治疗药物监测在炎症性肠病新型生物制剂治疗中的研究进展

炎症性肠病（IBD）是一种慢性肠道炎症性疾病,其治疗包括传统药物和生物制剂。治疗药物监测是优化生物制剂治疗的重要工具。肿瘤坏死因子抑制剂的治疗药物监测已被用于指导临床决策。然而新型生物制剂（维得利珠单抗和乌司奴单抗）的治疗药物监测在IBD中的应用价值目前尚不明确。本文就新型生物制剂治疗IBD的药代动力学、药物浓度与治疗结局、优化治疗等方面作一概括总结。     

炎症性肠病联合治疗的研究现状

随着炎症性肠病(inflammatory bowel disease,IBD)的发病率日益升高,其治疗也备受关注。从传统的治疗药物到新型制剂的开发及新的治疗手段如干细胞移植、粪便移植的出现,治疗观念也在不断更新,其中包括传统用药规则的革新及既往"step-up"向"step-down"治疗策略的扩展。而联合治疗作为一种重要的治疗手段,在很多研究中也展示了其特有的优势。本文就近几年与IBD相关的联合治疗从不同口服药物联合、不同剂型药物联合、非药物治疗与药物治疗联合及传统中医与常用西药联合等方面作一概述。     

新型生物制剂治疗炎症性肠病的研究进展

炎症性肠病(IBD)是一种慢性非特异性肠道炎症性疾病,传统的治疗药物包括氨基水杨酸类药物、糖皮质激素、免疫抑制剂等,长期使用不良反应多、复发率高,且对重度患者疗效不佳。研究表明生物制剂在IBD诱导和维持缓解、促进黏膜愈合、改善患者生活质量等方面效果显著。随着对IBD发病机制研究的深入,新型生物制剂的研发已广泛开展。本文就新型生物制剂治疗IBD的研究进展作一综述。     

肿瘤坏死因子-α抑制剂对炎症性肠病患者生育的影响

炎症性肠病(IBD)是一种病因尚未完全明确的肠道慢性非特异性炎症性疾病,包括克罗恩病(CD)和溃疡性结肠炎(UC),传统的治疗药物包括氨基水杨酸类药物、糖皮质激素以及免疫抑制剂,主要用于控制和缓解轻中度临床症状。肿瘤坏死因子(TNF)-α抑制剂等新型生物制剂对传统药物治疗无效和重症IBD患者具有显著疗效。IBD患者发病年龄多在生育期,药物对生育的影响越来越受学界关注。本文就TNF-α抑制剂对IBD患者生育影响的研究进展作一综述。     

炎症性肠病治疗的新进展

炎症性肠病(inflammatory bowel disease,IBD)主要包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD),其病因尚不明确,迄今也无有效的治愈方法.目前临床上的药物治疗包括传统药物治疗及新型生物制剂.传统药物主要有氨基水杨酸类、肾上腺糖皮质激素和免疫抑制剂;用于临床的新型生物制剂主要为肿瘤坏死因子(tumor necrosis factor-α,TNF-α)的单克隆抗体.随着研究的深入及制药的进步,IBD的治疗有了新的进展,如传统药物新剂型的出现及新的给药方式,新型治疗药物的问世.本文就IBD治疗新进展作一综述.     

炎症性肠病性别差异机制的研究

近年来,疾病的性别差异逐渐被人们关注,炎症性肠病(inflammatory bowel disease, IBD)的性别差异也成为一个新的研究热点。IBD传统治疗药物存在很大的局限性,了解IBD的性别差异,有助于为IBD的个体化治疗提供理论支持。本文将从IBD的流行病学、心理学、细胞生物学、遗传、年龄因素、肠道菌群以及治疗差异的相关进展作一概述。     

炎症性肠病实验研究的动物模型

炎症性肠病(IBD)主要包括溃疡性结肠炎(UC)和克罗恩病(CD),是一种反复发作的慢性非特异性肠道炎症性疾病,其确切的病因和发病机制至今还不清楚,治疗上也缺乏特异有效的药物[1]。因此,为研究其病因和发病机制以及开发新药物,建立理想的、类似于人类IBD的动物模型就显得非常重要。理想的IBD实验动物模型应具有如下特点:(1)肠道炎症的发生、病程、病理及病理生理学改变应与人类IBD相同或相似;(2)实验动物应具有明确的遗传背景;(3)实验动物应具有已知抗原易于诱导免疫反应的免疫学特点;(4)传统IBD治疗药物对其治疗有效;(5)实验动物在没…     

