溃疡性结肠炎治疗进展

<正>溃疡性结肠炎(ulcerative colitis,UC)是一种慢性非特异性直肠、结肠炎症,病变主要累及直肠、结肠黏膜和黏膜下层,病变范围多自远段结肠开始,可逆行向近段发展,甚至累及全结肠及末段回肠,呈连续性分布,常伴有肠道外疾病。本病以欧美多见,近年国内发病率有上升趋势。由于UC的病因与发病机制尚未完全阐明,治疗缺乏特异性药物。目前临床上常用的有传统的氨基水杨酸类制剂、肾上腺糖皮质激素及     

溃疡性结肠炎临床研究分析

目的对140例溃疡性结肠炎住院患者进行临床研究分析。方法对2006年1至2008年12月期间收治的140例UC患者临床资料采用统计描述方法进行回顾性分析。结果直肠33例（23．6％），直肠乙状结肠17例（12．1％），左半结肠15例（10．7％），全结肠51例（36．4％），区域性24例（17．1％）。结论临床治疗以内科治疗为主，手术率、死亡率均较低。     

溃疡性结肠炎的临床特点及治疗体会

目的总结溃疡性结肠炎（UC）的临床特点及治疗体会,提高对本病诊治的认识。方法收集住院患者30例的相关资料,总结其临床特点及治疗方案。结果30例住院病例中,男女之比为1．30：1,平均发病年龄46．3岁,高峰年龄段为31～60岁,有93．33％的患者病程小于10年。主要临床表现为腹泻、粘液血便、腹痛等,伴肠外表现者占13．33％。大肠镜检查以黏膜破损、炎症、出血为主要表现。病变范围以侵犯直肠及乙状结结肠者最多,二者合计占48。15％。病理组织检查,均有固有膜活动期非特异性炎症,部分伴有黏膜糜烂、溃疡、腺体非典型性增生及隐窝脓肿。并发穿孔1例,未发现癌变者。主要予糖皮质激素或／及SASP／5-ASA治疗。结论本组UC患者病程相对短,主要临床表现是腹泻、粘液血便、腹痛等,病变位于左半结肠为主,肠外表现者相对较多。结肠镜及活检病理组织检查是诊断UC的主要方法。并发症发生率低,无癌变者。氨基水杨酸盐及皮质类固醇仍是治疗UC的主要药物。     

溃疡性结肠炎72例临床分析

目的回顾性分析溃疡性结肠炎(UC)的临床资料,提高诊治水平。方法分析总结溃疡性结肠炎72例临床资料。结果 72例UC中,男女之比为1.48∶1,平均发病年龄(40.24±11.56)岁,高峰发病年龄30～39岁。临床表现以腹泻(80.56%)、黏液脓血便(72.22%)和腹痛(65.28%)为主,肠道外表现及并发症少见,无结肠癌变患者。病变多位于直肠、乙状结肠及左半结肠(62.5%)。血小板计数、红细胞沉降率及C反应蛋白在不同病情的UC患者中,差异有显著性。治疗以水杨酸类和类固醇激素为主。结论溃疡性结肠炎发病率逐年上升,结肠镜及病理检查,结合临床表现是及时、正确诊断的关键。血小板计数、红细胞沉降率及C反应蛋白对评价溃疡性结肠炎严重程度有意义,内科治疗疗效良好。     

河南长垣地区溃疡性结肠炎180例临床分析

目的：探讨溃疡性结肠炎（UC）的临床特点，指导诊治。方法对确诊为UC的长垣及其周边封丘、滑县等地的患者临床资料进行回顾性研究。结果 UC患者以黏液脓血便、腹痛、腹泻为主要临床表现，其中黏液或黏液脓血便发生率最高87.2%。病情以轻、中度多见（85.6%）。病变部位以直肠、乙状结肠及左半结肠为主。结肠镜下黏膜充血、糜烂、溃疡。治疗药物为5-氨基水杨酸联合益生菌及5-氨基水杨酸＋糖皮质激素＋锡类散灌肠治疗，临床症状明显缓解。结论河南省长垣地区UC患者以中青年为主，轻、中度病情居多，并发症多为结肠息肉，肠外表现少。病变部位以直肠、乙状结肠、左半结肠多见。5-氨基水杨酸联合糖皮质激素、锡类散局部灌肠效果好。确诊根据临床表现、结肠镜及病理检查。结肠镜检查对病变部位、范围，疾病严重程度及治疗方案选择具有重要作用。     

