肠道微生态改变在炎症性肠病中的作用

炎症性肠病（IBD）主要包括溃疡性结肠炎（UC）和克罗恩病（CD），其病因和发病机制尚未明确。目前认为IBD的病因为肠道微环境（肠道菌群）、宿主遗传易感性和黏膜免疫因素三者间的相互作用。近年来．随着微生态学的发展，肠道菌群与IBD发病的关系日益受到关注。本文就IBD时肠道菌群的变化、肠道微生态改变对IBD的影响以及微生态制剂对IBD的治疗作用作一综述。     

基于肠道菌群参与的炎症性肠病色氨酸代谢的研究进展

色氨酸是一种人体必需氨基酸,其主要通过3条代谢途径产生多种具有生物活性的产物,参与病理、生理过程。肠道菌群在调控色氨酸代谢途径中起着重要作用,其与IBD的发病机制及治疗密切相关,色氨酸可能是IBD与肠道菌群之间的枢纽。了解肠道菌群参与的IBD患者的色氨酸代谢途径,有助于发现新的IBD治疗靶标。该文就肠道菌群与色氨酸代谢之间的相互调节作用、IBD患者的色氨酸代谢变化、色氨酸代谢对IBD的作用机制及其潜在应用价值等的研究进展作一综述。     

肠道菌群与炎症性肠病

本文简述了肠道菌群与炎症性肠病(IBD)发病和诊治的关系,并展望未来对IBD进行肠道微生态的靶向治疗可能成为一种治疗新途径。     

肠道菌群与炎症性肠病

证据表明,肠道微菌群在炎症性肠病发病机制中具有重要作用,且是IBD患者控制肠道炎症反应和重要辅助因子之一。本文综述对肠道炎症有调节作用的肠道常驻菌群及其疗法。     

炎症性肠病与肠道菌群

炎症性肠病(IBD)包括溃疡性结肠炎(UC)和克罗恩病(CD),其特征是反复发生肠道溃疡,以腹痛、黏液脓血便为主要症状。IBD的发病机制仍不清楚,目前认为与宿主遗传易感性、黏膜免疫和肠道菌群有关。与正常人相比,IBD患者存在不同程度的菌群失调,主要表现在益生菌数量减少和条件致病菌数量增多。此文就IBD患者肠道菌群的分布和检测方法以及微生态制剂(MEA)对IBD的作用作一综述。     

肠外营养在炎症性肠病中的应用

目的分析和探讨肠外营养在炎症性肠病中的应用。方法 参照１９９３年全国慢性非感染肠道疾病学术研讨会制定的炎症性肠病的诊断标准对武汉同济医院消化内科１９８６年１月至１９９６年１２月的炎症性肠病住院病人进行了分析，着重探讨了以炎症性肠病的内科治疗，尤其是肠外营养的应用。结果 １１年间炎症性脾性病的年平均住院人数有所上升；其内科治疗除以柳氮磺胺吡啶５－氨基水杨酸为主要药物外，合理的肠外营养，明显改善了炎症     

炎症性肠病的肠道菌群变化

炎症性肠病(IBD)是一种慢性非特异性肠道炎性疾病,其确切病因及发病机制至今仍不清楚。近年来肠道菌群与IBD发病的关系日益受到关注,多项证据表明IBD患者存在肠道菌群紊乱。此文就IBD患者肠道菌群变化及益生菌在IBD中治疗作用的研究进展作一综述。     

肠道菌丛与炎症性肠病

炎症性肠病（inflammatory bowel disease，IBD）包括溃疡性结肠炎（ulcerative colitis，UC）和克罗恩病（Crohn＇s disease，CD）。病因至今不明，可能的病因包括由基因决定的宿主易感性、黏膜免疫和肠道微生态环境三的相互作用。目前研究较多的是肠道菌群与IBD发病的关系。肠道微生物的有害作用可见于一些IBD的动物模型。在这些动物模型中，动物在无菌的环境中不发生肠道炎症。Harper等人曾报道如果把已行回肠造口术的CD患的小肠流出物注入结肠，则诱导结肠炎症，然而将无菌的小肠超滤液注入结肠则不发生炎症。并不是所有的肠道细菌均可导致肠道炎症，一些细菌具有保护作用。这不但决定于它们分泌有毒物质的能力和细胞壁的成分（脂多糖，肽聚糖），也决定于DNA成分（尤其是CpG）。最近的一些研究表明，肠道微生态制剂包括乳酸杆菌、双歧杆菌和酵母菌对实验性结肠炎或人的IBD可以产生阻抑影响。     

炎症性肠病动物模型研究进展

炎症性肠病是消化系疾病研究的难点之一，选择合适的动物模型对于研究发病机制及寻求有效治疗手段十分重要。随着对该病研究的深入和新兴生物学技术的大规模应用，产生了很多新的模型制备方法，其动物模型日趋多样。     

