Increased levels of homocysteine in patients with ulcerative colitis

AIM: To investigate serum levels of homocysteine (Hcys) and the risk that altered levels carry for thrombosis development in ulcerative colitis (UC) patients. METHODS: 55 UC patients and 45 healthy adults were included. Hcys, vitamin B12 and folic acid levels were measured in both groups. Clinical history and thrombo- embolic events were investigated. RESULTS: The average Hcys level in the UC patients was 13.3 ± 1.93 μmmol/L (range 4.60-87) and was higher than the average Hcys level of the control group whi...     

Red blood cell folate is associated with the development of dysplasia and cancer in ulcerative colitis

Patients with extensive ulcerative colitis have a high risk of developing colon cancer. The etiology of mucosal dysplasia, a premalignant lesion that is used as a screening test in surveillance programs, is unknown. Previously, a case-control study [Lashner et al. (1989) Gastroenterology 97:255–259] suggested that folate supplementation was associated with a 62% reduction in the risk of developing dysplasia or cancer. The current case-control study was performed to obtain a better definition of this risk.All 67 patients with chronic ulcerative pancolitis having surveillance colonoscopy during a 1-year period were entered. There were 6 cases (4 with dysplasia and 2 with cancer) and 61 controls (no cancer or dysplasia). Red blood cell folate, reflecting intermediate-term stores, was a mean of 66.2 ng/ml lower in cases compared to controls. Serum folate, reflecting short-term stores, was not different between groups. Adjusting for confounding effects of age, sex, race, disease duration, and folate supplementation, the risk of dysplasia or cancer was significantly decreased by 18% for each 10 ng/ml increase in red blood cell folate (odds ratio 0.82, 95% confidence interval 0.68–0.99). Vitamins A, D, and E and carotene were lower in cases than in controls, but no water-soluble vitamin other than red blood cell folate was associated with an increased cancer risk. Depressed red blood cell folate is associated with an increased risk of dysplasia and cancer in patients with ulcerative colitis and may be a risk factor for neoplastic transformation.Research supported by the Washington Square Health Foundation, the University of Chicago Clinical Nutrition Research Unit, and the Gastrointestinal Research Foundation Junior Board     

血浆同型半胱氨酸及其代谢酶基因多态性与溃疡性结肠炎的相关性研究

目的 探讨血浆同型半胱氨酸(Hcy)、叶酸和维生素B12水平及Hcy代谢酶基因多态性与溃疡性结肠炎(UC)的关系.方法 收集310例UC患者和936名正常对照者,采用聚合酶链反应-限制性片断长度多态性(PCR-RELP)法检测亚甲基四氢叶酸还原酶(MTHFR)C677T、A1298C、甲硫氨酸合成酶(MTR) A2756G和甲硫氨酸合成还原酶(MTRR) A66G基因多态性;并从中随机选取88例UC患者和100名正常对照者,采用循环酶法检测血浆Hcy水平,微粒子免疫化学发光法检测叶酸和维生素B12浓度.结果 UC患者MTHFR A1298C、MTR A2756G和MTRRA66G突变的等位基因及基因型频率均明显增高(P值均<0.01).UC患者Hcy平均水平为(21.73±6.59)mmol/L,较正常对照组显著增高[(12.47±5.01)mmol/L,P<0.01],而叶酸和维生素B12平均水平分别为(11.25±6.19)nmol/L和(322.81±128.47)pmol/L,明显较正常对照组降低[(15.28±7.72)nmol/L和(422.59±129.36)pmol/L,P值均<0.01].Logistic回归分析提示血浆Hcy、叶酸和维生素B12浓度是UC的独立危险因素(P值均<0.01).结论 Hcy代谢酶基因多态性及血浆Hcy、叶酸和维生素B12水平异常与UC明显相关,为临床采用叶酸、维生素B12补充疗法治疗UC提供了理论依据.     