溃疡性结肠炎44例临床分析

溃疡性结肠炎（UC）是炎症性肠病的一种，是一种病因不明的直肠和结肠慢性炎症性疾病，近年来发病有上升趋势。本文共收集了我院近１０年来治疗的４４例UC，对此进行临床分析。一、临床资料１．一般资料全部资料来自我院消化科１９９９～２０００年诊治的UC共４４例，根据１９９３年在太原召开的全国慢性非感染性肠道疾病学术研讨会制定的溃疡性结肠炎诊断及治疗标准为基础进行诊断犤１犦。其中男２３例（５２．３％），女２１例（４７．７％），年龄１８～７０岁，平均３９．６岁，小于２０岁者发病率最低，只有１例（２．３％）；２０…     

24例外科治疗溃疡性结肠炎的临床分析

炎症性肠病（inflammatoryboweldisease，IBD）包括溃疡性结肠炎（ulcerativecolitis，UC）和克罗恩病，其中UC是病因不十分明确的直肠与结肠的慢性非特异性炎症性疾病。UC一般进行内科治疗，但据国内报道，约有20％~30％的患者，由于内科治疗无效或者出现并发症，需要进行手术治疗。本文回顾了2003年8月至2010年12月在浙江大学医学院附属第一医院因溃疡性结肠炎接受手术治疗的24倒患者，针对患者的一般情况、临床表现、内科治疗情况、手术原因、手术方式及预后等资料进行分析，并随访上述患者的病情演变及现状。在上述24例患者中，14例因内科治疗效果不佳而手术，8例因并发症而手术，1例因激素不耐受而手术，另外1例因伴结肠多发息肉而手术。其中切除部分结肠手术2例；全结肠直肠切除术＋回肠造口术15例；行IPAA＋保护性回肠造口术3例；3例行全结肠切除、回肠贮袋、肛管吻合术（IPAA）；1例行横结肠切除、近端追瘘、远端封闭术（Hartmann）。最终有18例患者接受随访，病情均平穗，生活质量也明显提高。     

慢性溃疡性结肠炎的中西医治疗

溃疡性结肠炎（UC）属于炎症性肠病,是一种原因不明的慢性结肠炎,病变主要在结肠黏膜层,且以溃疡为主,多累及直肠和远端结肠,但可向近端扩展,以及遍及整个结肠。     

中西医结合治疗溃疡性结肠炎40例疗效观察

溃疡性结肠炎（UC）又称慢性非特异性溃疡性结肠炎,系原因不明的大肠黏膜慢性炎症和溃疡病变,主要累及直肠、乙状直肠黏膜,临床表现以腹泻、腹痛、黏液及脓血便为主,少数患者可有便秘,病情易反复发作。     

溃疡性结肠炎的药物治疗

溃疡性结肠炎(Ulcerative colitis，UC)是一种原因不明的慢性结肠炎，属于非特异性的炎症性肠病(IBD)。病变主要限于结肠粘膜与粘膜下层，表现为炎症或溃疡，多累及直肠和远端结肠。也可向近端发展，遍及整个结肠，极少数患者末端回肠受累，临床上往往反复发作迁延数月、数年乃至数十年。药物治疗仍然是治疗溃疡性结肠炎的主要方     

