炎症性肠病合并艰难梭菌感染患者的临床特征及危险因素分析

目的 分析炎症性肠病（inflammatory bowel disease,IBD）合并艰难梭菌感染（clostridium difficile infection,CDI）住院患者的临床特征及危险因素。方法 回顾性调查2021年1月至2022年4月住院的IBD患者,在入院后立即留取粪便采用艰难梭菌表面抗原谷氨酸脱氢酶（glutamate dehydrogenase,GDH）和PCR法检测艰难梭菌感染情况。分析纳入患者CDI的发生情况、临床特征和危险因素。结果 228例IBD患者中,溃疡性结肠炎（ulcerative colitis,UC）100例,克罗恩病（Crohn’s disease,CD）128例,UC患者CDI阳性率25.0%,CD患者阳性率30.2%。UC患者中,CDI阳性组与阴性组在粪钙卫蛋白、C反应蛋白、白蛋白、肌酐、临床类型、入院前3个月内住院史和30d内糖皮质激素、美沙拉嗪、质子泵抑制剂使用史中,差异有显著性（P<0.05）;CD患者中,CDI阳性组与阴性组在病程、红细胞沉降率、C反应蛋白、总胆固醇、病变部位、乌司奴单抗、入院前3个月内住院史和30d内糖皮质激...     

原发性慢性闭角型青光眼的彩色多普勒测定

彩色多普勒成像技术（Color Doppler flowimag-ine,CDI）是目前临床常用的无创性诊断方法 ,它在二维显像的基础上,获取血流频谱,进行血流动力学研究。我们利用CDI检测了正常人15例（30眼）及CACG患者25例（36眼）手术前后眼动脉（ophthalmic artery ，OA）、     

CD4＋CD25highTr和CTLA-4与炎症性肠病的关系研究

目的研究炎症性肠病（IBD）患者外周血CD4＋CD25high调节性T细胞（CD4＋CD25highTr）及其表面功能性标志性分子细胞毒T淋巴细胞相关抗原（CTLA-4）水平的变化,分析其在IBD发病中的意义。方法采用流式细胞仪测定50例IBD患者,包括克罗恩病（CD）30例与溃疡性结肠炎（UC）20例,以及性别与年龄相配健康对照者（n=29）外周血CD4＋CD25highTr及其CTLA-4,并进行对比分析。结果 IBD患者外周血CD4＋CD25highTr水平明显低于健康对照组（P〈0.05）;IBD患者外周血CTLA-4水平明显低于健康对照组（P〈0.05）;IBD组患者外周血CD4＋水平与健康对照组比较无明显差异;而CD与UC患者组间各指标对比无统计学意义。结论在IBD患者外周血中CD4＋CD25highTr及CTLA-4均明显低于正常对照组,提示具有免疫抑制活性的调节性T细胞亚群缺乏或功能缺陷可能在IBD的发病中起着重要作用。     

凝血功能异常与炎症性肠病相关性的研究进展

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）。IBD的病因和发病机制尚未完全明确,目前认为与环境、遗传、免疫所致的炎症反应等有关。近年来的研究发现IBD患者存在血液高凝状态及肠道微血栓形成,进而引起肠粘膜坏死,促进溃疡形成,这可能为IBD致病的另一因素。     

髓过氧化物酶对炎症性肠病病情活动监测的临床价值

目的：探讨髓过氧化物酶（MPO）作为炎症性肠病（IBD）病情活动监测指标的临床价值。方法：分别观察了15例IBD活动组患者[其中活动期溃疡性结肠炎（UC）10例．活动期克罗恩病（CD）5例]、15例IBD非活动组患者（其中缓解期UC10例，缓解期CD5例）、12例对照组患者结肠粘膜病理变化．按Oshitani评分标准和D＇haens评分标准进行UC和CD组织学评分，测定结肠黏膜MPO活性。结果：IBD活动组、IBD非活动组病理组织评分均比对照组高，IBD活动组病理组织评分亦较IBD非活动组高，差异均有统计学意义（P〈0．01）。IBD活动组、IBD非活动组肠粘膜MPO活性均较对照组高，IBD活动组MPO活性较IBD非活动组高，差异均有统计学意义（P〈0．01）。结论：MPO活性与IBD病情活动程度呈正相关，可作为IBD病情活动的临测指标。     

