诱发炎症性肠病的环境危险因素

炎症性肠病(infl ammatory bowel disease,IBD)是一类病因不明的肠道慢性非特异性炎性疾病,包括溃疡性结 肠炎和克罗恩病。与IBD发病相关的危险因素包括环境、遗传和免疫因素等。其中,环境因素又包括吸烟、药物、饮 食、感染和精神心理因素等。     

高分辨魔角旋转核磁共振技术在慢性结肠炎诊断的应用探讨

目的利用高分辨魔角旋转核磁共振(NMR)技术鉴别诊断慢性结肠炎症。方法利用1H NMR技术检测溃疡性结肠炎组织5份,克罗恩病组织4份和正常直肠组织3份,观察肠组织的代谢组学变化。结果溃疡性结肠炎组织和克罗恩病组织的丙酸和乙酸峰值明显高于正常结肠组织;克罗恩病组织的牛磺酸明显高于溃疡性结肠炎组织中的牛磺酸和正常组织中的牛磺酸,溃疡性结肠炎组织中的牛磺酸峰值明显高于正常组织中的牛磺酸峰值。结论通过NMR技术检测出的代谢指标可以用来辅助鉴别诊断慢性结肠炎及其亚类型。     

肺表面活化蛋白A相似分子在炎症肠道疾病组织中的过量表达

目的：阐明炎症肠道疾病（inlammatory bowel disease,IBD）中肺表面活化蛋白A（pulmonary surfactant protein A,SP-A）相似分子的分布特征和CD68阳性巨噬细胞的免疫反应。方法：外科手术获得的结肠组织标本来自布朗大学医学院罗得岛医院病理科,应用免疫组织化学方法检测IBD患者肠道组织中SP-A相似分子的表达。结果：SP-A相似分子分布在肠道上皮、肠道绒毛表面,连接组织血管和某些炎症细胞。具有SP-A相似分子和CD68阳性表达的巨噬细胞数量炎症区域明显增加,高于正常组织。而免疫荧光双标记实验显示,一些CD68阳性巨噬细胞可以表达SP-A相似分子免疫反应。结论：SP-A是肺脏一种重要的宿主防御因子。     

巨细胞病毒感染与炎症性肠病相关性研究

目的:从CMV基因水平观察巨细胞病毒(cytomegalovirus,CMV)感染与炎症性肠病(inflammatory bowel disease,IBD)的相关性。方法:我们从2007～2010年.对76例溃疡性结肠炎(ulcerative colitis,UC)52例,克罗恩病(Crohn’s disease,CD)24例的成人患者进行研究,研究CMV感染者肠道病理标本及其血液的分子水平、肠道组织标本免疫组化,以40例非炎症性肠病者作为对照组。结果:免疫组化着色显示CMV抗原阳性9例(7例是UC、8例是严重IBD病例),对照组CMV抗原均阴性。PCR-CMV基因在全部IBD肠组织标本、血液中均阳性有23(30.3%)例,16(30.8%)例为UC,7(25.9%)例为CD。此外,5(6.6%)例IBD中(2例UC,3例CD)在肠道组织检测到CMV基因,而在血液中未检测到。在对照组,5(12.5%)例血液中检测到CMV基因,仅1例(2.5%)在肠道组织检测到CMV基因。结论:UC与对照组相比,更易检测到CMV(在血液和肠道组织样本)(P=0.034和P<0.0001),而CD患者与对照组相比,更易在肠道组织标本检测CMV基因(P=0.002),在血液或肠道检测到CMV基因与IBD持续时间明显相关(P=0.004和0.03),但与年龄、性别、疾病的严重程度、结肠镜下的活动性、全结肠炎、需要特殊治疗和外科手术无关。在本研究中,检测到肠道CMV基因或抗原常与IBD有关。     

炎症性肠病相关基因研究进展

炎症性肠病包括溃疡性结肠炎和克罗恩病,是一组病因未明的非特异性慢性肠道炎症性疾病,近年来发病呈上升趋势。越来越多的研究显示,相关基因的多态性在炎症性肠病的发病中起重要作用。很多文章从遗传学的角度讨论了与IBD有关的几组易感基因,如NOD2基因、白细胞介素相关基因、HLA基因、肿瘤坏死因子基因,以及近期内才被认为和IBD相关的MDR1(ABCB)基因、MY09B基因。     

