肠愈宁颗粒治疗溃疡性结肠炎临床疗效观察

[目的]观察肠愈宁颗粒治疗溃疡性结肠炎(UC)临床疗效。[方法]96例UC患者随机分为2组各48例,治疗组采用自拟方剂肠愈宁颗粒为主方进行治疗,与单纯采用西药治疗48例进行对照(对照组),观察2组临床疗效及治疗前后免疫球蛋白(Ig)、补体(C)、肿瘤坏死因子α(TNF-α)和白细胞介素8(IL-8)的变化。[结果]治疗组总有效率为93.75%,对照组为77.08%(P0.05);治疗组肠镜改变、Ig、C3、TNF-α和IL-8的改善均优于时照组(均P0.05)。[结论]肠愈宁颗粒治疗UC疗效明显,有较好的抗炎、调节免疫、改善肠道运动功能、促进溃疡修复及愈合的作用。     

肠愈宁颗粒联合美沙拉嗪治疗老年活动期溃疡性结肠炎的疗效及对血清炎症因子、免疫功能和凝血功能的影响

目的探讨肠愈宁颗粒联合美沙拉嗪治疗老年活动期溃疡性结肠炎的疗效及对血清炎症因子、免疫功能和凝血功能的影响。方法选择老年活动期溃疡性结肠炎患者174例,依据随机数字表法随机分为对照组87例与治疗组87例。对照组给予美沙拉嗪治疗,治疗组在对照组基础上结合肠愈宁颗粒治疗。两组疗程均为12 w。比较两组疗效,治疗前后肠道黏膜病变严重程度、炎症因子、免疫功能和凝血功能及治疗期间不良反应。结果治疗组治疗总有效率为91.96%,显著高于对照组(78.16%,P<0.05)。两组治疗后Geboes指数评分和Baron评分较治疗前显著降低(治疗组:t=57.113、46.199,对照组:t=38.183、32.269,均P<0.05);治疗组治疗后Geboes指数评分和Baron评分显著低于对照组(t=23.270、15.720,均P<0.05)。两组治疗后血清白细胞介素(IL)-1β、基质金属蛋白酶(MMP)-1和肿瘤坏死因子(TNF)-α水平较治疗前显著降低(治疗组:t=32.805、33.491、26.301,对照组:t=14.597、17.376、9.184,均P<0.05);治疗组治疗后血清IL-1β、MMP-1和TNF-α水平显著低于对照组(t=22.753、24.388、13.189,P<0.05)。两组治疗后CD3~+、CD4~+和CD4~+/CD8~+较治疗前显著升高(治疗组:t=17.864、19.472、23.775,对照组:t=11.743、13.003、12.216,均P<0.05);治疗组治疗后CD3~+、CD4~+和CD4~+/CD8~+显著高于对照组(t=10.783、7.867、9.652,均P<0.05)。两组血浆D-二聚体和纤维蛋白(Fib)水平较治疗前明显降低(均P<0.05),治疗组治疗后D-二聚体和Fib水平显著低于对照组(P<0.05)。两组治疗期间均未发生明显不良反应。结论肠愈宁颗粒联合美沙拉嗪治疗老年活动期溃疡性结肠炎患者疗效明显,可减轻肠道黏膜病变程度,减轻炎症反应,改善患者免疫功能和凝血功能,具有重要临床意义。     

健脾益肠方对溃疡性结肠炎患者维持治疗的疗效观察

目的:观察健脾益肠方在溃疡性结肠炎维持治疗期间对患者临床症状、疲劳状态、有效率、不良反应等方面的影响.方法:将2018年4月-2020年3月深圳市中医院收治的60例临床分型为脾虚湿困的溃疡性结肠炎缓解期的患者作为研究对象,随机分为治疗组和对照组,每组各30例.治疗组给予健脾益肠方,1剂/d,水煎,分2次口服;对照组给予...     

