粪钙卫蛋白在炎症性肠病、肠易激综合征和大肠癌鉴别诊断中的意义

目的探讨粪便钙卫蛋白在炎症性肠病(IBD)、肠易激综合征(IBS)和大肠癌(CRC)这3种消化道常见疾病鉴别诊断中的意义。方法 IBD患者30例,IBS患者20例,CRC患者30例,健康对照组20例。在结肠镜检查前1d,留取粪便标本约5g,采用ELISA方法定量检测粪便钙卫蛋白浓度。结果 IBD、IBS、CRC、健康对照组的粪钙卫蛋白浓度的中位数分别为1084.07μg/g粪便,24.45μg/g粪便,141.85μg/g粪便,21.89μg/g粪便。IBS组粪便钙卫蛋白浓度与对照组比较差异无统计学意义(P=0.13>0.05);IBD组粪便钙卫蛋白水平高于CRC患者、IBS组和健康对照组(P<0.05);CRC组粪便钙卫蛋白水平高于IBS组和健康对照组(P<0.05)。结论粪便钙卫蛋白检测作为一种非侵入性筛选试验,可为临床鉴别诊断IBD、IBS和CRC提供一种新指标。     

炎症性肠病相关骨质疏松研究进展

骨质疏松症是炎症性肠病(Inflammatory bowel disease,IBD)患者严重却又易被忽视的并发症之一,其发病机制至今仍未阐明,且鲜有IBD患者得到合适的抗骨质疏松治疗,本文就此内容作一综述.     

炎症性肠病的血液学表现

炎症性肠病(inflammatory bowel disease,IBD)是一类不明原因的慢性非特异性肠道炎症性疾病,主要包括溃疡性结肠炎(u|eemtive colitis,UC)和克罗恩病(Crohn's disease,CD).IBD可伴有贫血、凝血功能异常等多种血液学改变,现对IBD的血液学表现进行综述.     

炎症性肠病的血液学表现

炎症性肠病(inflammatory bowel disease,IBD)是一类不明原因的慢性非特异性肠道炎症性疾病,主要包括溃疡性结肠炎(u|eemtive colitis,UC)和克罗恩病(Crohn's disease,CD).IBD可伴有贫血、凝血功能异常等多种血液学改变,现对IBD的血液学表现进行综述.     

炎症性肠病的血液学表现

炎症性肠病(inflammatory bowel disease,IBD)是一类不明原因的慢性非特异性肠道炎症性疾病,主要包括溃疡性结肠炎(u|eemtive colitis,UC)和克罗恩病(Crohn's disease,CD).IBD可伴有贫血、凝血功能异常等多种血液学改变,现对IBD的血液学表现进行综述.     

炎症性肠病与骨质疏松

<正>炎症性肠病(inflammatory bowel disease,IBD)是以反复发作的慢性肠道炎症为特点的一组疾病,主要包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn disease,CD),同时伴有多种肠道外表现。骨质疏松症是一种以骨量低下、骨微结构破坏、骨脆性增加、易发生骨折为特征的全身性骨病,同时也是IBD严重却     

炎症性肠病营养评估及营养护理的现状

炎症性肠病(inflammatory bowel disease,IBD)是一种病因尚不十分清楚的慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD)[1]。IBD的发病     

