累及范围和严重程度；判断有无肠外并发症．并对临床疗效进行随访。     

白细胞介素-17C对溃疡性结肠炎的诊断价值

目的探讨血清白细胞介素-17C(IL-17C)在溃疡性结肠炎(UC)患者中表达的意义以及体外诊断价值。方法选择2017年12月-2018年6月就诊于济宁医学院附属医院的32例UC患者为UC组,另外选择50例正常健康体检者为健康对照组。收集两组的一般资料,包括性别、年龄、疾病严重程度等,采用酶联免疫吸附试验(ELISA)测定两组的血清IL-17C水平。根据UC病情严重程度不同将UC组分为轻度、中度、重度UC组,根据年龄不同将两组分为<40岁、40~60岁、>60岁组,比较不同分组的IL-17C水平。结果 UC组IL-17C水平明显高于健康对照组(ng/L:251.72±90.49比138.30±68.10),差异有统计学意义(P<0.05)。不同严重程度UC患者的IL-17C水平比较差异无统计学意义(P>0.05),健康对照组IL-17C水平随年龄增长呈上升趋势(P<0.05),UC组各年龄段IL-17C水平比较差异均无统计学意义(均P>0.05)。健康对照组和UC组内不同性别之间的IL-17C水平比较差异均无统计学意义(均P>0.05)。结论血清IL-17C可能在UC的发生发展过程中发挥作用,对诊断UC具有一定的临床价值,有利于UC的体外诊断。     

血清抗微生物抗体检测在炎性肠病临床诊断中的应用

目的分析血清抗微生物抗体检测在炎性肠病临床诊断中的应用。方法将炎性肠病76例分为克罗恩病(CD)组与溃疡性结肠炎(UC)组。2组空腹采集静脉血2mL,经离心处理后收集血清,采用间接免疫荧光法检测免疫球蛋白G(IgG)型与免疫球蛋白A(IgA)型抗酿酒酵母菌抗体(ASCA)、抗胰腺腺泡抗体(PAB)及抗小肠杯状细胞抗体(GAB),同时检测抗中性粒细胞细胞质抗体(pANCA)。结果 UC组ASCA-IgG和IgA的一种以上亚型阳性率低于CD组,其GAB、pANCA阳性率高于CD组(P0.05);2组PAB均未有阳性;CD组ASCA阳性特异性、敏感性为96.53%、18.75%;UC组pANCA阳性特异性、敏感性为96.37%、53.33%。结论血清抗微生物抗体检测可为炎性肠病临床诊断提供依据。     

炎症性肠病回盲部溃疡内镜下特征性表现与鉴别诊断

目的观察回盲部溃疡性病变黏膜特征性改变,初步诊断和鉴别诊断,为临床诊断提供有力依据。方法收集该院自2008年1月-2014年12月行结肠镜检查诊断为炎症性肠病性溃疡43例,观察溃疡特点及黏膜特征性改变。结果回盲部溃疡性病变内镜下特征性表现主要分为3种:溃疡表浅斑片地图状、溃疡较深不规则,沟槽状和回盲瓣瓣口受累变形伴假息肉形成。结果显示以上3种内镜下特征性改变,在单项及两组构成比方面,溃疡性结肠炎(UC)患者和克罗恩病(CD)患者比较,差异有统计学意义(P0.01),可以作为根据其作出初步的鉴别诊断。结论 CD、UC均缺乏诊断的金标准,诊断需结合临床、内镜和组织病理学表现进行综合分析并随访观察,但有一定的特征性表现及规律可循。所以在组织病理学没有充分证据的情况下,观察病变的内镜下特征性表现就显得尤为重要,可能会对临床诊断提供有力的依据。降低此类病变在诊断上的盲目性,提高回盲部溃疡性病变病因确诊率。     

86例溃疡性结肠炎患者精神心理因素状况及影响因素分析

[目的]探讨溃疡性结肠炎( UC)患者精神心理状况及其影响因素.[方法]采用焦虑抑郁情绪测量表 (HAD)对86例UC患者(UC组)及 86例健康者(对照组)评分,比较两组以及UC组中不同病情程度患者之间的评分差异,并分析其影响因素.[结果]UC患者HAD评分显著高于对照组(P<0.05).随着UC患者病情程度增加,H...     

