IL-17F与溃疡性结肠炎的研究进展

炎症性肠病是一类慢性、易反复发作的非特异性肠道炎性疾病,包括溃疡性结肠炎和克罗恩病。虽然距溃疡性结肠炎的首次报道至今已经有160余年的历史,但其发病机制至今尚未明确。目前认为溃疡性结肠炎是多因素相互作用的结果,主要包括环境、遗传、感染、免疫因素等。其中免疫功能的异常与溃疡性结肠炎的发病关系更为密切。最近研究发现一类新细胞亚群,称为Th17细胞。分化成熟的Th17细胞可分泌多种细胞因子,其中的IL-17F在溃疡性结肠炎的发生和发展中占有重要地位,为溃疡性结肠炎的临床治疗提供一种新的治疗策略。     

炎症性肠病患者使用英夫利西单抗治疗的护理

<正>炎症性肠病(inflammatory bowel diseases,IBD)包括克罗恩病(Crohn's disease,CD)和溃疡性结肠炎(ulcerative colitis,UC),是发生在胃肠道的慢性炎症性疾病。随着生物制剂的出现,"降阶梯治疗"已成为IBD药物治疗的新模式,并日益受到重视。英夫利西单抗(inflixinab,IFX)是人鼠嵌合的抗TNF-α单克隆抗体[1],用于激素和免疫抑     

炎症性肠病药物治疗现状与进展

炎症性肠病(IBD)是一种病因尚不明确的慢性非特异性肠道炎症性病变,包括溃疡性结肠炎(UC)和克罗恩病(CD)。其发病与遗传、环境、免疫有关。IBD在国外特别是白种人中发病率较高,随着诊断技术的提高,在国内该病的报道日渐增多。近年来对其病因、发病机理及治疗的研究取得了较大进展,尤其是一些新药的应用明显提高了疗效。对IBD的治疗,目前着眼于控制炎症和调节免疫紊乱,以有效控制疾病发作和维持缓解。传统治疗IBD的三大类药物(水杨酸类、类固醇激素类、免疫抑制剂)的研究取得了很大的发展,目前仍是治疗IBD最常用的药物。随着IBD发病…     

炎症性肠病免疫治疗新进展

炎症性肠病(inflammatory bowel disease,IBD)是一种病因尚不十分清楚的慢性肠道炎症性病变,包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn disease,CD).IBD的传统治疗主要是对症治疗,常用的方法包括水杨酸类、类固醇激素、免疫抑制剂、抗生素及手术切除等,其目的是减轻患者肠道炎症反应、恢复肠道正常营养吸收功能、维持和改善患者的生活质量、防止复发及恶变[1].目前大多数学者认为肠壁黏膜免疫调节异常、持续的肠道感染、肠道黏膜屏障缺损、遗传和环境等因素共同参与了疾病的发生、发展进程[2].近年来针对特异性免疫致病途径建立了免疫治疗的方法,选择性阻断其免疫性炎症级联反应,其靶向途径包括抑制T细胞活化、减少促炎细胞因子等[3].免疫治疗多用于常规保守治疗无效的慢性活动性CD和有活动性瘘管形成的中、重度IBD患者.目前IBD的免疫治疗药物研究进展迅速,现介绍如下.     

维得利珠单抗治疗炎症性肠病的临床疗效分析

目的 分析维得利珠单抗（VDZ）对炎症性肠病（IBD）的临床疗效,了解VDZ联合免疫抑制剂和（或）糖皮质激素是否具有更好的治疗效果。方法 统计使用VDZ治疗的活动期IBD患者共29例[溃疡性结肠炎（UC） 21例、克罗恩病（CD）8例],诱导缓解期为第0、2、6周各用药一次（300 mg静脉滴注）,维持缓解期每8周或每...     

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.     

柳氮磺胺吡啶联合锡类散灌肠治疗溃疡性结肠炎临床观察

溃疡性结肠炎（UC）的病因和发病机制仍未明确,其发病机制主要集中在遗传易感性、自身免疫异常、肠道菌群改变。当前治疗仍以糖皮质激素类、氨基水杨酸和免疫抑制剂等药物为主。笔者在常规治疗的基础上采用柳氮磺胺吡啶加锡类散灌肠治疗溃疡性结肠炎,取得满意疗效,现报道如下。     

炎症性肠病的比较影像学研究

目的探讨炎症性肠病的影像学特征。方法选取炎症性肠病患者41例,包括溃疡性结肠炎28例,克罗恩病13例。比较溃疡性结肠炎和克罗恩病的X线、CT、核磁共振(MRI)及其他影像学表现。结果溃疡性结肠炎和克罗恩病的X线、CT、核磁共振(MRI)及其他影像学表现存在一定的差异,临床需谨慎鉴别。结论任何检查方法在诊断炎症性肠病时都有其优势和局限性,需密切结合临床和其他实验室检查确认。     

静注免疫球蛋白治疗难治性广泛特发性结肠炎

静注免疫球蛋白治疗难治性广泛特发性结肠炎本文对静脉注射免疫球蛋白治疗难治性特发性炎性结肠疾病的效果及安全性进行了小样本试验。选择经免疫抑制剂或外科治疗无效的１２例难治性特发性结肠炎（溃疡性结肠炎９例、克隆氏病３例）作为观察对象。其中１１例经激素等多种...     

