炎症性肠病的影像学诊断

炎症性肠病（inflammatory bowel disease,IBD）是一种病因不明的慢性非特异性肠道炎症性疾病,包括克罗恩病（Crohn’s disease,CD）和溃疡性结肠炎（ulcerative colitis,UC）。影像学检查是诊断IBD的重要手段,目前主要包括X线钡剂检查和CT、MRI,其不仅可确诊IBD、鉴别CD与UC,还能评价病变的累及范围和严重程度；判断有无肠外并发症．并对临床疗效进行随访。     

重视炎症性肠病的皮肤表现

炎症性肠病（inflammatory bowel disease, IBD）患者皮肤表现类型多样,包括炎症累及皮肤的IBD特异性皮肤表现及反应性皮肤表现;与IBD并发的皮肤表现,以及继发于其他原因而出现的IBD继发性皮肤表现。溃疡性结肠炎（ulcerative colitis, UC）患者以结节性红斑、坏疽性脓皮病为多见;克罗恩病（Crohn's disease, CD）患者以皮肤的脓肿和瘘管多见。IBD皮肤表现可以出现在IBD诊断之前、之后或同时,部分特殊类型皮肤表现的出现对IBD诊断具有提示意义。IBD皮肤损害的治疗应以控制IBD病情为基础,根据皮肤损害的类型针对性治疗。     

本期专题导读

正炎症性肠病(inflammatory bowel diseases,IBD)在我国的发病率越来越高。2000年以前我国克罗恩病(Crohn's disease,CD)的发病率是0.85/10万,2010年在武汉IBD的发病率是1.96/10万,2011年广东统计IBD发病率是3.14/10万。为了广大医务工作者能更好地处理IBD,中华医学会消化病学分会炎症性肠病学组在2018年又更新了《中国炎症性肠病诊断与治疗的共识意见》,针对我国IBD发病具体情况制定了IBD的     

炎症性肠病的血清标志物研究进展

炎症性肠病(inflammatory bowel disease,IBD)是一种病因不明的慢性肠道炎症性疾病,包括克罗恩病(Crohn's disease,CD)和溃疡性结肠炎(ulcerative colitis,UC)。临床上诊断IBD主要依据临床症状、内窥镜、影像学和病理组织活检等检查。近年来,血清生物标志物(BM)检测在IBD常规诊断中的作用已引起广泛关注。BM检测的作用主要包括:IBD辅助诊断和鉴别诊断、疾病活动性判断、病情严重程度的风险分层和对疗效的预测等。本文就目前临床已应用的BM进行综述并介绍一些新近发现的BM。     

酿酒酵母菌抗原在炎症性肠病结肠组织中的表达及意义

目的研究酿酒酵母菌抗原在炎症性肠病(IBD)结肠黏膜组织中的表达,评价酿酒酵母菌抗原在IBD诊断中的作用,初步探讨其在IBD发病中的意义。方法随机抽取航天中心医院2003年1月至2009年4月47例有完整临床资料的IBD患者的蜡块标本,其中克罗恩病(CD)22例、溃疡性结肠炎(UC)25例,另取非IBD结肠炎患者的蜡块标本20例作对照组。采用免疫组织化学法对标本石蜡切片进行染色,检测酿酒酵母菌抗原在肠黏膜组织中的表达,采用χ2检验分析酿酒酵母菌抗原在不同肠病中表达的差异性。结果免疫组织化学分析表明酿酒酵母菌抗原在CD阳性表达率为86.4%(19/22),在UC中为80.0%(20/25),在非IBD结肠炎中为70.0%(14/20),三组之间的阳性表达率差异无统计学意义(χ2=1.716,P=0.424)。结论酿酒酵母菌抗原在IBD中的表达无疾病特异性,暂不能作为诊断及鉴别诊断IBD的指标;酿酒酵母菌抗原在CD、UC患者及非IBD结肠炎患者结肠黏膜内的较广泛表达,也提示此类抗原蛋白在IBD的发生发展中发挥着不确定的作用。     

靶向超声微泡造影剂诊断与治疗炎性肠病的研究进展

炎性肠病(IBD)是一种慢性肠道性疾病,病程迁延,严重影响患者的生活质量。随着超声分子影像学的发展,靶向超声微泡造影剂除可应用于IBD的诊断外,还可作为一种载体,实现所携带药物、抗体等的靶向释放,起到对IBD靶向治疗作用,在IBD的诊断和治疗领域展现出很好的应用前景。     