上皮紧密连接与炎性肠病的研究进展

炎症性肠病(IBD)主要是一组反复发作的慢性非特异性肠道炎症性疾病,包括克罗恩病和溃疡性结肠炎。IBD发病时,肠黏膜屏障功能异常,抗原移位刺激免疫细胞,产生大量炎性细胞因子及介质,炎性分子破坏紧密连接,加剧损伤肠黏膜屏障功能。通过保护肠上皮细胞骨架、修复上皮细胞及细胞间紧密连接能改善肠上皮屏障功能,这也是当前临床治疗IBD的新策略和新思路。     

Agglutinins to bacteria as a discriminatory test in Crohn’s disease

THE faecal flora of patients with Crohn’s disease differs from that of healthy subjects in that it contains higher concentrations of anaerobic Gram-negative rods and Gram-positive coccoid rods of the genera Peptostreptococcus, Eubacterium and Coprococcus. As part of an international study of agglutinins to these bacteria we submitted sera from 20 patients with Crohn’s disease, 19 with ulcerative colitis and 20 control subjects. These sera were tested in Rotterdam by personnel who had no prior knowledge of the diagnosis and were scored positive or negative for Crohn’s disease according to the strength of agglutination. In patients with Crohn’s disease the sera was strongly positive in 65% of cases. The test was positive in 26% of patients with ulcerative colitis, while all the control sera were negative for agglutinins. Our data compared favourably with that of the international survey. On the basis of these results the agglutinin test is put forward as a useful aid in discriminating between the two principal inflammatory bowel diseases and the significance and limitations of the test are discussed.     

小肠常见炎症性溃疡性疾患的X线诊断

目的分析小肠常见炎症性溃疡性疾患的X线表现。材料与方法18例小肠炎症性溃疡性疾患,男11例,女7例。其中肠结核6例,Crohn病6例,肠Behcet病4例,单纯性溃疡和缺血性肠炎各1例。16例有病理结果,2例经临床治疗证实。结果病变局限于回肠,肠结核6例其中有5例,Crohn病6例其中有4例,肠Behcet4例其中有3例,单纯性溃疡1例,1例缺血性肠炎均在回肠。部分病例及回盲部。18例均有溃疡,形态表现多种多样,但纵行溃疡和裂隙仅见于Crohn病。大而深的溃疡5例,3例为肠Behcet病,浅而不规则溃疡7例,5例见于肠结核。横行溃疡2例均见于肠结核。结论肠溃疡的形态、周围粘膜的变化和肠管变形等X线特征是各种疾患的诊断依据。强调正确的诊断决定于良好的X线检查技术和对形态变化的正确解释。     

小肠常见炎症性溃疡性疾患的X线诊断

目的分析小肠常见炎症性溃疡性疾患的X线表现。材料与方法18例小肠炎症性溃疡性疾患,男11例,女7例。其中肠结核6例,Crohn病6例,肠Behcet病4例,单纯性溃疡和缺血性肠炎各1例。16例有病理结果,2例经临床治疗证实。结果病变局限于回肠,肠结核6例其中有5例,Crohn病6例其中有4例,肠Behcet4例其中有3例,单纯性溃疡1例,1例缺血性肠炎均在回肠。部分病例及回盲部。18例均有溃疡,形态表现多种多样,但纵行溃疡和裂隙仅见于Crohn病。大而深的溃疡5例,3例为肠Behcet病,浅而不规则溃疡7例,5例见于肠结核。横行溃疡2例均见于肠结核。结论肠溃疡的形态、周围粘膜的变化和肠管变形等X线特征是各种疾患的诊断依据。强调正确的诊断决定于良好的X线检查技术和对形态变化的正确解释。     

Signposts to therapy: recent advances in inflammatory bowel disease research.