Reticulated platelet levels in patients with ulcerative colitis

Background and aims In this study, we investigated whether reticulated platelets (RP) would be useful markers in the evaluation of ulcerative colitis (UC) activity and also aimed to gain indirect information about the platelet kinetics. Materials and methods Complete blood count, C-reactive protein, erythrocyte sedimentation rate, and proportion of RP were measured in 16 active, 21 inactive UC patients, and 20 healthy blood donors. UC activity was assessed by Truelove–Witts criteria. Results Mean platelet count was increased in patients with active compared to inactive UC (p = 0.008) or healthy donors (p = 0.000). Mean platelet volume (MPV) was significantly decreased in patients with active compared to inactive (p = 0.015) and healthy donors (p = 0.001). RP values was significantly decreased in active and inactive UC groups compared to healthy donors (p = 0.000, p = 0.000, respectively), while there was no significant difference between active and inactive UC patients (p = 0.980). Significant negative correlation between platelet count and MPV in patients with active UC (r = −0.542, p = 0.030) was observed. Conclusions RP values is reduced in active and inactive UC patients compared to healthy donors. To our knowledge, this is the first study about proportion of RP with UC in literature. However, the role of low RP values have not been determined clinically. Further studies are needed to evaluate the role of platelet abnormalities and changes in megakaryopoiesis caused by inflammatory state on low MPV and RP values during the course of UC.     

A rare extraintestinal manifestation of ulcerative colitis: Tracheobronchitis associated with ulcerative colitis

We describe a 44 year-old woman who presented with dyspnea and cough 5 years after initial diagnosis of ulcerative colitis. The evaluation of patient showed findings of large airway inflammation with tracheal wall thickening and mucosal irregularities. The etiology was investigated and was diagnosed as tracheobronchitis that is a rare extraintestinal manifestation of ulcerative colitis. She was treated with systemic corticostreoids and rapid clinical improvement was detected.     

血清同型半胱氨酸、叶酸和维生素B_(12)浓度检测在非酒精性脂肪性肝病患者中的临床应用

目的:探讨血清同型半胱氨酸(Hcy)、叶酸和维生素B12浓度检测在非酒精脂肪性肝病(NAFLD)患者诊断中的临床意义。方法:根据CT检查结果将符合临床诊断标准的123例NAFLD患者分为轻度、中-重度脂肪肝组,以同期体检健康者139名作为对照组,测定血清Hcy、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、叶酸和维生素B12浓度,并进行Hcy与叶酸、维生素B12浓度的相关性分析。结果:中-重度NAFLD患者的Hcy、ALT、AST、TC、TG均明显高于轻度NAFLD组和健康对照组,HDL、维生素B12水平明显低于轻度NAFLD组和健康对照组(P<0.05)。轻度NAFLD组ALT、Hcy明显高于健康对照组,HDL明显低于健康对照组(P<0.05),并且血清Hcy与叶酸、维生素B12呈直线负相关。结论:NAFLD患者Hcy水平随着肝脏脂肪变性的加重而升高,高Hcy血症可能是NAFLD一个新的危险因素,提示Hcy在NAFLD发病中起一定作用。并且叶酸、维生素B12水平与Hcy水平具有相关性。     

缺血性结肠炎与溃疡性结肠炎的对比分析

目的:研究缺血性结肠炎(ischemic colitis,IC)与溃疡性结肠炎(ulcerative colitis,UC)临床及组织病理学的差异,有助两者的鉴别诊断,利于临床治疗.方法:收集20例IC和30例UC患者,对其临床及组织病理学等资料进行对比分析.结果:IC组发病时间[(5±7)d]明显较UC组发病时间[(953±1354)d]短.IC组中65%的患者伴有高血压、冠状动脉性心脏病、心房颤动、房性早搏、腹部手术史等疾病史中的一项或几项,明显高于UC组的20%;IC组以急性发病、腹痛(85%)、血便(60%)及腹泻(50%)多见,而UC且以腹痛(83%)、腹泻(63%)、黏液脓血便(57%)及里急后重(20%)为主要临床表现;在内镜表现方面,IC多以沿肠系膜侧分布的纵形溃疡为主(60%),且病变多仅累及肠腔的1/4～1/2周(80%),呈节段性分布(60%),与邻近正常黏膜分界清楚(75%),而UC则以弥漫性地图状溃疡为主(43%),病变多累及肠腔全周(90%),炎性息肉明显多见(37%).在组织病理学方面,血管扩张充血(90%)、间质严重水肿(95%)在IC中多见,血管壁增厚(50%)是其特征性表现,隐窝脓肿(47%)则在UC中多见.两组以上差异均有统计学意义(P<0.05).结论:组织病理学特点、肠镜下表现以及患者临床特征的差异,为IC和UC的鉴别提供了有力依据.     