康复新液灌肠联合美沙拉嗪治疗溃疡性结肠炎疗效观察

[目的]探讨康复新液灌肠联合美沙拉嗪治疗溃疡性结肠炎（UC）的疗效。[方法]132例轻中度UC患者,随机分成2组,治疗组66例,给予康复新液100ml,1次／d,灌肠;美沙拉嗪1g,3次／d,口服。对照组66例,给予美沙拉嗪1g,3次／d,口服。2组均予益生菌辅助治疗。于治疗8周后观察2组症状的缓解情况,同时复查电子结肠镜观察治疗效果。[结果]8周后临床症状：治疗组完全缓解率63．64％,总有效率为95．45％;对照组完全缓解率48．48％,总有效率为83．33％;2组比较差异有统计学意义（P〈0．05）。电子结肠镜：治疗组完全缓解率63．64％,总有效率为96．97％;对照组完全缓解率46．97％,总有效率为81．82％;2组比较差异有统计学意义（P〈0．05）。[结论]康复新液灌肠联合美沙拉嗪治疗UC临床疗效较好。     

美沙拉嗪灌肠剂治疗溃疡性结肠炎疗效观察

目的 探讨美沙拉嗪灌肠剂在溃疡性结肠炎(UC)治疗中的应用效果及其安全性.方法 选取住院治疗的轻、中度UC患者41例,随机分为两组;治疗组给予美沙拉嗪灌肠剂(含美沙拉嗪4.0 g)每晚1次保留灌肠1周;对照组地塞米松5 mg加入生理盐水60 ml每晚1次保留灌肠1周.两组均给予地塞米松10 mg加入生理盐水100 m1...     

美沙拉嗪栓塞肛治疗活动性溃疡性结肠炎疗效观察

目的探讨美沙拉嗪栓塞肛治疗活动性溃疡性结肠炎（UC）的临床疗效。方法将76例轻中度活动性UC患者随机分为两组各38例,观察组行美沙拉嗪栓塞肛1枚/次、1次/d,对照组口服水杨酸偶氮磺胺吡啶（SASP）1.0 g/次、4次/d;治疗8周后,比较其临床疗效和不良反应。结果观察组、对照组总有效率分别为94.74%、68.42%,不良反应发生率分别为10.53%、55.26%;两组总有效率、不良反应发生率比较均有统计学差异（P均〈0.05）。结论美沙拉嗪栓塞肛治疗轻中度活动性UC临床疗效好,不良反应少。     

双歧杆菌三联活菌联合美沙拉嗪治疗溃疡性结肠炎的临床疗效分析

[目的]探讨双歧杆菌三联活菌联合美沙拉嗪治疗溃疡性结肠炎（UC）的临床疗效.[方法]选取我院收治的UC患者134例,将患者随机分配为联合治疗组和对照组,每组67例.联合治疗组予以双歧杆菌三联活菌联合美沙拉嗪治疗,对照组则仅采用双歧杆菌三联活菌治疗.观察2组在治疗后患者的腹泻、腹痛、血便情况及其并发症.同时观察第1、2个疗程内镜下肠黏膜修复情况.[结果]联合治疗组患者腹痛腹泻及血便症状得到较好缓解.其中联合治疗组显效47例,有效14例,无效6例,有效率为91.05％;对照组中显效37例,有效14例,无效16例,有效率为76.12％,差异有统计学意义（P＜0.05）.联合治疗组第1、2个疗程内镜观察肠黏膜修复率达29.85％和40.30％,明显高于对照组的20.90％和26.87％,差异有统计学意义（P＜0.05）.[结论]双歧杆菌三联活菌联合美沙拉嗪治疗UC,临床效果显著.     

美沙拉嗪联合益生菌对老年中度活动期溃疡性结肠炎患者细胞因子水平的影响

目的研究美沙拉嗪联合益生菌对老年中度活动期溃疡性结肠炎患者因子的影响。方法选取100例老年中度活动期溃疡性结肠炎患者,按照随机分组的方式,分为对照组和研究组各50例。对照组予口服美沙拉嗪1.0 g/次,4次/d;研究组予口服美沙拉嗪联合益生菌(双歧三联活菌420 mg/次,3次/d)。两组均治疗8 w,观察比较两组治疗后总有效率及血清超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子(TNF)-α的水平。结果研究组治疗后总有效率明显大于对照组,差异有统计学意义(P0.05);研究组血清MDA、TNF-α水平明显较对照组降低,差异有统计学意义(P0.05)。研究组血清SOD水平明显高于对照组,差异有统计学意义(P0.05)。结论益生菌联合美沙拉嗪治疗老年中度活动期溃疡性结肠炎,可调节患者相关细胞因子的水平,其效果优于单用美沙拉嗪。     