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。     

老年患者肠系膜上动脉钙化性病变CT影像学特征及临床分析

目的探讨老年患者肠系膜上动脉（SMA）钙化性病变CT影像学特征,分析其临床特征。方法回顾性分析2016年6月~ 2020年4月在我院进行SMA CT检查的186例患者,分析患者的一般临床资料,根据是否存在缺血性肠病（IBD）分为IBD组（n=26）与非IBD组（n=160）,分析比较两组患者SMA钙化的检出率以及钙化斑块的部位、形态、数目及狭窄程度,探讨SMA钙化的CT影像学特征及与IBD的相关性。结果IBD组SMA钙化斑块总数高于非IBD组（P < 0.05）;IBD组SMA钙化斑块主要以SMA远段为主,其次是SMA近段,而非IBD组钙化斑块主要以SMA近段、SMA中段,位置分布情况差异有统计学意义（P < 0.05）,IBD组SMA斑块的血管夹角低于非IBD组（P < 0.05）;两组开口处狭窄程度比较差异有统计学意义（P < 0.05）;IBD组患者SMA斑块钙化程度与其开口狭窄程度呈正相关（P < 0.05）。结论老年患者SMA钙化性病变多以远段为主,且患者若同时存在开口处狭窄程度≥25%,提示可能存在IBD。      

炎症性肠病患者疲乏的研究进展

炎症性肠病（Inflammatory Bowel Disease,IBD）是一种慢性、反复发作的肠道疾病,包括溃疡性结肠炎（Ulcerative Colitis,UC）和克罗恩病（Crohn＇s Disease,CD）两种类型。疲乏是IBD患者中常见的主诉之一。Mitchell等[1]早在1988年调查了IBD患者的生活质量,结果显示,对IBD患者生活质量影响最大的全身症状是疲乏,严重影响了患者的体力活动、功能状态及生活质量。研究[2]显示,有41%～48%处于疾病稳定期的患者有疲乏的症状,高达86%的中度至重度IBD患者有疲乏症状,患者对疲乏症状的关注有时会高于肠道症状。传统的观念认为IBD是器官结构及功能障碍性疾病[3],医学治疗方法的进步在改善IBD患者肠道症状方面取得了很大的进步,然而疲乏作为患者主观的症状却很少受到重视。本文主要从疲乏的概念、IBD患者疲乏的测量工具、影响因素及干预措施几个方面进行综述。     

炎症性肠病患者疾病关注状况的调查及分析

炎症性肠病（ inflammatory bowel disease, IBD）是一种病因不明的慢性非特异性的肠道炎症性疾病，病程冗长，长期的肠道和全身症状严重影响到患者的情感和社会功能，患者内心所饱受的忧虑严重影响了患者的生活质量。本研究采用IBD疾病关注分级表（rating form of IBD patient concems，RFIPC）对患者进行调查及分析，以帮助医护人员加深对患者疾病感受和体验的理解，为今后提供综合护理干预提供依据。     

炎症性肠病伴骨关节病变患者中HLA-B27表达情况分析

目的：研究HLA-B27在炎症性肠病（IBD）伴骨关节病变患者中的表达情况及两者间的相关性。方法：采用微量淋巴细胞毒试验（CDC）检测92例炎症性肠病患者（溃疡性结肠炎69例,克罗恩病23例,伴骨关节病变者18例）及55例健康对照者血清中HLA-B27的表达。结果：IBD患者HLA-B27的阳性率为22.83%,与正常对照组（3.64%）相比有统计学差异（P〈0.01）。IBD伴骨关节病变及IBD不伴骨关节病变患者HLA-B27的阳性率分别为55.56%和17.58%,两者相比有统计学差异（P〈0.01）,HLA-B27与炎症性肠病伴骨关节病变具有显著相关性（OR=5.87）。结论：HLA-B27阳性有助于炎症性肠病的诊断,并与骨关节病变的发生率密切相关,利于预测病情。     