3种肠道疾病粪便钙卫蛋白水平变化及意义

目的探讨炎症性肠病(inflammatory bowel disease,IBD)、肠易激综合征(irritable bowel syndrome,IBS)、大肠癌患者粪便钙卫蛋白(fecal calprotectin,FC),血清C反应蛋白(C-reactive protein,CRP)、癌胚抗原(carcinoembryonic antigen,CEA)水平变化,及FC联合CRP、CEA在IBD、大肠癌中的诊断价值。方法肠道疾病患者90例,其中30例IBD患者为IBD组,30例IBS患者为IBS组,30例大肠癌患者为大肠癌组,于肠镜活检或手术前检测粪便FC,血清CRP及CEA水平,并进行比较;绘制ROC曲线,分析FC单独及联合血清CRP诊断IBD的效能,FC单独及联合血清CEA诊断大肠癌的价值。结果 IBD组粪便FC[811.43(576.66,938.73)μg/g]、血清CRP[(37.23±36.46)mg/L]水平高于IBS组[29.97(17.01,39.24)μg/g、(1.56±1.21)mg/L]和大肠癌组[211.23(88.02,346.47)μg/g、(12.37±10.59)mg/L],大肠癌组高于IBS组(P<0.05);大肠癌组CEA[(16.53±14.99)μg/L]水平高于IBD组[(2.22±1.01)μg/L]和IBS组[(2.07±1.23)μg/L](P<0.05),IBD组与IBS组比较差异无统计学意义(P>0.05);粪便FC以378.8μg/g为最佳截断值,诊断IBD的AUC为0.939(95%CI:0.887~0.991,P<0.001),灵敏度为86.7%,特异度为90.0%;以55.99μg/g最佳截断值,诊断大肠癌的AUC为0.516(95%CI:0.396~0.636,P=0.807),灵敏度为83.3%,特异度为50.0%;FC联合CRP诊断IBD的AUC为0.954,灵敏度为90.0%,特异度为95.0%;FC联合CEA诊断大肠癌的AUC为0.905,灵敏度为73.3%,特异度为95.0%。结论粪便FC、血清CRP可用于IBD、IBS和大肠癌的初步筛查,联合血清CRP、CEA检测可分别提高IBD、大肠癌诊断的准确性。     

炎症性肠病101例临床资料分析

炎症性肠病(inflammatory bowel disease,IBD)是一类慢性复发性肠道炎症,包括克罗恩病(Crohn disease,CD)和溃疡性结肠炎(ulcerative colitis,UC)。在西方国家相当常见,我国过去少见,但近年来报道逐渐增多,其中尤以UC为多[1],提示IBD已经成为肠道主要疾病。但目前就国人IBD发病     

粪便钙卫蛋白检测在肠易激综合征和炎症性肠病鉴别诊断中的意义分析

目的 探讨并分析粪便钙卫蛋白(FCP)检测在肠易激综合征和炎症性肠病鉴别诊断中的意义.方法 回归性分析2020年6月至2021年1月该院门诊及病房收集的肠易激综合征(IBS)患者29例,炎症性肠病(IBD)患者96例的临床资料,其中,溃疡性结肠炎(U C)患者36例,克罗恩病(CD)患者60例,采用酶联免疫吸附试验(E...     

载脂蛋白M在炎症性肠病中的测定及意义

目的 探讨血清载脂蛋白M (apolipoprotein M,apoM)在炎症性肠病(inflammatory bowel disease,IBD)患者血清中的表达及意义。方法 采用双抗夹心酶联免疫吸附法(enzyme-linked immuno sorbent assay,ELISA)检测101例IBD患者及69例健康对照组的血清apoM和肿瘤坏死因子a(tumor necrosis factor-a,TNF-α)水平,分析其与IBD疾病活动度的相关性。结果 溃疡性结肠炎(ulcerative colitis,UC)组、克罗恩病(Crohn＇s disesse,CD)组和健康对照组的血清apoM水平分别为(13.5±8.8) mg/L,(10.2±5.8) mg/L和(2.0±1.3) mg/L,且UC组血清apoM水平高于CD组,差异有统计学意义(P＜0.05);UC和CD患者血清apoM水平均随着疾病活动度的增加而升高,各等级间差异有统计学意义(P＜0.05);IBD组血清apoM水平与血清TNF-α水平呈正相关(r=0.314,P=0.001),以CD组为著(r=0.365,P=0.010)。结论 UC、CD患者血清apoM水平与疾病活动度相关,在评估IBD疾病活动度上有潜在的运用价值。     

髓过氧化物酶对炎症性肠病病情活动监测的临床价值

目的：探讨髓过氧化物酶（MPO）作为炎症性肠病（IBD）病情活动监测指标的临床价值。方法：分别观察了15例IBD活动组患者[其中活动期溃疡性结肠炎（UC）10例．活动期克罗恩病（CD）5例]、15例IBD非活动组患者（其中缓解期UC10例，缓解期CD5例）、12例对照组患者结肠粘膜病理变化．按Oshitani评分标准和D＇haens评分标准进行UC和CD组织学评分，测定结肠黏膜MPO活性。结果：IBD活动组、IBD非活动组病理组织评分均比对照组高，IBD活动组病理组织评分亦较IBD非活动组高，差异均有统计学意义（P〈0．01）。IBD活动组、IBD非活动组肠粘膜MPO活性均较对照组高，IBD活动组MPO活性较IBD非活动组高，差异均有统计学意义（P〈0．01）。结论：MPO活性与IBD病情活动程度呈正相关，可作为IBD病情活动的临测指标。     