Research on ulcerative colitis and Crohn disease, the two conditions grouped under the heading of inflammatory bowel disease (IBD), is improving our understanding of how the intestine functions at the cellular level in health and disease. Researchers in the McGill Inflammatory Bowel Disease Research Program are studying the factors that affect the transport of nutrients, salt and water across cell membranes in the intestinal epithelium and investigating the cellular mechanisms of diarrhea. Their main interest is in how the intestine adapts in response to inflammation. Their findings promise to yield new targets for the pharmacologic and dietary management of IBD.     

中药治疗炎症性肠病作用靶点探究

炎症性肠病(inflammatory bowel disease,IBD)是一类病因未明、侵及胃肠道的自身免疫性疾病,包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD),其发病机制与免疫、遗传、感染等多种因素有关。由于IBD的全身性、难治性及西药治疗的局限性,为了另辟蹊径,近年来中医药治疗IBD的研究越发被重视,并且已经深入到中药治疗IBD的药理作用机制领域,文章就近5年来中药治疗IBD的作用靶点研究做一综述。     

重度溃疡性结肠炎合并卡波西肉瘤1例并文献综述

卡波西肉瘤是与人类疱疹病毒-8感染相关的血管增生性疾病,多见于免疫功能低下的人群,服用免疫抑制剂或糖皮质激素可能是导致人类免疫缺陷病毒阴性患者发生卡波西肉瘤的原因之一.本文报告1例接受糖皮质激素治疗的重度溃疡性结肠炎患者发生的皮肤卡波西肉瘤,并进行文献综述.患者男性,64岁,诊断溃疡性结肠炎1年,因重度溃疡性结肠炎发作接受激素治疗,4个多月后患者躯干,四肢出现多发暗紫色丘疹,结节,质地坚硬,下肢为著,经皮肤组织活检病理学检查提示皮肤卡波西肉瘤,免疫组织化学检测显示人类疱疹病毒-8染色阳性,经停用糖皮质激素,并行化疗后病情缓解.分别在万方数据知识服务平台和中国知网以"卡波西肉瘤"和"炎症性肠病"为检索词检索相关文献,未检索到中文文献.在PubMed上以("ulcerative colitis" OR "Crohn's disease" OR "inflammatory bowel disease") AND (Kaposi sarcoma)为检索词检索,共检索到38篇英文文献,另从相关文献中补充,共检索到25例与炎症性肠病相关的卡波西肉瘤,连同本例的26例患者中,男性占绝大多数(80.8%,21/26).平均年龄(51.1±16.4)岁,溃疡性结肠炎20例,克罗恩病6例.22例患者报告了人类免疫缺陷病毒检测结果,均为阴性.所有患者均使用过至少一种免疫功能调节剂,包括糖皮质激素,硫唑嘌呤/6-巯基嘌呤,氨甲喋呤,环孢菌素,抗肿瘤坏死因子α单克隆抗体.14例报告人疱疹病毒-8结果的患者中,13例阳性,1例阴性.病变单纯累及肠道者18例,单纯累及皮肤者3例,5例患者同时累及皮肤和肠道.25例报告了治疗方案,其中3例患者仅停用免疫调节剂,1例患者停药后接受放疗,1例患者停药后接受化疗,20例患者接受手术治疗,总体而言预后良好.炎症性肠病相关的卡波西肉瘤往往与使用激素,免疫抑制剂和生物制剂有关.鉴别卡波西肉瘤,炎症性肠病相关和药物相关的皮肤表现至关重要.此外,在诊疗过程中重视多学科团队的协同作用,能够更早,更准确地对少见病例做出诊断和治疗.     

炎症性肠病肠壁纤维化机制研究进展

炎症性肠病主要包括溃疡性结肠炎和克罗恩病,是一组病因尚不十分明确的慢性非特异性肠道炎症性疾病,肠壁纤维化是它很重要的一个并发症。肠壁纤维化的机制尚不清楚,可能是慢性炎症和肠道间质细胞、细胞因子和局部炎性细胞之间复杂的相互作用而导致。肠壁纤维化目前没有较好的治疗方法,因此,对其发病机制的研究进展进行综述,以期为临床治疗提供线索。     

Association between the promoter polymorphism T/C at position -159 of the CD14 gene and anti-inflammatory therapy in patients with inflammatory bowel disease