美沙拉嗪口服联合锡类散保留灌肠治疗溃疡性结肠炎40例

[目的]观察口服美沙拉嗪联合锡类散保留灌肠治疗溃疡性结肠炎(UC)疗效.[方法]83例活动期UC患者随机分为2组,治疗组口服美沙拉嗪肠溶片1.0 g,4次/d,八味锡类散1.0 g加入0.9%氯化钠100 ml中,保留灌肠,1次/d;对照组口服美沙拉嗪肠溶片1.0 g,4次/d,疗程均为4周.比较2组的临床疗效及不良反应.[结果]2组患者治疗4周后症状明显改善,治疗组总有效率及临床治愈率分别为100%和95.0%,对照组分别为93.0%和74.4%.2组比较差异均有统计学意义(P＜0.05),2组患者治疗后均未发现严重不良反应.[结论]美沙拉嗪口服联合锡类散保留灌肠治疗UC疗效显著.     

穴位强化埋线疗法联合口服美沙拉嗪治疗溃疡性结肠炎疗效观察

目的观察穴位强化埋线疗法联合口服美沙拉嗪治疗溃疡性结肠炎（UC）的疗效。方法将93例进入UC临床缓解期1周的患者随机分为3组,穴位埋线组（31例）采用穴位强化埋线疗法,美沙拉嗪组（32例）口服美沙拉嗪,联合治疗组（30例）采用穴位强化埋线疗法联合口服美沙拉嗪。观察两组12个月时复发率、缓解时间、不良反应。结果穴位埋线组、美沙拉嗪组、联合治疗组复发率分别为45．2％（14／31）、40．6％（13／32）、16．7％（5／30）,穴位埋线组、美沙拉嗪组分别与联合治疗组比较P均〈0．05;穴位埋线组、美沙拉嗪组、联合治疗组缓解时间分别为（201±8）、（219±77）、（260±67）d,穴位埋线组、美沙拉嗪组分别与联合治疗组比较P均〈0．05;穴位埋线组、联合治疗组无不良反应,美沙拉嗪组有2例在用药2周时出现皮疹、4例用药早期有轻微腹胀,未影响继续治疗。结论穴位强化埋线疗法联合口服美沙拉嗪治疗UC疗效较好,可减少复发,延长缓解时间。     

Granulocytapheresis in the treatment of patients with active ulcerative colitis

In recent years, considering the role of inflammatory processes and the involvement of the immune system in ulcerative colitis, granulocytapheresis, a technique for removing circulating leukocytes and preventing their migration into the intestinal mucosa, has been proposed for the treatment of acute ulcerative colitis. Initially introduced for the treatment of patients who did not respond to conventional therapy only, this new therapy may become a useful and safe method to induce clinical remission in patients with acute disease. This article will review the clinical applications and issues concerning the use of granulocytapheresis in ulcerative colitis.     

青白栓抗大鼠溃疡性结肠炎的实验研究

[目的]探讨青白栓对大鼠溃疡性结肠炎（UC）的治疗作用。[方法]采用二硝基氯苯和乙酸复合方法制备大鼠UC模型，经病理切片证实造模成功后，随机分为5组，青白栓高、中、低剂量组，模型组和柳氮磺吡啶栓组。各组大鼠根据其分组分别给予相应的处理20d后，检测各组大鼠结肠组织中超氧化物歧化酶（SOD）、丙二醛（MDA）和血清白细胞介素2（IL-2）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、IgA、IgM、体重及肠重指数的变化。[结果]青白栓高、中剂量组动物组织中SOD显著降低，MDA显著下降（P〈0．01），青白栓高剂量组动物血清中IL-2、IL-6、TNF-α均显著降低（P〈0．05，〈0．01）。[结论]青白栓可有效地用于实验性UC的治疗。     