电子结肠镜结合病理检查对大肠溃疡病因诊断的价值

目的探讨不同病因所致大肠溃疡的特征和诊断方法,以期提高对相应疾病的认识。方法回顾性分析肇庆市第一人民医院186例大肠溃疡患者的临床特点、电子结肠镜检查和活检病理资料。结果大肠溃疡的病因以溃疡性结肠炎(UC)、克罗恩病(CD)、感染性肠炎、肠结核、缺血性结肠炎、大肠孤立性溃疡、内痔/息肉术后、恶性淋巴瘤等常见。临床诊断的敏感性为33.3%,病理诊断为46.2%,内镜诊断为61.3%,电子结肠镜检查结合病理诊断为73.1%。电子结肠镜下UC多为弥漫分布的不规则浅小溃疡;肠结核多为环形溃疡;CD多有铺路石样改变;缺血性结肠炎病变与正常肠段界限明显。多数UC患者可见隐窝脓肿;异型淋巴细胞见于恶性淋巴瘤,经免疫酶标检查可证实;干酪样肉芽肿和抗酸染色阳性对肠结核有确诊意义,肠结核和CD中均可见非干酪样肉芽肿。结论大肠溃疡病因复杂多样,电子结肠镜结合病理检查对大肠溃疡的病因诊断有重要价值,可明显提高其诊断敏感性。     

Natural history of ulcerative colitis: current knowledge

The clinical presentation at the time of diagnosis and the disease course of ulcerative colitis (UC) are heterogeneous and variable over time. In population-based epidemiological follow-up studies from the last decades, the extent of UC has shown only slight variation. At diagnosis, the initial extent is evenly distributed among proctitis, left-sided, and extensive colitis with some exceptions. The disease course may vary from a single attack to chronic symptoms that reduce the quality of life as well as lead to disease extension, colectomy or even to the development of colitis-associated colorectal cancer in some cases. Important predictive clinical factors and biomarkers of disease course have been under increasing scrutiny. Those identified may eventually lead to a more personalized, tailored therapy. In this review article, the authors summarize the available evidence on the natural history and predictive markers for evaluating the course of UC.     

Surgical approach to ulcerative colitis: when is the best timing after medical treatment?

Ulcerative colitis (UC) is a chronic inflammatory condition of the mucosa affecting the rectum and extending up the colon in a continuous manner. Its etiology is unknown, but is most probably the result of the interaction of genetic and environmental factors. Approximately 30% of UC patients will need to undergo surgery at some point during their lifetime, despite progresses made in medical therapies. Indications for surgery include acute severe colitis with its complications, steroid-or antiTNF-refractory colitis (or growth impairment in children), and the onset of colorectal dysplasia/cancer. Recently, the introduction of biologic agents has provided a rationale for prolonging medical therapy before considering surgery in the treatment of active, moderate to severe colitis. When surgery becomes indicated, especially in the urgent setting, it usually involves dealing with immunosuppressive medications, possibly impacting the onset of post-operative septic complications. In both acute and chronic settings, patients should be informed about the medical and surgical options and their respective prognoses; the crucial decision regarding the timing for surgery should be shared by both gastroenterologists and colorectal surgeons. The aim of the present review is to highlight surgical indications and options for UC patients as well as the evidence about surgical complications following medical therapies, in order to aid clinicians in determining the best timing for surgery.     

Long-term aminosalicylate therapy is under-used in patients with ulcerative colitis: a cross-sectional survey

BACKGROUND: There is evidence from case-control studies that aminosalicylate drugs can reduce colorectal cancer risk by 75-81% in patients with ulcerative colitis. Patients may fail to comply with long-term therapies, however, or may have been advised to discontinue treatment once in remission. AIM: To describe the usage of long-term aminosalicylate therapy in patients with ulcerative colitis. METHODS: A cross-sectional study was performed using data extracted from general practitioner clinical records on demographic features, extent and duration of disease, use of aminosalicylate therapy and specialist care. RESULTS: Three hundred and sixty-three people had ulcerative colitis and no history of colorectal surgery. Ninety-five of 175 (54%) patients with proctitis, 78 of 123 (63%) patients with left-sided colitis and 28 of 45 (62%) patients with extensive colitis were currently taking an aminosalicylate drug. Those doing so were more likely to be under specialist care than to be definitely or possibly discharged (odds ratio, 4.9; 95% confidence interval, 2.9-8.4). The likelihood of current aminosalicylate therapy was not related to gender or the extent of disease, but was negatively related to the duration of disease. CONCLUSIONS: A substantial minority of patients with ulcerative colitis does not take long-term aminosalicylate therapy. Those who do are more likely to be under specialist care, to be older or to have disease of shorter duration.     