Infliximab and ulcerative colitis

Tumour necrosis factor (TNF)-α is an inflammatory cytokine that plays a main role in the inflammatory process underlying inflammatory bowel disease (IBD). Despite the fact that the cytokine profiles associated with ulcerative colitis (UC) and Crohn’s disease (CD) are classically considered different (a Th2 pattern in UC and a Th1 pattern in CD), there are several evidences in vitro and in vivo that TNF-α has an important role in UC. For this reason, infliximab, the chimeric monoclonal antibody to TNF-α, has been evaluated in the therapy of UC. The drug has been evaluated in different clinical settings both in adults and in children: in moderate–severe steroid-dependent UC, in severe refractory UC as rescue therapy, in active non-steroid-refractory UC, in resistant pouchitis and in maintenance of moderate–severe UC responsive to infliximab. On the basis of the randomised controlled trials (RCTs), it is possible to draw the following conclusions for adults: infliximab seems active in severe steroid-refractory UC, allowing colectomy to be spared even if further controlled trials are needed with a larger sample of patients adopting strict and well-defined inclusion criteria. The drug seems active in inducing remission after 8 weeks in steroid-refractory patients, in patients taking steroids (even if it is not clear at which dosage of steroid dependence the drug is more active) and also in patients failing aminosalicylates therapy. The long-term response of infliximab in comparison to placebo in these subgroups of patients is not clinically impressive even if it is statistically significant. Further trials are warranted in order to establish the role of infliximab in steroid-dependent UC (defined with clear criteria), in maintaining remission after severe UC, in non-steroid-dependent moderate–severe UC and in refractory pouchitis. For children it is not possible to draw the same conclusions, due to a lack of RCTs, despite the encouraging data coming from open studies, mainly in steroid-refractory UC.     

A comprehensive review and update on ulcerative colitis,

Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disorder of the colon that causes continuous mucosal inflammation extending from the rectum to the more proximal colon, with variable extents. UC is characterized by a relapsing and remitting course. UC was first described by Samuel Wilks in 1859 and it is more common than Crohn's disease worldwide. The overall incidence and prevalence of UC is reported to be 1.2–20.3 and 7.6–245 cases per 100,000 persons/year respectively. UC has a bimodal age distribution with an incidence peak in the 2nd or 3rd decades and followed by second peak between 50 and 80 years of age. The key risk factors for UC include genetics, environmental factors, autoimmunity and gut microbiota. The classic presentation of UC include bloody diarrhea with or without mucus, rectal urgency, tenesmus, and variable degrees of abdominal pain that is often relieved by defecation. UC is diagnosed based on the combination of clinical presentation, endoscopic findings, histology, and the absence of alternative diagnoses. In addition to confirming the diagnosis of UC, it is also important to define the extent and severity of inflammation, which aids in the selection of appropriate treatment and for predicting the patient's prognosis. Ileocolonoscopy with biopsy is the only way to make a definitive diagnosis of UC. A pathognomonic finding of UC is the presence of continuous colonic inflammation characterized by erythema, loss of normal vascular pattern, granularity, erosions, friability, bleeding, and ulcerations, with distinct demarcation between inflamed and non-inflamed bowel. Histopathology is the definitive tool in diagnosing UC, assessing the disease severity and identifying intraepithelial neoplasia (dysplasia) or cancer. The classical histological changes in UC include decreased crypt density, crypt architectural distortion, irregular mucosal surface and heavy diffuse transmucosal inflammation, in the absence of genuine granulomas. Abdominal computed tomographic (CT) scanning is the preferred initial radiographic imaging study in UC patients with acute abdominal symptoms. The hallmark CT finding of UC is mural thickening with a mean wall thickness of 8 mm, as opposed to a 2–3 mm mean wall thickness of the normal colon. The Mayo scoring system is a commonly used index to assess disease severity and monitor patients during therapy. The goals of treatment in UC are three fold—improve quality of life, achieve steroid free remission and minimize the risk of cancer. The choice of treatment depends on disease extent, severity and the course of the disease. For proctitis, topical 5-aminosalicylic acid (5-ASA) drugs are used as the first line agents. UC patients with more extensive or severe disease should be treated with a combination of oral and topical 5-ASA drugs +/− corticosteroids to induce remission. Patients with severe UC need to be hospitalized for treatment. The options in these patients include intravenous steroids and if refractory, calcineurin inhibitors (cyclosporine, tacrolimus) or tumor necrosis factor-α antibodies (infliximab) are utilized. Once remission is induced, patients are then continued on appropriate medications to maintain remission. Indications for emergency surgery include refractory toxic megacolon, colonic perforation, or severe colorectal bleeding.     