炎症性肠病患者肠道菌群变化及其与炎性指标的关系

目的 观察炎症性肠病（IBD）患者肠道菌群变化,并观察其与白细胞（WBC）、血小板（PLT）、红细胞沉降率（ESR）和C反应蛋白（CRP）的关系.方法 选取IBD患者65例,检测所有患者粪便标本中10种细菌的数量及WBC、PLT计数、ESR和血清CRP水平.结果 溃疡性结肠炎（UC）组和克罗恩病（CD）组肠杆菌（EMB）、肠球菌（EC）、酵母菌（SB）均较对照组显著升高（P ＜0.05或P＜0.01）,UC组小梭菌（SC）显著升高（P＜0.05）;2组消化球菌（PS）、拟杆菌（BD）、双歧杆菌（BL）、乳杆菌（LC）和真杆菌（ES）均显著下降（P＜0.05或P＜0.01）;活动组EMB、ES、SB、SC、BD、BL、LC及WBC、PLT、ESR、CRP与缓解组差异显著（P＜0.05或P＜0.01）;WBC、PLT和CRP均与EC负相关,ESR与SB正相关（P＜0.01）.结论 IBD患者存在显著肠道菌群紊乱,炎性指标与部分菌种失衡相关.     

炎症性肠病患者红细胞分布宽度与疾病活动性的关系

目的 探讨IBD患者的RDW与疾病活动性的关系,评价RDW是否可以作为监测IBD活动性的指标.方法 选取IBD患者256例,分为2组:UC患者组:136例,包括活动期80例,缓解期56例;CD患者组:120例,包括活动期75例,缓解期45例;同时选取60例细菌性痢疾患者作为疾病对照组,选取门诊健康体检者80名作为健康对照组.利用Bayer Advia 2120全血细胞分析仪、IMMAGE800双光径免疫浊度分析仪、Vacuette全自动血沉分析仪分别检测各组患者和健康对照者的RDW、Hb、WBC、PLT、CRP、ESR、MCV等指标,判断疾病不同阶段RDW的变化趋势,同时分析RDW与CRP、ESR、PLT、Hb、MCV等指标的相关性.利用ROC曲线分析RDW鉴别IBD活动性的敏感度和特异度,验证其与IBD活动性的关系.结果 UC活动期组RDW值为(16.1±2.7),UC缓解期组为(13.5±2.1),疾病对照组为(13.0±2.0),健康对照组为(12.8±1.8),4组间RDW值差异有统计学意义(F=51.9,P＜0.01),其中UC活动期组RDW值显著高于UC缓解期组、疾病对照组和健康对照组(t值分别为8.12、9.67、11.85,P均＜0.05),UC缓解期组RDW值显著高于疾病对照组和健康对照组(t值分别为2.45、2.67,P均＜0.05).CD活动期组RDW值为(16.9±2.2),CD缓解期组为(13.8±1.1),疾病对照组为(13.0±2.0),健康对照组为(12.8±1.8),4组间RDW值差异有统计学意义(F=113.9,P＜0.01),其中CD活动期组RDW值显著高于CD缓解期组、疾病对照组和健康对照组(t值分别为11.47、18.63、18.72,P均＜0.05),CD缓解期组RDW值显著高于疾病对照组和健康对照组(t值分别为3.60、3.72,P均＜0.05).UC组和CD组RDW与CRP、ESR均呈正相关(r分别为0.484、0.525、0.286、0.358,P分别＜0.01、＜0.01、＜0.05、＜0.01),与Hb、MCV呈负相关(r分别为-0.378、-0.271、-0.329,-0.298,P分别＜0.01、＜0.01、＜0.05、＜0.01).在UC患者组中,与CRP、ESR、PLT、Hb、MCV相比,RDW的曲线下面积(0.854)最大,当RDW的cut-off值为14.0时,判断活动期UC的敏感度为82%(65/80),特异度为72%(40/56);在CD患者组中,RDW的曲线下面积(0.925)也最大,当RDW的cut-off值为14.5时,判断活动期CD的敏感度为88%(66/75),特异度为82%(37/45).结论 IBD患者RDW值的变化可以作为判断IBD活动性及监测病情的有用指标.     