他克莫司治疗炎症性肠病的最新进展

炎症性肠病(inflammatory bowel disease, IBD)的传统用药包括氨基水杨酸制剂、糖皮质激素、免疫抑制剂如硫嘌呤类、环孢素等药物.近十多年来,抗肿瘤坏死因子药物(anti-tumor necrosis factor, anti-TNF)的应用使IBD患者的临床缓解方面取得了显著进展,但其仍然存在无反应、无法耐受和停用后复发等问题.近些年来发现,他克莫司,一种新型强效免疫抑制剂,作为治疗IBD的二线治疗药物被使用.目前,他克莫司的短期诱导缓解作用相对明显,被逐渐应用在传统药物难治或者anti-TNF难治的IBD中.少数研究发现,在适当的监测下,他克莫司可以长期安全地使用.但其长期疗效和长期使用安全性的证据还比较少.本文就他克莫司在IBD中的治疗最新进展及其与anti-TNF的比较作一综述.     

单克隆抗体Infliximab治疗炎症性肠病的研究进展

Infliximab是一种嵌合型单克隆抗体,可靶向炎症性肠病(IBD)发病机制中起重要作用的促炎细胞因子-人肿瘤坏死因子-α(TNF-α)。Infliximab通过与巨噬细胞和T细胞表面的TNF-α结合而拮抗TNF-α的生物活性。Infliximab比大多数治疗IBD传统药物起效迅速,且药物不良反应较小。Infliximab可以有效治疗IBD,提高患者的生活质量。     

干细胞治疗炎症性肠病的安全性及有效性

炎症性肠病(inflammatory bowel disease,IBD)是一组以复杂的病因和病理生理学改变为基础的疾病,涉及肠道微生物的改变、异常免疫反应、肠上皮细胞和血管系统提供的重要屏障的破坏,并且是一种难以治愈的疾病。药物治疗及手术切除等传统治疗方式存在明显的不足。近年干细胞因其生物学特性开辟了治疗IBD的新型方法。本文就传统方式治疗IBD的不足进行概括,并对干细胞尤其是间充质干细胞移植治疗IBD的安全性、有效性文献进行了回顾总结。     

Characteristics of inflammatory bowel diseases in patients with concurrent immune-mediated inflammatory diseases

Patients with inflammatory bowel disease (IBD) are more likely to have concurrent immune-mediated inflammatory diseases (IMIDs) than those without IBD. IMIDs have been observed to alter the phenotype and outcomes of IBD in recent studies. Several studies have found that IBD patients with concurrent IMIDs may have more extensive or severe disease phenotypes, and are considered to be at increased risk of requiring biologics and IBD-related surgeries, suggesting that having multiple IMIDs is a poor prognostic factor for IBD. Furthermore, IBD patients with primary sclerosing cholangitis and Takayasu arteritis are reported to have unique endoscopic phenotypes, suggesting concurrent IMIDs can influence IBD phenotype with specific intestinal inflammatory distributions. In this review, we discuss the pathogenesis, disease phenotypes, and clinical outcomes in IBD patients with concomitant IMIDs.     

Roles of G protein-coupled receptors in inflammatory bowel disease

Inflammatory bowel disease(IBD) is a complex disease with multiple pathogenic factors. Although the pathogenesis of IBD is still unclear, a current hypothesis suggests that genetic susceptibility, environmental factors, a dysfunctional immune system, the microbiome, and the interactions of these factors substantially contribute to the occurrence and development of IBD. Although existing and emerging drugs have been proven to be effective in treating IBD,none can cure IBD permanently. G protein-coupled receptors(GPCRs) are critical signaling molecules implicated in the immune response, cell proliferation,inflammation regulation and intestinal barrier maintenance. Breakthroughs in the understanding of the structures and functions of GPCRs have provided a driving force for exploring the roles of GPCRs in the pathogenesis of diseases, thereby leading to the development of GPCR-targeted medication. To date, a number of GPCRs have been shown to be associated with IBD, significantly advancing the drug discovery process for IBD. The associations between GPCRs and disease activity, disease severity, and disease phenotypes have also paved new avenues for the precise management of patients with IBD. In this review, we mainly focus on the roles of the most studied proton-sensing GPCRs, cannabinoid receptors,and estrogen-related GPCRs in the pathogenesis of IBD and their potential clinical values in IBD and some other diseases.     