炎症性肠病血清学标志物的研究进展

炎症性肠病(IBD)是一种病因不明的慢性肠道炎性疾病,包括克罗恩病(CD)和溃疡性结肠炎(UC)。当前IBD的诊断基于内窥镜下特点和组织病理学表现,但检查为侵入性且操作复杂。寻找一种简单、无创、敏感、经济、快速的方法来应用于IBD的诊断及病情评估成为目前亟待解决的问题,因此关于IBD的特异性血清学标志物已成为IBD的研究热点。文章结合国内外IBD领域的新近研究,对一些传统的血清学标志物的新进展以及最新发现的标志物,如抗酶原颗粒膜糖蛋白2(GP2)抗体、抗CUB和带状疱疹透明区样域蛋白1(CUZD1)抗体、巨噬细胞凋亡抑制因子(AIM)、血清源性透明质酸相关蛋白(SHAP)等进行介绍。     

核医学在炎症性肠病中的应用进展

综述核医学影像(SPECT及PET/CT)在炎症性肠病(inflammatory bowel disease,IBD)中的应用进展,放射性核素标记WBC SPECT及18F-FDG PET/CT是目前在IBD诊疗中应用最广的显像方法,可用于IBD的诊断、疗效判断及预后评价等。     

炎症性肠病药物治疗现状与进展

炎症性肠病(IBD)是一种病因尚不明确的慢性非特异性肠道炎症性病变,包括溃疡性结肠炎(UC)和克罗恩病(CD)。其发病与遗传、环境、免疫有关。IBD在国外特别是白种人中发病率较高,随着诊断技术的提高,在国内该病的报道日渐增多。近年来对其病因、发病机理及治疗的研究取得了较大进展,尤其是一些新药的应用明显提高了疗效。对IBD的治疗,目前着眼于控制炎症和调节免疫紊乱,以有效控制疾病发作和维持缓解。传统治疗IBD的三大类药物(水杨酸类、类固醇激素类、免疫抑制剂)的研究取得了很大的发展,目前仍是治疗IBD最常用的药物。随着IBD发病…     

高频超声在儿童炎症性肠病中的诊断价值

目的 探讨高频超声在儿童炎症性肠病中的诊断价值。方法 对比正常体检儿童及炎症性肠病患儿不同部位的肠壁厚度、层次结构及周围改变,分析高频超声在IBD中的声像图特点并总结诊断要点。结果 正常儿童及炎症性肠病患儿二者不同部位肠壁厚度均存在显著差异(P <0.05),其肠壁层次结构及周围组织之间也有不同表现。结论 利用高频超声检测肠壁厚度及其周围情况可以为IBD的诊断提供有力参考。     

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。     

Early macrophage MRI of inflammatory lesions predicts lesion severity and disease development in relapsing EAE

Magnetic resonance imaging (MRI) is of great utility in diagnosis and monitoring of multiple sclerosis (MS). Axonal loss is considered the main cause of accumulating irreversible disability. MRI using ultrasmall-super-paramagnetic-iron-oxide (USPIO) nanoparticles is a new technique to disclose in vivo central nervous system (CNS) inflammatory lesions infiltrated by macrophages in experimental autoimmune encephalomyelitis (EAE). Here, we raised the question of whether USPIO-enhanced MRI could serve as a tool to predict disease severity. We investigated, in a relapsing EAE model with various degrees of disease severity, the interindividual differences at the beginning of CNS inflammation as revealed in vivo by MRI with USPIO in correlation to the severity of both acute and chronic tissue damage including axonal loss. At the onset of the disease, observation of MRI alterations with USPIO allowed assignment of animals into USPIO+ and USPIO- groups. In 54.5% of diseased rats, MRI with USPIO+ at first attack revealed signal abnormalities mainly localized in the brainstem and cerebellum. Although animals did not present any clinically significant differences during the first attack, USPIO+ rats presented significantly more important tissue alterations at the first attack (onset and initiated recovery phase) and, at the second attack, more severe clinical disease with axonal loss compared to USPIO- rats. MRI lesion load and volume at the first attack correlate significantly with inflammation, macrophage recruitment, demyelination, acute axonal damage and, at the second attack, extent of axonal loss. This new MRI application of in vivo monitoring of macrophage infiltration provides a new platform to investigate the severity of inflammatory demyelinating CNS diseases.     