Immune response to intestinal bacteria and genetic predisposition seem to play a crucial role in the pathogenesis of inflammatory bowel disease. A single nucleotide polymorphism in the promoter of the lipopolysaccharide-receptor CD14 gene (T/C at position -159) has recently been described. To evaluate the role of the CD14 gene in anti-inflammatory therapy, the functionally relevant T(-159)-->C promoter polymorphism has been genotyped in 72 patients with inflammatory bowel disease and associated with the cumulative steroid dose. Cumulative corticosteroid dose was significantly higher in ulcerative colitis patients with the TT genotype (2447.7 +/- 927.0 mg/yr) compared with the CT genotype (142.3 +/- 142.3 mg/yr, p=0.016) and the CC genotype (391.7 +/- 272.7 mg/yr, p=0.047). In contrast, in patients with Crohn's disease there was no significant difference of the cumulative corticosteroid doses between the various T(-159)-->C promoter CD14 genotypes. An altered immune response to lipopolysaccharides with influence on the anti-inflammatory therapy seems to play a role in the genetic predisposition to ulcerative colitis. Genetic stratification will lead to the development of individualized therapies in inflammatory bowel disease.     

重度溃疡性结肠炎合并卡波西肉瘤1例并文献综述

卡波西肉瘤是与人类疱疹病毒-8感染相关的血管增生性疾病,多见于免疫功能低下的人群,服用免疫抑制剂或糖皮质激素可能是导致人类免疫缺陷病毒阴性患者发生卡波西肉瘤的原因之一.本文报告1例接受糖皮质激素治疗的重度溃疡性结肠炎患者发生的皮肤卡波西肉瘤,并进行文献综述.患者男性,64岁,诊断溃疡性结肠炎1年,因重度溃疡性结肠炎发作接受激素治疗,4个多月后患者躯干,四肢出现多发暗紫色丘疹,结节,质地坚硬,下肢为著,经皮肤组织活检病理学检查提示皮肤卡波西肉瘤,免疫组织化学检测显示人类疱疹病毒-8染色阳性,经停用糖皮质激素,并行化疗后病情缓解.分别在万方数据知识服务平台和中国知网以"卡波西肉瘤"和"炎症性肠病"为检索词检索相关文献,未检索到中文文献.在PubMed上以("ulcerative colitis" OR "Crohn's disease" OR "inflammatory bowel disease") AND (Kaposi sarcoma)为检索词检索,共检索到38篇英文文献,另从相关文献中补充,共检索到25例与炎症性肠病相关的卡波西肉瘤,连同本例的26例患者中,男性占绝大多数(80.8%,21/26).平均年龄(51.1±16.4)岁,溃疡性结肠炎20例,克罗恩病6例.22例患者报告了人类免疫缺陷病毒检测结果,均为阴性.所有患者均使用过至少一种免疫功能调节剂,包括糖皮质激素,硫唑嘌呤/6-巯基嘌呤,氨甲喋呤,环孢菌素,抗肿瘤坏死因子α单克隆抗体.14例报告人疱疹病毒-8结果的患者中,13例阳性,1例阴性.病变单纯累及肠道者18例,单纯累及皮肤者3例,5例患者同时累及皮肤和肠道.25例报告了治疗方案,其中3例患者仅停用免疫调节剂,1例患者停药后接受放疗,1例患者停药后接受化疗,20例患者接受手术治疗,总体而言预后良好.炎症性肠病相关的卡波西肉瘤往往与使用激素,免疫抑制剂和生物制剂有关.鉴别卡波西肉瘤,炎症性肠病相关和药物相关的皮肤表现至关重要.此外,在诊疗过程中重视多学科团队的协同作用,能够更早,更准确地对少见病例做出诊断和治疗.     

Acute severe ulcerative colitis: timing is everything

The idiopathic inflammatory bowel diseases comprise mainly two types of intestinal disorder, Crohn disease and ulcerative colitis. The clinical course is marked by exacerbations and remissions that occur spontaneously in response to treatment or intercurrent illness. The disease affects approximately 240,000 patients in the UK. Acute severe ulcerative colitis is a medical emergency; prompt effective treatment at the point of admission can avoid significant morbidity and be potentially life-saving. Although such patients need specialist management, it is imperative that emergency care physicians are aware of the important principles of management of this condition to achieve successful outcomes. Corticosteroids remain the cornerstone of initial therapy, but a third of patients will fail to respond, and further management involves critical and timely decisions on whether to use rescue therapy in the form of ciclosporin or infliximab without compromising the health or safety of the patient or to offer timely surgery. The evidence base for the choices for optimal management of this condition is presented.     