Paraoxonase-1 and arylesterase levels in patients with ulcerative colitis

Background and study aims

The role of oxidative stress in inflammatory bowel disease is increasingly recognised as an important factor. It is assumed that reduced levels of paraoxonase-1 (PON-1) and arylesterase (ARE) may lead to increased inflammation due to increased oxidative stress. This study aimed to investigate the relationship between ARE and PON-1 levels in ulcerative colitis (UC) patients and the difference in these levels in UC patients in comparison to the control group.

饮食与溃疡性结肠炎

饮食因素被认为是溃疡性结肠炎发病的危险因素.研究表明,过多摄入红肉,高脂肪和高蛋白饮食与本病的发病和复发有关联.另一方面,补充益生菌、鱼油和饮食纤维具有较好疗效.本文综述饮食因素在溃疡性结肠炎发病和治疗中作用的研究进展.     

Budd-Chiari syndrome in a patient with ulcerative colitis and no inherited coagulopathy

We report a case of 27 year old female patient who was admitted to the hospital with an acute flare up of ulcerative colitis.The patient presented with complaints of persistent abdominal pain and bloody diarrhea despite aggressive therapy for her ulcerative colitis.A CT scan of the abdomen on admission revealed hepatic vein thrombosis,suggesting a diagnosis of Budd-Chiari syndrome.Significantly,an associated thrombosis of the inferior mesenteric vein was also detected.Based on imaging data and clinical assessment,the patient was started on anticoagulation therapy and an extensive work-up for hypercoagulability was initiated.Up to the time of publication,no significant findings suggesting this patient has an underlying coagulation disorder have been found.Based on our search of PUBMED,this report is one of only five reported adult cases of Budd-Chiari Syndrome associated with ulcerative colitis in the English literature in living patients without evidence of a co-existing coagulation disorder.This case highlights the potential for thrombosis at unusual sites in ulcerative colitis patients even in the absence of classical coagulation abnormalities.In addition to the case presented,we provide a brief review of previously reported cases of Budd-Chiari Syndrome occurring in patients with inflammatory bowel disease.     

非酒精性脂肪肝患者同型半胱氨酸浓度及叶酸与维生素B12浓度变化及相关性

目的:探讨非酒精性脂肪性肝病(NAFLD)患者同型半胱氨酸浓度、叶酸与维生素B_(12)浓度变化及其关系.方法:对199例健康体检人群行B超检查,其中NAFLD 67例,正常对照组132例,分别检测血浆Hcy、叶酸与维生素B_(12)浓度并进行相关性分析.结果:NAFLD患者血Hcy水平高于正常对照组(18.64±11.2μmol/L vs 12.49±6.4μmol/L,P<0.01),并且Hcy与叶酸、维生素B_(12)呈直线负相关(r=-0.381,P<0.01;r=-0.561,P<0.001)结论:NAFLD患者血Hcy增高,高Hcy血症可能是NAFLD一个新的危险因素.     

溃疡性结肠炎免疫学发病机制进展

溃疡性结肠炎（UC）是一种肠道慢性非特异性炎症，病变主要位于结肠的黏膜和黏膜下层，多累及直肠和远端结肠。临床表现为腹泻、腹痛和黏液脓血便，并伴有一些肠外表现，如脱髓鞘疾病、多发性硬化症、视神经炎，骨质疏松嵋。等。UC病因不明，通常认为是环境、遗传及免疫等因素共同作用所致。我国本病发病率较低，但近年来本病也逐年呈上升趋势。在UC研究领域中，对免疫因素进展研究较快，本文就近年来免疫方面进展概述如下：     

TLRs在溃疡性结肠炎小鼠结肠中的表达研究

目的 观察溃疡性结肠炎（UC）小鼠模型结肠组织中TLR2、TLR4和TLR9的表达情况,为UC发病机制的研究提供新思路.方法 将6～8周龄健康雄性BALB/c小鼠随机分为两组：正常对照组（n=10）和UC模型组（n=10）,正常对照组小鼠蒸馏水自由饮用7d.UC模型组小鼠5％ DSS溶液自由饮用7d造模.7d后处死小鼠,采用实时荧光定量PCR方法检测各组小鼠结肠黏膜组织中TLR2、TLR4和TLR9 mRNA的表达情况.结果 正常对照组结肠组织中无TLR2、TLR4和TLR9 mRNA的表达,而UC组结肠组织中TLR2、TLR4和TLR9 mRNA表达明显,两组比较差异有统计学意义（P＜0.05）.结论 TLR2、TLR4、TLR9可能参与了UC的发病过程.     