Mucosal and Invading Bacteria in Patients with Inflammatory Bowel Disease Compared with Controls

Background: Endogenous intestinal bacteria and/or specific bacterial pathogens are suspected of being involved in the pathogenesis of inflammatory bowel diseases (IBD). The aim of this study was to investigate IBD tissues for different bacterial population groups harbouring the mucosal surface and/or invading the mucosa. Methods: Tissue sections from surgical resections from the terminal ileum and/or the colon from 24 IBD patients (12 active ulcerative colitis (UC), 12 active Crohn disease (CD)) and 14 non-IBD controls were studied by fluorescent in situ hybridization on a quantifiable basis. Results: More bacteria were detected on the mucosal surface of IBD patients than on those of non-IBD controls ( P < 0.05). Bacterial invasion of the mucosa was evident in 83.3% of colonic specimens from the UC patients, in 55.6% of the ileal and in 25% of the colonic specimens from the CD patients, but no bacteria were detected in the tissues of the controls. Colonic UC specimens were colonized by a variety of organisms, such as bacteria belonging to the gamma subdivision of Proteobacteria , the Enterobacteriaceae , the Bacteroides/Prevotella cluster, the Clostridium histolyticum/Clostridium lituseburense group, the Clostridium coccoides/Eubacterium rectale group, high G + C Gram-positive bacteria, or sulphate-reducing bacteria, while CD samples harboured mainly bacteria belonging to the former three groups. Conclusion: Pathogenic events in CD and UC may be associated with different alterations in the mucosal flora of the ileum and colon.     

Increased Serum Levels of Eotaxin in Patients with Inflammatory Bowel Disease

Background: The CC-chemokines eotaxin and eotaxin-2, produced by epithelial and phagocytic cells, are potent and selective chemoattractants for eosinophils and basophils. The eosinophil is a potent inflammatory cell thought to play an important role in the pathogenesis of inflammatory bowel disease (IBD). In this study we investigated the serum concentrations of eotaxin and eotaxin-2 in patients with Crohn disease and ulcerative colitis. Methods: Thirty-one patients with Crohn disease, 35 patients with ulcerative colitis and 41 control patients were studied. Eotaxin and eotaxin-2 serum levels were measured with solid phase sandwich enzyme-linked immunosorbent assays. Results:     

Staphylococcus aureus in Inflammatory Bowel Disease

Background: The potential role of superantigens in inflammatory bowel disease (IBD), particularly Crohn disease, has been broached in studies of the functions of T cell receptors. Staphylococcal cells have been found in intestinal lymph follicles of IBDs. To clarify a role of staphylococcal superantigens in IBD, we attempted to determine whether Staphylococcus aureus could be detected in intestinal mucosa, including surgical specimens and lymph follicles of initial cases. Methods: One-hundred-and-six colonic and ileal specimens were obtained from 38 Crohn disease, 25 ulcerative colitis and 36 non-IBD patients through therapeutic surgery or endoscopic biopsy. In Crohn disease, 23 surgical specimens and 11 biopsy specimens from initial cases were included. DNA was extracted with phenol-chloroform after homogenization and proteinase K treatment in 73 mucosal specimens. Using an inverted microscope, lymph follicle tissue was microdissected from the remaining 33, mostly biopsy, specimens. DNA was then extracted by freeze-thawing. A coagulase gene characteristic of S. aureus was sought. A nested polymerase chain reaction was performed utilizing primers that amplify a region of the coagulase gene. Polymerase chain reaction products were analyzed with polyacrylamide gel electrophoresis. Results: Only one surgically resected colonic specimen, from a 42-year-old male ulcerative colitis patient, registered positive staphylocoagulase amplification. Conclusions: Staphylococcal superantigens are not involved in either the early lesions or the established lesions of Crohn disease. However, S. aureus infection occasionally may occur during the course of IBD.     

C反应蛋白反映炎症性肠病的活动性

背景：临床上评估炎症性肠病活动性的方法有临床活动度、C反应蛋白（CRP）和血沉等，三者常不一致。目的：探讨CRP评估炎症性肠病活动性的价值。方法：以Logistic回归法分析80例克罗恩病（CD）、70例溃疡性结肠炎（UC）患者血清CRP与血沉、临床活动度、内镜表现活动性、组织学活动性、低白蛋白血症、贫血、白细胞升高的关系；比较临床严重度、病变部位和药物治疗对CRP的影响。结果：CD中CRP与血沉相关；UC中CRP与血沉、外周血白细胞升高相关。CRP在活动性CD中显著升高（P〈0．01），重度CD和结肠CD中CRP升高较其他各组明显（P〈0．05）；活动性UC中CRP亦显著升高（P〈0．01），重度组中CRP升高较其他组明显（P〈0．05）。药物有效控制临床表现时．CRP显著下降（P〈0．01），复发时重新升高（P〉0．05）。结论：CRP升高更适于反映中至重度结肠CD和UC的活动性：具有快速反映药物治疗有效性的特点。     