Granulomonocytapheresis as a cell-dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes

Ulcerative colitis (UC) and Crohn's disease (CD) are major phenotypes of the chronic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms. The chronic nature of IBD means that patients require life-long medications, and this may lead to drug dependency, loss of response together with adverse side effects as additional morbidity factors. The efficacy of antitumour necrosis factor (TNF)-α biologics has validated the role of inflammatory cytokines notably TNF-α in the exacerbation and perpetuation of IBD. However, cytokines are released by myeloid lineage leucocytes like the CD14⁺CD16⁺ monocyte phenotype. Additionally in IBD, myeloid leucocytes are elevated with activation behavior, while lymphocytes are compromised. Therefore, patients' leucocytes appear logical targets of therapy. Adsorptive granulomonocytapheresis (GMA) with an Adacolumn uses carriers, which interact with the Fcγ receptor expressing leucocytes and deplete the elevated myeloid leucocytes, while the neutrophils, which re-enter the circulation via the Adacolumn outflow (≥40%) are phagocytosed by CD19 B-cells to become interleukin (IL)-10 producing Bregs or CD19^highCD1D^high B-cells. IL-10 is an anti-inflammatory cytokine. GMA has been applied to treat patients with IBD. The efficacy outcomes have been impressive as well as disappointing, the clinical response to GMA defines the patients' disease course and severity at entry. Efficacy outcomes in patients with deep ulcers together with extensive loss of the mucosal tissue are not encouraging, while patients without these features respond well and attain a favorable long-term disease course. Accordingly, for responder patients, GMA fulfills a desire to be treated without drugs.     

Elevation of serum pyruvate kinase M2 (PKM2) in IBD and its relationship to IBD indices

ObjectivesEndoscopy remains the gold standard to diagnose and evaluate inflammatory bowel disease (IBD) activity. Current biomarkers or their combinations cannot adequately predict IBD risk, diagnosis, progression or relapse, and response to therapy. Pyruvate kinase M2 (PKM2) is emerging as a significant mediator of the inflammatory process. We aimed to assess levels of serum PKM2 in healthy and newly diagnosed IBD patients and its relationship with IBD indices and microbiota changes.Design and methodsIBD serum samples from newly diagnosed patients were collected and analyzed using a PKM2-ELISA and correlated with disease activity scores, IBD disease type, and intestinal microbiota. Furthermore, we tested the genetic and protein expression of PKM2 in an in vitro intestinal cell model of inflammation.ResultsSerum PKM2 levels were 6-fold higher in IBD patients compared to healthy controls, with no sensitivity to disease phenotype (Crohn's Disease or Ulcerative Colitis) or localization of inflammation. Serum PKM2 had considerably less interindividual variability than established IBD fecal biomarkers. A positive Pearson correlation (r = 0.6121) existed between serum PKM2 and Bacteroidetes fecal levels in Crohn's disease (CD), while a negative (r = − 0.6128) correlation was observed with Actinobacteria fecal levels. Furthermore, LPS (500 ng/mL) significantly increased PKM2 expression in vitro, which was significantly suppressed by an anti-inflammatory flaxseed bioactive agent.ConclusionOur data suggests PKM2 as a putative biomarker for IBD and the dysbiosis of microflora in CD. Investigations involving larger number of clinical patients are necessary to validate its use as a serum biomarker of IBD.     

Fecal leukocyte proteins in inflammatory bowel disease and irritable bowel syndrome

The aim of this prospective study was to compare five different leukocyte proteins in feces of patients with chronic inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and healthy persons who underwent prophylactic colonoscopy. METHODS: The leukocyte proteins calprotectin, lactoferrin, lysozyme, myeloperoxidase, and PMN-elastase were determined with immunoassays in fecal samples of three consecutive feces (e.g. three days) in 40 healthy persons, 39 patients with chronic IBD (of these 21 with Crohn's disease and 18 with ulcerative colitis), and 40 patients with IBS. RESULTS: ROC curves calculated for healthy persons and patients with IBD yielded the following areas under the curves (AUCs): PMN-elastase 0.916, calprotectin 0.872, myeloperoxidase 0.750, lysozyme 0.726, and lactoferrin 0.693. The AUCs of PMN-elastase and calprotectin were not significantly different (p = 0.327), whereas PMN-elastase or calprotectin vs. the other proteins were significantly different (p < 0.001). PMN-elastase and calprotectin correlated with the endoscopically classified severity of inflammation. All fecal leukocyte markers in IBS were found in the range of the healthy persons. Data on storage stability of leukocyte proteins in fecal supernatants are given. CONCLUSION: Fecal PMN-elastase and calprotectin support the differentiation of chronic IBD from IBS and correlate with the severity of inflammation.     