溃疡性结肠炎的危险因素

溃疡性结肠炎是一种慢性非特异性肠道炎症性疾病,其发病率在世界范围内有逐渐升高的趋势,其病因不明。现概括了溃疡性结肠炎发生的影响因素,其中遗传、高脂饮食、肠道细菌失调、口服避孕药、精神紧张、过敏史等是溃疡性结肠炎的危险因素;阑尾切除术可降低溃疡性结肠炎的危险性,吸烟使患溃疡性结肠炎的危险性降低。     

Salmonellosis and ulcerative colitis. A causal relationship or just a coincidence

Coincidence of salmonellosis and ulcerative colitis is a rare clinical problem. Salmonella infection was reported to complicate the ulcerative colitis, as either facilitating its occurrence or activation. In this article, we present a case with salmonellosis whose clinicopathological findings also suggested ulcerative colitis. The patient improved rapidly after taking additional mesalazine to norfloxacin treatment. We conclude that salmonella infection might have either been coincidentally present or might have triggered an early ulcerative colitis in this patient who did not have history of inflammatory bowel diseases. In case of persistent severe diarrhea despite appropriate treatment, the possibility of a coincident inflammatory bowel disease such as ulcerative colitis should always be considered, especially in endemic regions for salmonellosis.     

Relative incidence of Crohn's disease and ulcerative colitis in six Melbourne hospitals

Information on the relative incidence of Crohn's disease and ulcerative colitis was obtained by a prospective investigation at six Melbourne teaching hospitals. One hundred and eleven patients who presented with chronic inflammatory bowel diseases between 1980-1981 were admitted to the study. Forty (36%) patients were diagnosed as having Crohn's disease and 63 (57%) patients as having ulcerative colitis. The type of chronic inflammatory bowel disease could not be determined in eight (7%) patients. These findings suggest that the relative frequency of Crohn's disease and ulcerative colitis in Melbourne hospitals is within the range that is reported for northern Europe and the United States.     

血小板与淋巴细胞比值对溃疡性结肠炎鉴别诊断及其严重程度判定的临床意义分析

目的 评估血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)对溃疡性结肠炎的临床应用价值.方法 选取2009年6月至2016年6月于上海长海医院就诊的192例患者,其中溃疡性结肠炎97例,肠易激综合征95例,分析2组患者PLR差异,并评价PLR对溃疡性结肠炎诊断的敏感性、特异性;通过改良的Mayo评分系统评估溃疡性结肠炎疾病活动度,结肠镜确定病变蔓延部位,评估PLR与疾病活动度及病变蔓延部位的相关性.结果 与肠易激综合征对照组相比,溃疡性结肠炎患者白细胞计数、血小板计数、PLR、红细胞沉降率、C反应蛋白显著增高,血红蛋白显著降低,差异具有统计学意义(P<0.05).PLR在溃疡性结肠炎与肠易激综合征组间差异有统计学意义,通过受试者工作曲线(receiver operating characteristic curve,ROC)分析,PLR检测的敏感度和特异度分别为67%和58%.肠易激综合征和轻、中、重度溃疡性结肠炎的PLR分别是123.73±60.47、114.32±43.66、160.19±56.52、253.35±86.82.肠易激综合征PLR与轻度溃疡性结肠炎PLR比较差异无统计学意义(P=0.54),与中、重度溃疡性结肠炎PLR比较差异均有统计学意义(P<0.05);轻、中、重度溃疡性结肠炎PLR比较差异均有统计学意义(P<0.05).PLR在溃疡性结肠炎不同病变蔓延部位之间差异无统计学意义(P>0.05).结论 PLR在溃疡性结肠炎与肠易激综合征鉴别诊断中具有一定价值和临床意义,并且可以判断溃疡性结肠炎的活动度.