血小板相关参数对评估炎症性肠病活动性的临床意义

目的探讨血小板相关参数评估炎症性肠病(IBD)活动性的价值。方法回顾性收集2010年1月至2019年6月九江学院附属医院消化内科住院的溃疡性结肠炎(UC)及克罗恩病(CD)患者共206例,另选取于九江学院附属医院健康体检50例健康人员作为对照;收集研究对象临床资料,并依据病史、Myao活动指数、蒙特利尔分级及克罗恩病活动指数(CDAI)对患者进行分组及疾病严重程度分级。收集患者首次诊断时的血常规检测指标。结果IBD患者的血小板相关参数除P-LCR外与对照组比较均有明显差异(P<0.05);CD患者PCT及PLT显著高于UC(P分别0.007、<0.001);IBD活动期患者血小板参数与对照组存在显著差异(P<0.05);且UC患者病情与血小板参数存在相关性,重度患者PLT高于轻度患者(P<0.05)、MPV低于轻度患者(P=0.001);将MPV、PDW、P-LCR、PCT、PLT联合诊断IBD的活动性,得到AUC=0.857,95%CI 0.803~0.912,P<0.05。结论MPV、PDW在IBD活动期降低;PLT、PCT则增高;血小板相关参数联合诊断可较好反映IBD活动性。     

Antibiotics for Treatment of Clostridium difficile Infection in Hospitalized Patients with Inflammatory Bowel Disease

Patients with inflammatory bowel disease (IBD), namely ulcerative colitis (UC) and Crohn''s disease (CD), have worse outcomes with Clostridium difficile infection (CDI), including increased readmissions, colectomy, and death. Oral vancomycin is recommended for the treatment of severe CDI, while metronidazole is the standard of care for nonsevere infection. We aimed to assess treatment outcomes of CDI in IBD. We conducted a retrospective observational study of inpatients with CDI and IBD from January 2006 through December 2010. CDI severity was assessed using published criteria. Outcomes included readmission for CDI within 30 days and 12 weeks, length of stay, colectomy, and death. A total of 114 patients met inclusion criteria (UC, 62; CD, 52). Thirty-day readmissions were more common among UC than CD patients (24.2% versus 9.6%; P = 0.04). Same-admission colectomy occurred in 27.4% of UC patients and 0% of CD patients (P < 0.01). Severe CDI was more common among UC than CD patients (32.2% versus 19.4%; P = 0.12) but not statistically significant. Two patients died from CDI-associated complications (UC, 1; CD, 1). Patients with UC and nonsevere CDI had fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen compared to those treated with metronidazole (30-day readmissions, 31.0% versus 0% [P = 0.04]; length of stay, 13.62 days versus 6.38 days [P = 0.02]). Patients with UC and nonsevere CDI have fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen relative to those treated with metronidazole alone. Patients with ulcerative colitis and CDI should be treated with vancomycin.     

未确定型炎症性肠病的临床特征分析

【目的】通过对未确定型炎症性肠病患者的临床特征进行分析加深对该型炎性肠病的认识。【方法】对2001年3月至2008年12月期间住院病人中符合炎性肠病的258例患者的临床特点进行回顾性分组分析。【结果】258例患者中未确定型炎性肠病32例（12．4％）,克罗恩病（CD）71例（27．5％）,溃疡性结肠炎（UC）155例（60．1％）。首发症状为腹泻、粘性血便、腹痛和发热。【结论】与克罗恩病及溃疡性结肠炎相比未确定型炎性肠病有一些自己的特点,有可能是一个独立病变。     

Potential role of soluble angiopoietin-2 and Tie-2 in patients with inflammatory bowel disease