艰难梭菌感染的预防及疫苗研究进展

艰难梭菌是抗生素相关性腹泻及伪膜性肠炎等医院获得性感染性疾病的主要病原菌。近些年高致病性BI/NAP1/027核糖体分型成为流行菌株,时常出现感染爆发流行,复发率及病死率呈上升趋势,造成极大的人力、财力、物力损失。因此,重视起艰难梭菌感控是必要的。疫苗研究是防治艰难梭菌的重要手段,国外研制艰难梭菌疫苗近20年,取得了一定进展。本文将对艰难梭菌预防及疫苗研究现状进行总结,期望能为临床医师和科研人员提供参考。     

Antibiotics for Treatment of Clostridium difficile Infection in Hospitalized Patients with Inflammatory Bowel Disease

Patients with inflammatory bowel disease (IBD), namely ulcerative colitis (UC) and Crohn''s disease (CD), have worse outcomes with Clostridium difficile infection (CDI), including increased readmissions, colectomy, and death. Oral vancomycin is recommended for the treatment of severe CDI, while metronidazole is the standard of care for nonsevere infection. We aimed to assess treatment outcomes of CDI in IBD. We conducted a retrospective observational study of inpatients with CDI and IBD from January 2006 through December 2010. CDI severity was assessed using published criteria. Outcomes included readmission for CDI within 30 days and 12 weeks, length of stay, colectomy, and death. A total of 114 patients met inclusion criteria (UC, 62; CD, 52). Thirty-day readmissions were more common among UC than CD patients (24.2% versus 9.6%; P = 0.04). Same-admission colectomy occurred in 27.4% of UC patients and 0% of CD patients (P < 0.01). Severe CDI was more common among UC than CD patients (32.2% versus 19.4%; P = 0.12) but not statistically significant. Two patients died from CDI-associated complications (UC, 1; CD, 1). Patients with UC and nonsevere CDI had fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen compared to those treated with metronidazole (30-day readmissions, 31.0% versus 0% [P = 0.04]; length of stay, 13.62 days versus 6.38 days [P = 0.02]). Patients with UC and nonsevere CDI have fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen relative to those treated with metronidazole alone. Patients with ulcerative colitis and CDI should be treated with vancomycin.     

肠道微生态与炎症性肠病

炎症性肠病（IBD）是具有遗传易感性的个体对肠道微环境的改变发生持续的异常免疫反应,所导致的慢性炎症性疾病,肠道微生态的改变在IBD的发病中起到重要的作用,本文综述了肠道微生态的构成和作用、IBD患者微生态的改变以及与肠道微生态改变相关的治疗手段在IBD患者中的治疗前景。     

Evaluation of gut dysbiosis using serum and fecal bile acid profiles

Dysbiosis in the intestinal microflora can affect the gut production of microbial metabolites, and toxic substances can disrupt the barrier function of the intestinal wall, leading to the development of various diseases. Decreased levels of Clostridium subcluster XIVa (XIVa) are associated with the intestinal dysbiosis found in inflammatory bowel disease (IBD) and Clostridium difficile infection (CDI). Since XIVa is a bacterial group responsible for the conversion of primary bile acids (BAs) to secondary BAs, the proportion of intestinal XIVa can be predicted by determining the ratio of deoxycholic acid (DCA)/[DCA + cholic acid (CA)] in feces orserum. For example, serum DCA/(DCA+CA) was significantly lower in IBD patients than in healthy controls, even in the remission period. These results suggest that a low proportion of intestinal XIVa in IBD patients might be a precondition for IBD onset but not a consequence of intestinal inflammation. Another report showed that a reduced serum DCA/(DCA + CA) ratio could predict susceptibility to CDI. Thus, the BA profile, particularly the ratio of secondary to primary BAs, can serve as a surrogate marker of the intestinal dysbiosis caused by decreased XIVa.     

Clostridium difficile: improving the prevention paradigm in healthcare settings

Clostridium difficile infection (CDI) is a major public health problem worldwide with significant morbidity and mortality that is spread by spores and fecal oral transmission. A variety of risk factors have been identified. Some risk factors such as age, are not amenable to change, while others such as antimicrobial utilization have resulted in broadly implemented antimicrobial stewardship programs. New risk factors are emerging such as proton pump inhibitor (PPI) use, irritable bowel disease (IBD) and obesity, with others yet to be determined. Prevention of spread of CDI is imperative, since therapy remains imperfect. We review established and emerging risks for CDI and offer potential preventative strategies with the use of a multidisciplinary CDI prevention bundle checklist.     