克罗恩病与溃疡性结肠炎鉴别诊断的临床病例分析

目的探讨克罗恩病和溃疡性结肠炎的鉴别诊断。方法收集了18例克罗恩病和29例溃疡性结肠炎,回顾分析两者的临床、内镜及病理特点。结果血便以溃疡性结肠炎明显多见（P〈0．01）,消瘦以克罗恩病多见（P〈0．05）;腹痛、腹泻、发热等两者无显著差异。克罗恩病、溃疡性结肠炎内镜检查,内镜下卵石样改变、裂隙样溃疡及菜花样肿快仅见于克罗恩病（P〈0．05）;肠黏膜充血水肿、糜烂、假性息肉等两者无显著差异。克罗恩病可累及整个胃肠道,主要以回盲部为主;而溃疡性结肠炎仅累及结肠与直肠。结论血便、消瘦等临床表现对两者的鉴别诊断有重要的参考意义,而裂隙样溃疡、瘘管、非干酪性肉芽肿是克罗恩病的特征性表现,确诊需依靠内镜和病理。     

Isolation of pure, active alpha 2 macroglobulin from small-scale plasma samples

This paper presents a rapid method for the separation and quantitation of steroids obtained from normal and tumor tissue of the human adrenal and ovary. The tissues are initially extracted by organic solvent to separate the steroids from water-soluble compounds. The organically soluble steroids from the human tissues are chromatographed using a previously validated high performance liquid chromatography (HPLC) technique. This results in- the rapid separation of progesterone, pregnenolone and corticosteroid pathway steroids. The steroids of the progesterone pathway (progesterone, testosterone, androstenedione, 17-hydroxyprogesterone) are directly quantitated by integration (using 254 nm absorbance) of the resultant peak areas. These direct quantitative results are compared to the results obtained by radioimmunoassay of the various steroids present in the sample. This use of HPLC results in the rapid separation and direct quantitation (in 40–50 min) of these steroids from human tissues.     

Storming the castle: A case report of multi‐system dysregulation in a child with Castleman disease

Castleman disease is a non‐clonal, lymphoproliferative disorder rarely seen in children. Presented is a 12‐year‐old male with progressive abdominal pain, vomiting, and fever. Diagnostic testing revealed multi‐organ system involvement and the diagnosis was ultimately made with tissue biopsy. Marked disease regression occurred after high‐dose steroids and continued interleukin‐6 inhibition.     

Esophageal perforations masked by steroids

Esophageal perforation is usually an acute, life-threatening event, and its diagnosis can be established on the basis of obvious clinical and radiographic findings. This article describes two cases whereby symptoms of esophageal perforations were masked by concomitant administration of steroids, thus causing marked delay in diagnosis and treatment. Esophageal rupture should be considered when patients receiving steroids develop unexplained fever with pleural effusion or pneumomediastinum, particularly following instrumentation or forceful retching.     

Evidence base for using corticosteroids to treat HIV-associated immune reconstitution syndrome

Most of the evidence supporting the use of corticosteroids (steroids) for immune reconstitution syndrome (IRS) comes from case reports or retrospective series and is of low quality. However, when steroids are used, they have usually been associated with clinical improvement or resolution of IRS. Except in the case of hepatitis B- or C-associated IRS, there have been no reports of worsening of the IRS or adverse outcome due to steroid use. After ruling out other conditions which can mimic IRS, clinicians should strongly consider steroids when managing IRS associated with mycobacterial or fungal pathogens when there is severe disease, or when other measures have failed.     

Evidence base for using corticosteroids to treat HIV-associated immune reconstitution syndrome

Most of the evidence supporting the use of corticosteroids (steroids) for immune reconstitution syndrome (IRS) comes from case reports or retrospective series and is of low quality. However, when steroids are used, they have usually been associated with clinical improvement or resolution of IRS. Except in the case of hepatitis B- or C-associated IRS, there have been no reports of worsening of the IRS or adverse outcome due to steroid use. After ruling out other conditions which can mimic IRS, clinicians should strongly consider steroids when managing IRS associated with mycobacterial or fungal pathogens when there is severe disease, or when other measures have failed.     

Wells’ syndrome possibly caused by hematologic malignancy,influenza vaccination or ibrutinib: A case report

BACKGROUNDWells’ syndrome (eosinophilic cellulitis) is an uncommon eosinophilic dermatosis of uncertain pathogenesis, characterized by clinical polymorphism and suggestive but nonspecific histopathologic traits. Its course is recurrent, and response to therapy is unpredictable. In a case in which the patient has a number of potential triggers for the manifestation of Wells’ syndrome skin rash, the treating physician must decide or must make an assumption in order to establish the most likely clinical scenario. This is important for the patient’s future treatment plans.CASE SUMMARYWe describe the clinical case of a 46-year-old female with chronic lymphocytic leukemia who had already received treatment for several months with ibrutinib. She was diagnosed with Wells’ syndrome 10 d after an influenza vaccination containing thimerosal. Based on the literature, the patient was treated with a course of oral steroids. Resolution of clinical symptoms and rash were observed in response to the treatment. Ibrutinib was not discontinued.CONCLUSIONThe etiology of Wells’ syndrome remains unknown. Clinically, it resembles bacterial cellulitis. Lack of response to antibiotic treatment should lead the physician to consider a diagnosis of Wells’ syndrome. Treating the underlying condition is important and may lead to resolution of the syndrome. However, the most common and effective treatment to limit the course of the disease are systemic steroids.     