Anti-Saccharomyces cerevisiae Antibodies in Inflammatory Bowel Disease: a Family Study

Background: Antibodies to Saccharomyces cerevisiae (ASCA) have been described as specific markers for Crohn disease (CD). The reason for this disease specific generation of antibodies is not clear. Therefore, a family study was performed to evaluate whether the antibody production was due to genetic or environmental factors. Methods: Seventy-one patients with CD, 25 patients with ulcerative colitis (UC), their 282 first-degree relatives, and 32 spouses were included. As controls, 43 sera from healthy persons and 69 sera from patients with various autoimmune disorders were tested for ASCA by indirect immunofluorescence and ELISA. Results: ASCA were detected in 68% of the patients with CD and in none of the controls, UC patients included. Forty-eight (25%) first-degree relatives ofpatients with CD were ASCA-positive. ASCA status of relatives was not related to the fact whether these persons lived in the same household with the patients or not. However, one of the spouses of CD patients (4%) was found to be ASCA-positive and the antibody was also found in 5 (6%) ofthe relatives of UC patients. Conclusions: ASCA are specific markers for CD. Since these antibodies are found in 25% of first-degree relatives, the generation of ASCA may be mainly related to genetic influences although environmental factors may also play a certain role.     

Musculoskeletal Manifestations in a Population-based Cohort of Inflammatory Bowel Disease Patients

Background: Musculoskeletal disorders are the most common extra-intestinal manifestation of inflammatory bowel disease (IBD). Wide ranges of prevalence have been reported depending on the criteria used to define spondylarthropathy and on the selection of patients. We aimed to evaluate the prevalence and clinical spectrum of musculoskeletal manifestations in an inception cohort of European IBD patients. Methods: From 1 October 1991 to 30 September 1993, 202 IBD patients were diagnosed in three centres of two countries (Italy and The Netherlands) by means of a population-based inception cohort study. Of this group of patients, 160 (79%) were interviewed and examined by a rheumatologist and a gastroenterologist in the period June-September 1996. A total of 139/160 patients had an anteroposterior radiograph of the pelvis, and in 140/160 HLA-B27 was determined. Results: 53 (33.1%) of the 160 patients had experienced at least one musculoskeletal manifestation, 29 (18.1%) satisfied the European Spondylarthropathy Study Group (ESSG) criteria for spondylarthropathy and 5 (3.1%) satisfied the modified New York criteria for ankylosing spondylitis. However, 23 (14.4%) patients developed one or more spondylarthropathy-related manifestations without fulfilling any of the classification criteria. In patients satisfying ESSG criteria a significantly higher frequency of women ( P = 0.03), of ocular and liver involvement ( P = 0.01 and P = 0.03, respectively), and use of immunosuppressive drugs ( P = 0.02) was observed. Conclusion: Our study shows a high prevalence of musculoskeletal manifestations in an inception cohort of IBD patients. The clinical spectrum is broader than that defined by spondylarthropathy criteria.     

炎症性肠病的鉴别诊断

近年来我国炎症性肠病的发病率和患病率均呈上升趋势．作为临床难点的鉴别诊断问题日益引起临床医师的高度重视。本文对炎症性肠病与感染性结肠炎和非感染性结肠炎的鉴别诊断进行阐述．强调应对慢性腹泻、腹痛患者进行及时准确的诊断和鉴别诊断,以最大程度地降低临床漏诊率和误诊率。     

英夫利昔单抗治疗炎症性肠病的研究进展

肿瘤坏死因子－α（TNF－α）是一种促炎细胞因子,在炎症性肠病（IBD）的发病过程中起重要作用。英夫利昔,单抗（infliximab）是一种人-鼠嵌合型TNF-αIgGl单克隆抗体,与体内多种形式的TNF-α有较强结合能力。美国食品药品管理局（FDA）于1998年批准该制剂用于治疗传统药物治疗无效的中重度或合并瘘管的克罗恩病（CD）,试验显示其对难治性活动性溃疡性结肠炎（UC）亦有一定疗效。英夫利昔单抗的使用已积累了10年的经验,本文对其作用机制、疗效、安全性方面的研究进展作一综述。     

炎症性肠病治疗中的新概念

炎症性肠病（IBD）主要包括溃疡性结肠炎（UC）和克罗恩病（CD）,其治疗疗程长、效果不佳、容易反复,主要原因为目前对该病的发病机制仍不甚了解以及缺乏特异性治疗药物。随着对IBD发病机制认识的不断深入,其发病过程中的炎症和免疫途径不断被揭示,这些新理念的发展直接导致了新的治疗药物和治疗方法的出现。本文主要结合目前IBD发病机制的研究进展,对其治疗中的一些新概念作一论述。