Plasma total homocysteine in the active stage of ulcerative colitis

BACKGROUND: Homocysteine, an independent risk factor for thromboembolism, has been recently shown to be elevated in ulcerative colitis (UC). However, its relation to the activity of the disease remain unclear. METHODS: Two groups were studied: group consisted of 1-30 patients with UC (17 men, 13 women, mean age 50.3 +/- 14.7 years), including 15 patients with active disease. Group 2 (controls) consisted of 21 age-, sex-, bodyweight-matched healthy persons (12 men, nine women, mean age 53.1 +/- 12.8 years). Total plasma homocysteine (tHcy) and serum folate and vitamin B12 as well as selected coagulation parameters were assessed. RESULTS: Mean tHcy in UC patients was significantly higher than in healthy controls: 10.8 +/- 3.1 mmol/L versus 6.8 +/- 2.5 mmol/L (P < 0.001). Patients with active disease had higher tHcy than patients in remission: 11.2 +/- 3.5 mmol/L versus 9.0 +/- 2.3 mmol/L (P = 0.048). Patients with > or =4 recurrences of the disease had also higher tHcy than the others: 11.5 +/- 3.6 mmol/L versus 9.0 +/- 2.1 mmol/L (P = 0.035). The tHcy correlated with duration of disease: r = 0.6632 (P < 0.05). Folate and B12 levels were within their reference ranges in all subjects. However, in the patients with active disease the platelet count, fibrinogen and D-dimer were significantly higher than in the patients in remission and the controls. CONCLUSIONS: Ulcerative colitis is associated with elevated tHcy concentration, particularly in the active stage, and in more recurrent types of the disease; this elevation does not seem to be prevented by a normal folate status and might have an enhancing effect on the procoagulation blood profile.     

自拟消溃肠炎散治疗溃疡性结肠炎临床疗效观察

[目的]观察自拟消溃肠炎散治疗溃疡性结肠炎(UC)的疗效.[方法]将80例UC患者随机分为2组,对照组采用口服柳氮磺胺吡啶片4 g/d与甲硝唑100 ml加地塞米松5 mg保留灌肠,治疗组采用自拟消溃肠炎散中药保留灌肠.[结果]总有效率对照组为77.5％,治疗组为97.5％,治疗组疗效优于对照组(P＜0.05).[结论]自拟消溃肠炎散保留灌肠治疗UC疗效明显,有促进溃疡愈合的作用.     

Vitamin D regulates the tight-junction protein expression in active ulcerative colitis

Objective: Epithelial barrier function is primarily regulated by the tight-junction proteins. Ulcerative colitis (UC) is characterized by Th2 immune response with inflammation and epithelial barrier dysfunction, including an elevation of claudin-2 protein function. Recent studies support an important role of vitamin D in the pathogenesis as well as potential therapy of IBD. Vitamin D deficiency is in fact common in patients with IBD. The aim of the study was to determine whether vitamin D could affect IL-13 and IL-6 levels, and regulate the activity of tight-junction proteins. Claudin-1, -2, -4, and -7 in the inflamed and non-inflamed colonic mucosa of UC patients.

Material and methods: Biopsies from inflamed and non-inflamed tract of colon and rectum from the same active UC patients were cultured with1,25(OH)₂D₃. IL-13, IL-6 and the tight-junction proteins level were determined.

Results: Claudin-1 and claudin-2 proteins were up-regulated in active UC. The treatment with 1,25(OH)₂D₃ decreases the claudin-1 and claudin-2 protein levels in both inflamed and non-inflamed tract. Claudin-4 and claudin-7 proteins were down-regulated and their levels increase after incubation with the 1,25(OH)₂D₃. When the biopsies were incubated with 1,25(OH)₂D₃, a decrease in IL-13 and IL-6 levels was registered.

Conclusions: Our results, indicating the inhibition of cytokine levels and the regulation of claudin-2, claudin-4, and claudin-7 by 1,25(OH)₂D₃, suggest that vitamin D may represent a potential therapeutic agent for the treatment of active UC.     

保留灌肠治疗溃疡性结肠炎疗效观察

[目的]观察10%鸦胆子乳联合地塞米松保留灌肠治疗溃疡性结肠炎的临床疗效.[方法]10%鸦胆子乳50 ml加地塞米松5 mg混合充分摇匀,用18～20号肛管每晚经肛门插入保留灌肠2 h,1个月为1个疗程.如未治愈可进行第2个疗程治疗.疗程结束后均经结肠镜复查.[结果]48例患者经1个疗程治愈38例(78.5%),其中轻度32例,中度6例;好转10例(21.5%),其中中度6例,重度4例.伴腺瘤息肉2例,炎性息肉5例.1例腺瘤息肉经2个疗程灌肠治疗,腺瘤脱落,另1例腺瘤息肉者行肛肠科手术;5例炎性息肉经治疗均消失.其余病例均获临床治愈,其治愈率为97.5%.[结论]该疗效理想而可靠,简便易行,值得临床尝试和推广.     