B1a lymphocytes in ulcerative colitis

Background and aims B1a lymphocytes (CD5+) are the major contributors of natural antibodies (Ab) implicated in the initial protection against several infections. The aim of this study was to assess the expression of these cells in the peripheral blood of ulcerative colitis (UC) patients who underwent restorative proctocolectomy (RPC) and others who were not operated on. Materials and methods The blood concentration of CD5+ B cells was analysed by three-colour flow cytometry. Blood was collected from 38 UC patients, 20 of whom had undergone RPC and compared with the results in 18 healthy controls and in 12 familial adenomatous polyposis (FAP) patients who had undergone RPC. We were interested in evaluating if there was any correlation between B1a blood cell concentration and ESR and CRP levels, clinical, endoscopic and histological activity, perinuclear anti-neutrophil cytoplasmic antibody (pANCA) and extra-intestinal symptoms. Results B1a cell blood concentration was reduced in non-operated UC patients (20.7 ± 4.6/μl) with respect to that in healthy controls (71.1 ± 18.0/μl, p < 0.05). It was also lower in UC patients with RPC (24.9 ± 1.0/μl) compared to RPC for FAP (48.2 ± 6.2, p < 0.05). B1a cell rate correlated inversely in UC patients with ESR (R = −0.41, p < 0.05) and CRP levels (R = −0.47, p = 0.01). Conclusion B1a cell concentration was reduced in the blood of patients with UC even after the diseased organ was surgically removed by proctocolectomy. As these cells play an important role in natural immunity against luminal stimuli, consistently lower levels that are found in UC patients could be responsible for the impaired immunologic response to gut antigens in this disease.     

非酒精性脂肪肝患者血浆同型半胱氨酸水平测定及临床意义

目的 探讨非酒精性脂肪性肝病(NAFLD)患者空腹血清同型半胱氨酸(Hcy) 浓度变化的临床意义,同时探讨在NAFLD中Hcy浓度与叶酸及维生素B12浓度变化的相关性.方法 对352例健康体检人群行B超检查,其中NAFLD组159例,正常对照组193例,分别检测血浆Hcy、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移...     

叶酸、维生素B6、维生素B12对大鼠同型半胱氨酸水平及动脉损伤的影响

目的 :观察补充叶酸、维生素 B6 和维生素 B1 2 对高蛋氨酸 (Met)喂饲所引起高同型半胱氨酸 (Hcy)血症及动脉损伤的影响。　　方法 :Wistar大鼠 30只随机分成 3组 :对照组、高 Met组和给药组 ,每组 10只 ,分别喂以普通鼠饲料、普通鼠饲料添加 1% Met、普通饲料添加 1% Met同时每只鼠每天添加叶酸 0 .5 mg、维生素 B6 2 .5 mg和维生素 B1 2 5 0 μg,喂养 3个月。测定血浆总 Hcy(t Hcy)浓度、血清叶酸浓度及红细胞超氧化物歧化酶 (SOD)和谷胱甘肽过氧化物酶 (GPX)活力。光镜、电镜检测主动脉组织学改变。　　结果 :实验前 ,血浆 t Hcy、血清叶酸浓度 3组间无明显差异。实验后 ,给药组血清叶酸浓度明显高于实验前和高 Met组及对照组 (P<0 .0 1) ,血浆 t Hcy断食 2 h和 7h均低于高 Met组 (P<0 .0 1) ,且断食 7h降至对照组水平 (P>0 .0 5 ) ,但断食 2 h仍高于对照组。实验后红细胞 SOD活力高 Met组明显升高 ,给药组较高 Met组明显减低 ,与对照组无明显差异。红细胞 GPX活力 3组间无差异。组织学检测发现给药组主动脉损伤程度明显轻于高 Met组。　　结论 :补充叶酸、维生素 B6 和维生素 B1 2 可降低高 Met摄入所致高 Hcy血症 ,削弱后者引起的过氧化应激 ,减轻动脉损伤程度     

What sequence of pathogenetic events leads to acute ulcerative colitis?