溃疡性结肠炎患者中血小板计数与一氧化氮的相关性及其临床意义

目的探讨活动性溃疡性结肠炎（UC）中血小板计数和一氧化氮（NO）的关系。方法选取溃疡性结肠炎病例173例,根据Truelove评分分为轻、中、重度,正常对照组40例,统计检测各组的血小板计数和一氧化氮水平。结果活动性UC患者血清一氧化氮水平及血小板计数明显增高,并与病情的轻重有关（P〈0.05）。血小板计数、一氧化氮分别与溃疡性结肠炎的严重程度分级有关,并且二者呈正相关。结论抑制NO在治疗活动性溃疡性结肠炎方面具有重要临床意义。     

Ulcerative proctitis: an update on the pharmacotherapy and management

Introduction: Ulcerative colitis (UC) presents as proctitis in approximately a quarter of the patients. It may progress into left-sided or extensive colitis in up to 50% of cases upon long-term follow-up.

Areas covered: Currently available data on ulcerative proctitis are summarized and critically reviewed. Extensive literature search (MEDLINE) was performed to identify relevant articles up to March 2014.

Expert opinion: The short-term goal of the treatment in UC is to induce remission, whereas long-term goals are to maintain remission and prevent disease progression. Topically administered 5-aminosalicylates (5-ASA) and corticosteroids are effective in the treatment of proctitis, although they seem to be underused in everyday practice. Locally administered 5-ASA preparations are more effective than oral compounds. The combination of topical and oral 5-ASA and steroids should be considered for escalation of treatment. Refractory patients should be re-evaluated to exclude for compliance failures, infections or proximal disease extent. True refractory or steroid-dependent patients may require immunomodulators or biological therapy. Alternative medicine can be used complementarily, while experimental approaches are reserved for patients failing conventional medication. Proctocolectomy may be the last resort of treatment. Upon long-term, 5-ASA maintenance treatment is indicated in all UC cases to prevent relapse and disease progression.     

结肠镜检查对下消化道出血的病因分析

目的 探讨不同年龄阶段下消化道出血的病因及发病特点.方法 对2008年5月-2010年12月我院收治的下消化道出血168例患者的结肠镜检查结果进行回顾性分析.结果 下消化道出血排名前5位的病因依次为:结直肠炎(46例,27.38％)、肛周疾病(32例,19.05％)、大肠癌(30例,17.86％)、息肉(27例,16.07％)和炎症性肠病(29例,17.26％).老年组大肠癌的发病率高于其余两组(P＜ 0.01,P＜0.05),中青年组结直肠炎发病率高于其他两组(P＜0.05).男性大肠癌、息肉、肛周疾病的发病率均高于女性,差异有显著性(尸＜ 0.05).结论 下消化道出血的发病与年龄、性别相关,结直肠炎、肛周疾病、大肠癌、息肉和炎症性肠病为其主要病因.     