Complications of extraintestinal endocrine disease associated with ulcerative colitis--association of ulcerative colitis and autoimmune thyroid disease

We experienced a rare case of Basedow's disease followed by ulcerative colitis (UC). The association of UC and autoimmune thyroid disease was reviewed and discussed. A high frequency of endocrine autoimmunity, especially autoimmune thyroid disease, was reported in patients with UC. But prevalence of autoimmune thyroid disease associated with UC varies widely in different studies. Some authors described that it was impossible to say that the observed numbers of UC associated with thyroid disease exceed to those to be expected in a random sample of the general populations. The hypothesis that autoimmunity is important in the pathogenesis of UC and thyroid disease continues to stimulate interest. But the evidence for autoimmunity acting in these diseases is not quite as convinced. Further investigation is warranted to clarify the exact relationships between UC and thyroid disease.     

Infliximab and ulcerative colitis

Tumour necrosis factor (TNF)-alpha is an inflammatory cytokine that plays a main role in the inflammatory process underlying inflammatory bowel disease (IBD). Despite the fact that the cytokine profiles associated with ulcerative colitis (UC) and Crohn's disease (CD) are classically considered different (a Th2 pattern in UC and a Th1 pattern in CD), there are several evidences in vitro and in vivo that TNF-alpha has an important role in UC. For this reason, infliximab, the chimeric monoclonal antibody to TNF-alpha, has been evaluated in the therapy of UC. The drug has been evaluated in different clinical settings both in adults and in children: in moderate-severe steroid-dependent UC, in severe refractory UC as rescue therapy, in active non-steroid-refractory UC, in resistant pouchitis and in maintenance of moderate-severe UC responsive to infliximab. On the basis of the randomised controlled trials (RCTs), it is possible to draw the following conclusions for adults: infliximab seems active in severe steroid-refractory UC, allowing colectomy to be spared even if further controlled trials are needed with a larger sample of patients adopting strict and well-defined inclusion criteria. The drug seems active in inducing remission after 8 weeks in steroid-refractory patients, in patients taking steroids (even if it is not clear at which dosage of steroid dependence the drug is more active) and also in patients failing aminosalicylates therapy. The long-term response of infliximab in comparison to placebo in these subgroups of patients is not clinically impressive even if it is statistically significant. Further trials are warranted in order to establish the role of infliximab in steroid-dependent UC (defined with clear criteria), in maintaining remission after severe UC, in non-steroid-dependent moderate-severe UC and in refractory pouchitis. For children it is not possible to draw the same conclusions, due to a lack of RCTs, despite the encouraging data coming from open studies, mainly in steroid-refractory UC.     

炎症性肠病诊断与治疗的共识意见(2018年，北京)溃疡性结肠炎部分解读

2018年5月,中华消化杂志在线发表了中华医学会消化病学分会炎症性肠病学组制订的《炎症性肠病诊断与治疗的共识意见(2018年,北京)》,该共识意见在2012年共识意见的基础上对炎症性肠病的诊治进展进行了更新与完善,为医务人员规范诊治炎症性肠病提供了更新、更全面的依据。本文主要对共识意见中溃疡性结肠炎的诊断和治疗部分进行解读,以期加深临床医师对新共识的认识与理解,提高溃疡性结肠炎的诊治水平。