炎症性肠病患者的营养支持治疗

溃疡性结肠炎和克罗恩病等炎症性肠病患者常伴有营养不良及生长发育障碍。营养支持治疗在炎症性肠病治疗中占有重要地位。应常规对炎症性肠病患者进行营养风险筛查,并采用适当方法进行营养评定,以便及时进行营养支持。肠内营养支持作为儿童克罗恩病患者诱导缓解和维持治疗的首选,在成人患者中作为药物的替代治疗。有多种营养制剂,不同患者对不同的营养制剂反应不同,需选择合适的制剂,进行个体化治疗,才能发挥营养制剂的最大效用。     

Age-Stratified Treatment Response Rates in Hospitalized Patients with Clostridium difficile Infection Treated with Metronidazole

Consensus on the optimal treatment of Clostridium difficile infection (CDI) is rapidly changing. Treatment with metronidazole has been associated with increased clinical failure rates; however, the reasons for this are unclear. The purpose of this study was to assess age-related treatment response rates in hospitalized patients with CDI treated with metronidazole. This was a retrospective, multicenter cohort study of hospitalized patients with CDI. Patients were assessed for refractory CDI, defined as persistent diarrhea after 7 days of metronidazole therapy, and stratified by age and clinical characteristics. A total of 242 individuals, aged 60 ± 18 years (Charlson comorbidity index, 3.8 ± 2.4; Horn''s index, 1.7 ± 1.0) were included. One hundred twenty-eight patients (53%) had severe CDI. Seventy patients (29%) had refractory CDI, a percentage that increased from 22% to 28% and to 37% for patients aged less than 50 years, for patients from 50 to 70 years, and for patients aged >70 years, respectively (P = 0.05). In multivariate analysis, Horn''s index (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.50 to 2.77; P < 0.001), severe CDI (OR, 2.25; 95% CI, 1.15 to 4.41; P = 0.018), and continued use of antibiotics (OR, 2.65; 95% CI, 1.30 to 5.39; P = 0.0072) were identified as significant predictors of refractory CDI. Age was not identified as an independent risk factor for refractory CDI. Therefore, hospitalized elderly patients with CDI treated with metronidazole had increased refractory CDI rates likely due to increased underlying severity of illness, severity of CDI, and concomitant antibiotic use. These results may help identify patients that may benefit from alternative C. difficile treatments other than metronidazole.     

Is there a role for fish oil in inflammatory bowel disease?

A number of animal and human studies suggest omega 3-fatty acids are anti-inflammatory. As a result they may have a therapeutic role in inflammatory bowel disease (IBD). The aim of this review is to briefly assess the literature about the utility of poly-unsaturated fatty acids (PUFAs) in the management of IBD. Taken together, almost all studies suggest some beneficial effects of n-3 PUFAs in IBD but the mechanism remains controversial. In addition, clinical benefit seems to be largely confined to ulcerative colitis. However all studies have concluded that these compounds have no potential for a steroid/aminosalicylic acid sparing effect or to maintain remission. Now the question arises as to whether this treatment is of real value to IBD patients? Clearly they have some therapeutic potential but further work is needed.     

儿童中枢性尿崩症的MRI诊断价值

目的：探讨磁共振成像（MRI）在儿童中枢性尿崩症（CDI）中的应用价值。材料和方法：对18例临床确诊为儿童CDI患者的MRI平扫及增强检查结果进行回顾性分析。结果：18例CDI患儿垂体后叶T1WI高信号均消失。其中颅咽管瘤7例，生殖细胞瘤2例，下丘脑-垂体区占位性病变3例，3例垂体柄和，或下丘脑漏斗部局限性梭形或球形增粗，单纯垂体后叶T1WI高信号消失者3例。结论：基于儿童CDI自身的特点，MRI平扫及增强扫描对诊断儿童CDI及寻找其病因具有重要价值。垂体后叶T1WI高信号消失是儿童CDI的非特异性MRI指标。