2型糖尿病与结直肠癌的相关性及合并2型糖尿病的结直肠癌的特点

目的 探讨2型糖尿病与结直肠癌的相关性,分析合并2型糖尿病的结直肠癌的特点.方法收集结直肠癌患者844例（结直肠癌组）和非肿瘤患者1 275例（对照组）的临床资料,应用Logistics回归模型分析2型糖尿病与结直肠癌是否存在相关性.根据是否合并2型糖尿病,将结直肠癌患者分为结直肠癌合并2型糖尿病组及结直肠癌未合并2型糖尿病组,比较2组患者的性别比、年龄分布、组织学类型Dukes期及病灶分布.结果 Logistic回归模型分析显示结直肠癌合并2型糖尿病组患者的患病风险是结直肠癌未合并2型糖尿病组的3.572倍,P=0.000.结直肠癌合并2型糖尿病组患者年龄≥60岁者153例（62.4%）,40~59岁者82例（33.5%）,＜40岁者10例（4.1%）;结直肠癌未合并2型糖尿病组患者年龄≥60岁者322例（53.8%）,40~59岁者208例（34.7%）,＜40岁者69例（11.5%）.结直肠癌合并2型糖尿病组患者年龄≥60岁者比例高于结直肠癌未合并2型糖尿病组,＜40岁者比例较低,2组比较差异均有统计学意义（均P＜0.05）.结直肠癌合并2型糖尿病组病灶分布在直肠151例（61.6%）,结肠94例（38.4%）,结直肠癌未合并2型糖尿病组病灶分布在直肠323例（53.9%）,结肠276例（46.1%）,2组间差异有统计学意义（均P＜0.05）.结直肠癌合并2型糖尿病组患者Dukes＆#39; A期17例（6.9%）,B期76例（31.1%）,C＋D期152例（62.0%）;结直肠癌未合并2型糖尿病组患者分别为64例（10.7%）、221例（36.9%）、314例（52.4%）;结直肠癌合并2型糖尿病组患者处于Dukes＆#39; C＋D期比例高于结直肠癌未合并2型糖尿病组患者,差异有统计学意义（P=0.011）.结论 2型糖尿病是结直肠癌的危险因素,合并2型糖尿病的结直肠癌主要发生于≥60岁的患者,病变主要分布在直肠,预后较差.     

溃疡性结肠炎208例诊治分析

目的回顾性调查近5年郑州大学第一附属医院溃疡性结肠炎（UC）患者的发病状况及5-ASA制剂的疗效。方法调查2005年1月至2010年3月208例住院UC患者。观察UC发病率、年龄、性别、职业、临床表现、结肠镜和组织病理学检查、治疗药物及疗效进行分析。结果 UC住院患者近5年发病率呈上升趋势;平均年龄为（45.25±16.30）岁,发病高峰在40~49岁;男女比例：1.29∶1;临床表现以腹泻（92%）、血便（86%）、黏液便（71%）、腹痛（70%）表现为主;病变范围：以全结肠炎（45%）为主;病程以1~5年为主;住院患者接受结肠镜检查占80.2%,缓解期进行结肠镜检查占11.7%;使用5-ASA制剂治疗占93.5%;急性期平均服药时间（4.06±1.43）周;急性期服用5-ASA剂量以2~3g为主,占69.9%;缓解期服药时间与维持缓解时间呈正相关;缓解期服用5-ASA剂量：以大于2g为主,占69.2%;服药依从性与维持缓解呈正相关;6个月内复发者占51.48%。结论近5年住院UC患者呈上升趋势,5-ASA是维持治疗的有效药物,其有效剂量应大于2g/d,缓解期与维持治疗时间呈正相关,应大于6m。良好的服药依从性能明显延长缓解期,减少复发。     

Review article: colorectal carcinoma and inflammatory bowel disease

The risk of colorectal cancer for any patient with ulcerative colitis is estimated to be 2% after 10 years, 8% after 20 years and 18% after 30 years of disease. The relative risk of colorectal cancer in Crohn's colitis is approximately 5.6 and should raise the same concerns as in ulcerative colitis. Risk factors for colorectal cancer include disease duration, early onset, extensive disease, primary sclerosing cholangitis and a family history of sporadic colorectal cancer. All patients should have a review colonoscopy 8-10 years after diagnosis to establish the extent of the disease. Surveillance should begin 8-10 years after disease onset for pancolitis and 15-20 years after disease onset for left-sided disease. Regular surveillance is recommended, with a screening interval every 3 years in the second decade of disease and annually by the fourth decade. Random biopsies should be taken at regular intervals with attention paid to dysplasia-associated lesions or masses, irregular plaques, villiform elevations, ulcers and strictures. Dysplasia is recognized as a premalignant condition, but the likelihood of progression to cancer is difficult to predict. High-grade dysplasia, confirmed by two expert gastrointestinal pathologists, is a strong indication for colectomy, as is low-grade dysplasia, although the diagnosis of low-grade dysplasia is unreliable. Surveillance programmes indicate that the overall 5-year survival rate is higher in surveyed patients, although patients still present with Dukes C cancers or disseminated malignancy. Surveillance has huge socioeconomic implications. As surveillance is not 100% effective, alternative ways of reducing the cancer risk with chemopreventive agents, such as aminosalicylates, are being considered.