Management of ulcerative colitis

Ulcerative colitis is a chronic inflammatory bowel disease. The disease is diagnosed on the basis of clinical parameters and endoscopic-histologic evaluation. 5-aminosalicylic acid (5-ASA, mesalamine) represents the first-line treatment of choice. For patients with distal and left-sided disease the use of rectal preparations is effective. Most patients respond to 5-ASA suppositories or to topic steroids such as budesonide suppositories or hydrocortisone foam. For patients with extended disease, oral medications are mandatory. In case of low- to moderate-grade inflammation, 5-ASA preparations should be implemented. In the case of severe disease treatment with steroids is required. Following induction of remission, prophylactic treatment with 5-ASA (1.5 g/d) should be maintained. For patients with frequent or severe relapses, immunosuppressive therapy with azathioprine or 6-mercaptopurine is indicated. In case of a fulminant course of disease, treatment with intravenous cyclosporine is required in patients who have not responded to high-dose intravenous steroids. When all conservative treatment options fail, proctocolectomy with construction of an ileoanal pouch should be performed. New therapeutic strategies such as infliximab and interferons are being evaluated in clinical trials. The long-term complications of ulcerative colitis include steroid-induced osteoporosis and anemia and should be treated adequately. Finally, the risk for development of colorectal cancer increases steadily with disease duration and dysplasia should be screened for by endoscopic surveillance programs.     

Anabolic steroid use by athletes. How serious are the health hazards?

Use of anabolic steroids is widespread in the athletic community, especially among power athletes, who have used them for about 30 years. Despite educational and preventive measures, steroid use has increased. Controversy continues regarding the enhancement of athletic performance and the incidence of major side effects. Some investigators have suggested that the hazards of anabolic steroids may be overstated in the diseased population and are minimal or absent in healthy subjects. Yet, many questions are unanswered. Current data do not link life-threatening side effects with intermittent use of anabolic steroids. However, many concerns remain. Dangerous situations include use of anabolic steroids by adolescents, preadolescents, and persons with liver or heart disease and use of oral compounds in high doses for long periods. A coordinated team approach (with representatives from sports, medicine, advertising, and the pharmaceutical industry) is needed to determine the real risks of anabolic steroids to athletes who are considering their use.     

Monoclonal antibodies for the treatment of asthma

Asthma is a chronic inflammatory disease of the airways which can have a detrimental effect on quality of life and in extreme cases cause death. Although the majority of patients can control their asthma symptoms with a combination of steroids and beta agonists there is still a group of patients whose asthma remains symptomatic despite the best available treatment. These severe asthmatic patients represent the unmet medical need in asthma and are the focus of those developing novel monoclonal antibody based drugs. The complex networks of cytokines and cells involved in the pathology of asthma provide plenty of scope for intervention with monoclonal antibody based drugs which are able to block cytokine or chemokine receptor interactions, deplete cells expressing a specific receptor or block cell/cell interactions. At present anti-IgE (Xolair©) is the only monoclonal antibody based drug approved for the treatment of asthma. However, a number of other antibody based drugs have been clinically tested in asthma including anti-IL-5, anti-IL-4, anti-IL-13, anti-TNFα, anti-CCR3, anti-CCR4 and anti-OX40L. This review will examine the development of these monoclonal antibody based therapies. Since many of these therapies have targeted key pathways in asthma pathology these studies provide information on patient stratification and asthma pathology.     

Current status of drug therapy for inflammatory bowel disease

Both topical steroids and sulfasalazine are useful for patients with ulcerative proctitis and distal colitis. For patients with more extensive ulcerative colitis with moderate symptoms, prednisone and/or sulfasalazine will result in improvement in about 80% of patients. Parenteral corticosteroids or ACTH should be used in the setting of severe colitis and antibiotics added if the patient appears toxic. Sulfasalazine is of proven efficacy as maintenance therapy in ulcerative colitis. Prednisone and sulfasalazine are useful in Crohn's disease, although the latter is of limited use in patients with ileitis alone. Immunosuppressive agents such as azathioprine and 6-mercaptopurine may be especially helpful in Crohn's patients refractory to other drugs or dependent on high doses of steroids. Azathioprine is of proven usefulness as maintenance treatment of Crohn's disease. Metronidazole is as effective as sulfasalazine in Crohn's disease involving the colon and has an important role in severe perineal disease. New forms of steroid enemas and topical and oral forms of 5-aminosalicylate based on sulfasalazine should be available soon for patients with both ulcerative colitis and Crohn's disease.