The etiology of ulcerative colitis remains unresolved despite new immunologic, biochemical, and microbiologic observations made in this disease. A sequence of pathogenetic events has been adduced from abnormalities reported from human and experimental colitis with the express purpose of establishing priority of factors that may lead to an attack of acute ulcerative colitis. The presence of undefined bacterial metabolites in the colonic lumen causing specific breadown of fatty acid oxidation in colonic epithelial cells is proposed to be the initiating event of the disease process that leads to an immune response and eicosanoid response perpetuating epithelial cell damage. The proposals embody the thesis that primary metabolic damage to colonocytes determines the clinical and pathologic manifestations of ulcerative colitis.     

溃疡性结肠炎患者白细胞介素-6活性研究

目的探讨白细胞介素-6(IL-6)在溃疡性结肠炎(UC)中的表达水平.方法以外周血单核细胞(PBMC)体外培养诱生IL-6.以B9细胞与培养液共育,测定IL-6水平,将健康人(HC)与UC患者进行比较研究,其中HC组20例,UC组25例(静止期与轻、中、重组,例数分别为5、10、6、4例).结果UC组与对照组IL-6活性分别为(261.48±82.01)U/ml和(100.00±57.65)U/ml,两者差异有非常显著性(P＜0.001).UC组静止期与轻、中、重三组比较IL-6活性依次为(121.06±43.00)U/ml、(240.23±61.60)U/ml、(275.83±78.40)U/ml及(315.00±142.92)U/ml,P值分别小于0.02、0.02及0.1.而静止期与对照组相比差异无显著性(P＞0.05).按病变累及范围,全结肠组与左半结肠组IL-6活性分别为(312.33±107.34)U/ml和(244.88±69.97)U/ml,两组间差异无显著性(P＞0.05).结论UC活动期患者IL-6活性明显高于对照与静止期患者,且随病情加重呈上升趋势.IL-6活性与病变累及范围无关.``     

白细胞介素在溃疡性结肠炎中的作用

溃疡性结肠炎(ulcerative colitis,UC)是一种以慢性肠道炎症为特征的炎症性肠病。UC的发病机制还未完全明确,其发生与免疫、遗传、环境及感染因素有关,细胞因子在UC等炎症性肠病中起到重要作用。白细胞介素(interleukin,IL)是细胞因子中最主要的具有多种生物活性的一组淋巴因子,并在免疫细胞的发育、分化、免疫应答等过程中有重要调节作用。目前研究发现很多IL在UC的发病中起重要作用。本文对在UC中起重要作用的IL作一概述。     

Adhesion molecules in chronic ulcerative colitis

Background and aims The adhesion molecule expression in colonic mucosa is pivotal for transition from quiescent to active stage of ulcerative colitis (UC). The aim of the present study is to reveal the adhesion molecule profile of colonic mucosa in the active stage of UC and in remission. Materials and methods Biopsy specimens obtained from 14 patients with UC (seven with active disease and seven with UC in remission) and from seven controls were used. Immunohistochemistry was performed with antibodies against ICAM-1, VCAM-1, E-selectin, LFA-1, Mac-1, and VLA-4. Results In controls, slight ICAM-1 positivity was observed on thety endothelium of blood vessels of the mucosal and submucosal layer and only single ICAM-1-, Mac-1-, and LFA-1-positive cells were found. In all patients with UC, the endothelium of venules in the edematous mucosal and submucosal layers was ICAM-1-, VCAM-1-, and E-selectin-positive. Numerous ICAM-1- and LFA-1-positive and less VCAM-1-, Mac-1-, and VLA-4-positive inflammatory cells were detected in mucous layers of acute UC. In specimens of UC in remission, the inflammatory cells positive for the studied adhesion molecules were significantly less in number in the mucosa and submucosa (p < 0.05). Conclusions Based on the increased expression of ICAM-1, VCAM-1, and their ligands LFA-1 and VLA-4 in patients with UC, we can conclude that these adhesion molecules play a key role in the adherence of lymphocytes and macrophages to endothelial cells maintaining the chronic inflammation. Presence of E-selectin on endothelial cells of venules could be a sign of relapse after remission in UC.