BACKGROUND: Angiogenesis has been suggested to play an important role in inflammatory bowel disease (IBD). The aim of the study was to evaluate the serum markers of angiogenesis angiopoietin-2 (Ang-2) and soluble angiopoietin receptor Tie-2 in patients with ulcerative colitis (UC) and Crohn's disease (CD). MATERIALS AND METHODS: Serum Ang-2 and Tie-2 serum levels were measured in 160 IBD patients (79 UC and 81 CD) and in 80 matched healthy controls using commercially available enzyme-linked immunosorbent assays. Serum Ang-2 and Tie-2 levels were correlated with the disease activity, as well as the type, localization and treatment of the disease. RESULTS: Median serum Ang-2 and Tie-2 levels were significantly higher in both the UC patients and the CD patients compared with the healthy controls (P < 0.05 and P < 0.001, respectively). The IBD patients with early disease (diagnosis < 2 years) had significantly higher (P = 0.04) median serum Ang-2 levels but significantly lower (P = 0.02) median serum Tie-2 levels as compared with IBD patients with late disease (diagnosis > 2 years). The CD patients with active disease had significantly higher levels of Ang-2 compared with non-active disease (P = 0.02). Serum levels of both Ang-2 and Tie-2 were not correlated with laboratory markers such as ESR, CRP, white blood cell count, platelet count and albumin. CONCLUSIONS: Serum Ang-2 and Tie-2 levels are elevated in patients with IBD. These markers may mediate angiogenesis and vascular permeability in the mucosa of patients with IBD.     

联合检测炎症性肠病患者抗酿酒酵母细胞抗体和抗中性粒细胞抗体的临床意义

目的 探讨联合检测炎症性肠病(IBD)患者血清中抗酿酒酵母细胞抗体(ASCA)和抗中性粒细胞胞浆抗体(ANCA)对IBD诊断和鉴别诊断的应用价值.方法 用ELISA法和间接免疫荧光法分别测定159例IBD患者[溃疡性结肠炎(UC)97例,克罗恩病(CD)62例],167例主诉为腹痛、腹泻并除外IBD的患者和25名健康人血清中IgG型与IgA型ASCA和ANCA.结果 ASCA-IgA/IgG在CD组、UC组、疾病对照组和健康对照组中的阳性率分别为43.5%、14.4%、29.3%和0;CD组的阳性率显著高于UC组和疾病对照组(X2值分别为16.76、4.12,P分别<0.01、<0.05).ANCA在以上各组中的阳性率分别为8.1%、56.7%、4.8%和0;UC组中阳性率显著高于CD组和疾病对照组(X2值分别为38.08、90.47,P均<0.01);ASCA+/ANCA-组合诊断CD的敏感度、特异度、阳性预测值分别为40.3%,93.8%和80.6%;而ANCA+/ASCA-组合诊断UC的敏感度、特异度和阳性预测值分别为48.5%,98.4%和97.9%;ASCA在手术治疗与未手术治疗CD患者中的阳性率差异具有统计学意义(P=0.03).结论 ASCA或ANCA单项检测不能有效的筛选IBD患者,但2项指标联合检测有助于对UC和CD进行鉴别诊断.同时检测IgA型和IgG型ASCA可提高CD诊断的敏感度.中国人群中ASCA阳性可能与手术治疗相关.     

Prevalence,incidence and mortality of inflammatory bowel disease in Catalonia. A population-based analysis

Abstract

Introduction: Few recent data on the epidemiology of inflammatory bowel disease (IBD) are available, especially in Southern Europe.

Aim: To evaluate the prevalence, incidence and mortality of IBD in Catalonia during the period 2011–2016.

Material and methods: Data on the prevalence, incidence and mortality of IBD were obtained from the Catalan Health Surveillance System (CHSS). Crude incidence and prevalence rates were calculated for all the Catalan population. Trends in age-sex-adjusted rates were also estimated, and logistic regression was used to calculate the adjusted mortality odds ratio (OR). Data for Crohn’s disease (CD) and ulcerative colitis (UC) were analyzed separately.

Results: The prevalence per 100,000 inhabitants in 2016 was 353.9 for UC and 191.4 for CD. The total number of IBD patients rose from 29543 in 2011 to 40614 in 2016. IBD was associated with significantly elevated adjusted mortality ratios: 1.28 (95% CI: 1.6–1.4) for UC and 1.85 (95% CI: 1.62–2.12) for CD.

Conclusions: IBD prevalence is very high and is increasing rapidly in Catalonia. Both CD and UC are associated with significantly higher mortality rates.

• Key message

• Crohn disease and ulcerative colitis present a small but significant increase in mortality compared to non-inflammatory bowel disease.

• The prevalence of inflammatory bowel disease is increasing rapidly in Catalonia.

• Data on prevalence and incidence suggest that the number of patients may double in approximately 10 years.