Right-sided ulcerative colitis

This report describes a case of right-sided ulcerative colitis in which multiple shallow ulcers and erosion with symmetric luminal stenosis were distributed segmentally from the ascending colon to the cecum, with a skip lesion composed of superficial erosions in the right half of the transverse colon. Both the rectum and the left colon were spared at the time of onset. Biopsies taken from the lesions showed non-specific inflammation, while those from the rectum and sigmoid colon showed no abnormal findings. A 5-year follow-up study was made based on radiography and endoscopy. Other inflammatory bowel diseases, such as Crohn's disease, tuberculosis, Yersinosis, Behçet's disease, and ischemic colitis were all ruled out, based on the macroscopic and microscopic findings as well as the clinical course. To our knowledge, this is the first report of right-sided ulcerative colitis that has been followed for a long period.     

Medical approaches and future options in chronic active ulcerative colitis

Background Immunosuppressive therapy employing purine analogues is the therapeutic mainstay in patients with chronic active ulcerative colitis. However, despite therapeutic optimization according to thiopurine-methyltransferase activity or red blood cell 6-thioguanine levels, a substantial proportion of patients does not tolerate azathioprine or 6-mercaptopurine or relapses during this treatment. In the latter multiple therapeutic regimens comprising 6-thioguanine, cyclosporin or tacrolimus, methotrexate, cyclophosphamide, infliximab, interferons, heparin, leukocyte apheresis, and various other regimens might be considered aiming at long-term remission. Many of these treatment forms have only been evaluated in small mostly uncontrolled trials.Objective In this review existing treatment modalities and future options for patients with chronic active ulcerative colitis will be discussed focusing on immunomodulating approaches.     

Cytomegalovirus infection in ulcerative colitis

Objective. Cytomegalovirus (CMV) infection has been reported as an exacerbating factor in inflammatory bowel disease but the relationship between CMV infection and ulcerative colitis (UC) remains unclear. There has been no detailed research to elucidate the clinicopathologic features of CMV infection in UC using surgical specimens. The aim of this study was to investigate the clinicopathologic features of CMV infection in UC patients who had undergone colectomy.

Material and methods. Surgical specimens taken from UC patients were examined for CMV infection. The patients were divided into three groups: severe, refractory, and UC-associated dysplasia or cancer according to the operative indications. CMV infection rates were evaluated and a comparison of clinical parameters was made between CMV-positive and CMV-negative patients, and the risk factors for CMV infection were analyzed using multivariate analyses.

Results. It was found that 25% of 32 patients were positive for CMV in the severe UC group; 8.3% of 72 patients were positive for CMV in the refractory UC group. None of the 22 patients was positive for CMV in the UC-associated dysplasia or cancer group. The CMV-positive rate in the severe UC group was significantly higher than that in the other groups (p<0.05). Patients’ age at the time of operation was higher in the CMV-positive group than in the CMV-negative group among the patients with severe UC (p<0.01), and age at operation was an independent risk factor for CMV infection.

Conclusions. CMV is found more frequently in severe UC than refractory UC and UC-associated cancer or dysplasia. Higher age can be a risk factor for CMV infection in patients with severe UC. However, a high steroid dose may not always be a risk factor for CMV infection.     

Very low intraluminal colonic pH in patients with active ulcerative colitis

Intraluminal gastrointestinal pH was measured in seven patients with active ulcerative colitis (four male, three female). A radiotelemetry capsule was used, and its location was determined by fluoroscopy. Satisfactory measurements were obtained from six, in all of whom pH levels were normal in the stomach and small intestine. Three patients also had normal pH values in the colon. However, in the remaining three patients very low pH levels (lowest values 2.3, 2.9, and 3.4) were found in the proximal parts of the colon. Five of the seven patients, including the three with low pH in the colon, underwent colectomy. The mechanism behind the low intraluminal pH in some patients with ulcerative colitis is speculative. Increased fecal concentrations of lactate occur in active disease, but some of the pH values measured in our study were below the pK_a value of lactate. The study demonstrates that very low intraluminal pH levels in the colon occur in some patients with active ulcerative colitis. This might be an indicator of severe activity of the disease.