炎症性肠病相关性肝病的研究进展

炎症性肠病(inflammatory bowel disease,IBD)是一种累及回肠、结肠、直肠的特发性炎症性疾病,本病主要包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD)。除常见的消化道症状外,研究发现IBD合并肝脏疾病较为常见,是IBD常见的肠外表现之一,其严重影响IBD的预后与转归。本文就IBD相关性肝病的分类和总结作一概述,以期为IBD及其肝脏病变的临床诊疗提供参考。     

La enfermedad inflamatoria intestinal y los riesgos de enfermedad cardiovascular

Inflammatory bowel disease (IBD) includes both ulcerative colitis and Crohn's disease, which are well recognised as chronic systemic and immune-mediated conditions that frequently involve extraintestinal manifestations. Although comorbidities have long been the subject of research in other chronic inflammatory diseases, this concept is also emerging in IBD. Many pathologies have been linked to IBD, including cardiovascular disease, which is the main cause of death in developed countries. IBD patients are at increased risk of conditions such as early atherosclerosis and myocardial infarction or venous thrombosis and pulmonary thromboembolism. The aim of this review is to make an approximation of the physiopathology of the different manifestations of cardiovascular disease in patients with IBD and how to prevent them.     

Hepatobiliary associations with inflammatory bowel disease

Hepatobiliary disease is not uncommon in patients with inflammatory bowel disease (IBD). The most common autoimmune hepatic associations are primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH). The immunosuppressant medications used in the treatment of IBD also have potential hepatotoxicity. PSC is most commonly associated with IBD, specifically ulcerative colitis. AIH, a more classic autoimmune disease diagnosed commonly in isolation of other conditions in the same individual, is less commonly associated with IBD. Additionally, a subgroup of patients have features of both PSC and AIH, termed overlap syndrome, that is also sometimes seen in IBD patients. This review will discuss the most common liver disease associations seen in patients with IBD: PSC, AIH and overlap syndrome. Additionally, the most common drug-related hepatotoxicities encountered when treating IBD will be reviewed.     

IBD: a family affair

The recent molecular advances in the understanding of the genetics of inflammatory bowel disease (IBD) have their grounding in studies examining IBD within different family groups and populations. The risk of IBD is highest in first-degree relatives of an IBD proband but more distant relatives are also at increased risk. The risk is higher for relatives of a CD proband. The risks of developing IBD for 'high-risk' relatives might be as great as 1 in 3 but in general first-degree relatives have a 1 in 10-20 risk. Three recent systematic studies have identified a total of 326 European twin pairs to examine disease concordance rates. The derived heritability in Crohn's disease is greater than for many complex diseases and is currently under detailed examination. Strong concordance has been shown, in particular for disease type and disease location, in multiplex families and twin studies. More than 75% children are diagnosed with IBD at a younger age than their parents but true genetic anticipation appears unlikely.     

Scoring systems in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic, relapsing condition affecting the GI tract that can affect individuals of any age and results in lifelong treatment, frequently including the need for surgery. Historically, the lack of a single effective and sensitive test for IBD has posed a great challenge in assessing disease severity, effectiveness of medication and predicting outcomes for this complex condition. Several IBD scoring and classification systems have been developed over many years to classify and characterize IBD patients, with the goal of helping to better define the disease status and effectiveness of therapy. Recent genetic investigations have revealed the complexity of IBD at the pathophysiologic level, revealing numerous genetic mutations associated with the disease. Thus, these clinically based IBD classification systems can provide the basis for the eventual correlation between the underlying genotype with clinical expression of disease and lead to better characterization of disease subtypes and, hopefully, customized treatment regimens.     

Obesity and novel management of inflammatory bowel disease

Obesity is prevalent within the inflammatory bowel disease(IBD) population,particularly in newly developed countries.Several epidemiological studies have suggested that 15%-40% of IBD patients are obese,and there is a potential role of obesity in the pathogenesis of IBD.The dysfunction of mesenteric fat worsens the inflammatory course of Crohn’s disease and may induce formation of strictures or fistulas.Furthermore,obesity may affect the disease course or treatment response of IBD.Given the incr...     

Differences between adults and children: genetics and beyond

Clinical observations and epidemiological studies have highlighted some important differences in disease course and phenotypes between pediatric inflammatory bowel disease (IBD) and adult-onset IBD. Also from a therapeutic angle, the approach to young-onset IBD is different with a more rapid introduction of azathioprine and a high threshold for long and systemic steroid use, which may affect bone mineral density and growth. The observed clinical differences have been an area of scientific research and genetic studies have been the focus of attention. Specific candidate gene studies as well as genome-wide association studies have been performed in pediatric IBD. With the exception of very early-onset IBD occurring before the age of 2 years; no overt differences in genetic susceptibility have been identified. In contrast, very early-onset IBD seems in particular to be a genetic disease with defects in the IL10 signaling pathway being the principal example. This review aims to answer some straightforward questions arising in this topic by giving concise information.