双能量CT评价克罗恩病活动性的研究进展

克罗恩病是胃肠道慢性炎症性疾病,诊断方法主要有内镜、CT小肠造影、MRI小肠造影以及生化标记物等,但目前仍缺少金标准。双能量CT成像可实现CT检查的多参数成像,并在降低辐射剂量的同时优化图像质量。本文就双能量CT的成像原理以及多参数分析在评价克罗恩病活动性中的应用进行综述。     

经腹肠道超声在炎症性肠病诊断中的应用及进展

炎症性肠病(IBD)是一种慢性炎症性疾病,病程漫长,症状发作与缓解反复交替,通常需要终身治疗。经腹肠道超声(TUBS)已成为临床IBD疑诊患者筛查的首选影像技术,对确定IBD病变的部位和范围、发现腹部并发症、评估炎症活动性及治疗后随访均有很高的敏感度和特异度。口服肠道超声造影、经静脉超声造影等超声新技术扩大了TBUS在IBD中的应用能力;而新兴的超声分子成像技术更有望使TBUS在疾病早期诊断上取得突破。     

Targeting Improves MSC Treatment of Inflammatory Bowel Disease

Inflammatory bowel disease (IBD), which includes Crohn''s disease and ulcerative colitis, is an inflammatory autoimmune disease characterized by T-cell infiltration to the colon. Mesenchymal stem cells (MSCs) have the potential to rescue IBD owing to their immunosuppressive capabilities and clinical studies have shown positive influence on intestinal graft versus host disease. We demonstrate here a new method to coat MSCs with antibodies against addressins to enhance their delivery to the colon and thereby increase the therapeutic effectiveness. Bioluminescence imaging (BLI) demonstrated that vascular cell adhesion molecule antibody (Ab)-coated MSCs (Ab_VCAM-1- MSCs) had the highest delivery efficiency to inflamed mesenteric lymph node (MLN) and colon compared to untreated MSCs, Ab_isotype-MSCs, and Ab_MAdCAM-MSCs. Therapeutically, when mice with IBD were injected with addressin Ab-coated MSCs, they showed dramatically improved survival rates, higher IBD therapeutic scores, and significantly improved body weight gain compared to mice injected with MSCs only, isotype Ab, free Ab plus MSCs, or vehicle-only controls. These data demonstrate that anti-addressin Ab coating on MSC increased cell delivery to inflamed colon and increased the efficacy of MSC treatment of IBD. This is the first study showing an increased therapeutic efficacy when stem cells are first coated with antibodies specifically target them to inflamed sites.     

钙卫蛋白及抗中性粒细胞胞浆抗体联合检测对炎症性肠病的诊断价值研究

目的 探讨钙卫蛋白与抗中性粒细胞胞浆抗体(ANCA)联合检测对炎症性肠病(IBD)的诊断价值.方法 收集确诊为IBD的患者79例作为IBD组,腹痛、腹泻等排除IBD的患者42例作为疾病对照组,健康体检者34例作为健康对照组.分别检测血液样本中ANCA和粪便样本中钙卫蛋白的水平.结果 79例IBD患者粪便钙卫蛋白浓度为(493.86±204.18)μg/g高于疾病对照组[(71.46±60.51)μg/g]和健康对照组[(36.19±13.46)μg/g].钙卫蛋白在IBD组、疾病对照组和健康对照组中的阳性率分别为57.0%、19.0%、0.0%;ANCA在三组中的阳性率分别为63.3%、4.8%、0.0%.IBD组的钙卫蛋白、ANCA阳性率显著高于其他两组(P＜0.05).钙卫蛋白与ANCA联合检测在IBD组、疾病对照组和健康对照组中的阳性率分别为78.5%、23.8%和0.0%.结论 钙卫蛋白和ANCA联合检测可显著提高IBD的诊断率,为临床IBD的早期诊断和治疗提供可靠依据.