溃疡性结肠炎相关性结直肠癌危险因素分析及延伸网络护理效果评价

目的分析溃疡性结直肠炎相关性结直肠癌危险因素,并探讨延伸网络护理对患者遵医行为的影响。方法选取2012年1月至2015年1月于我院治疗的120例溃疡性结肠炎患者为研究对象,分析其临床资料,总结导致患者病灶癌变的危险因素,并对患者实施延伸网络护理,比较护理前后患者遵医行为与生活质量。结果溃疡性结肠炎相关癌患者年龄、病程、病变范围、病灶癌变前活检有不典型增生、激素的使用、未进行内镜随访与溃疡性结肠炎患者比较,差异具有统计学意义(P0.05);护理后,患者遵医行为明显高于护理前,GQOLI评分明显高于护理前,差异均具有统计学意义(P0.05)。结论年龄、病程、病变范围、病灶癌变前活检有不典型增生、激素的使用、未进行内镜随访是导致溃疡性结肠炎相关结直肠癌发生的危险因素;对溃疡性结肠炎患者实施延伸网络护理可提高患者的遵医行为与生活质量。     

溃疡性结肠炎癌变监测的研究进展

长病程的溃疡性结肠炎(ulcerative colitis,UC)癌变风险增加,进而发展为UC相关性结直肠癌(UC-colorectal cancer,UC-CRC)。UC-CRC是长病程UC患者最为严重的并发症。而多数UC-CRC都是由异型增生发展而来,因而识别高危人群,早期监测和诊断有着极其重要的价值。目前临床上监测主要依靠内镜+病理活检,而随着技术的发展,新的内镜技术已广泛应用于临床;同时伴随着分子生物学技术的创新和应用,一些特异性的生物标志物也被发现可用于早期UC-CRC的监测。本文就目前UC癌变监测的现状、内镜监测及生物标志物监测的进展进行综述。     

溃疡性结肠炎相关肿瘤3例诊疗报道并文献复习

目的探讨溃疡性结肠炎(ulcerative colitis, UC)相关肿瘤的临床特点、诊治、预后。方法对3例UC相关肿瘤患者的临床资料进行回顾性分析并复习相关文献。结果 3例UC相关肿瘤患者病程均超过10年;肠镜提示肿瘤性病变均为息肉样病变;2例为广泛结肠型结肠炎,1例为左半结肠型结肠炎;病理1例提示癌,2例活检组织提示中-度和重度异型增生;异型增生患者内镜下切除后经规范5-氨基水杨酸(5-aminosailcylic acid, 5-ASA)治疗及内镜下监测,病变处于黏膜愈合;1例癌变患者因未及时治疗,后期出现肿瘤多处转移。结论 UC相关肿瘤患者病程长,多见于广泛结肠受累的患者,以息肉样病变为主的肿瘤性病变可以内镜下切除,辅以规范治疗及监测,预后较好。     

溃疡性结肠炎相关异型增生和溃疡性结肠炎相关性结直肠癌56例的临床特征

目的分析溃疡性结肠炎(UC)相关瘤变[包括UC相关异型增生和溃疡性结肠炎相关性结直肠癌(UC-CRC)]患者的临床特征。方法回顾性分析2010年1月至2019年7月就诊于空军军医大学西京消化病医院的56例UC相关瘤变患者的临床资料。将56例UC相关瘤变患者分为低级别异型增生(LGD)组(38例)和进展期瘤变组(18例), 进展期瘤变包括高级别异型增生患者5例和UC-CRC患者13例。统计学方法采用Mann-WhitneyU检验、卡方检验或Fisher确切概率法。结果 UC相关瘤变年龄为(47.4±14.7)岁, 病变范围以广泛结肠型为主, 占71.4%(40/56), 5例(8.9%)患者合并结直肠狭窄。进展期瘤变组病程长于LGD组[10.5年(3.5年, 14.5年)比2.0年(1.0年, 5.0年)], 差异有统计学意义(U=155.000, P=0.001), 进展期瘤变组18例患者中有4例合并结直肠狭窄, 该比例高于LGD组的2.6%(1/38), 差异有统计学意义(Fisher确切概率法, P=0.033)。进展期瘤变组有7例患者为多灶性病变。13例UC-CRC患者中有5例癌...     

溃疡性结肠炎癌变相关机制研究进展

炎症性肠病(inflammatory bowel disease, IBD)包括溃疡性结肠炎(ulcerative colitis, UC)的发病率在我国呈逐渐升高的趋势。随着诊治水平的进展，长病程的UC患者逐渐增多，发生结直肠癌(colorectal cancer, CRC)的风险明显增加。UC癌变的危险因素主要包括长病程、广泛肠段受累、累积炎症负担(cumulative inflammatory burden, CIB)、合并原发性硬化性胆管炎(primary sclerosing cholangitis, PSC)、CRC家族史等，其中炎症的反复发作是癌变的独立危险因素。结肠炎相关结直肠癌(colitis-associated colorectal cancer, CAC)与散发性CRC在癌变模式、发生机制、分子特征等方面均存在差异。本文将结合近年来的研究进展，详细阐述遗传和表观遗传的改变、氧化应激、异常免疫反应以及肠道菌群失调在炎癌转化中发挥的作用。基于危险因素对UC患者进行CAC风险分层，高危患者应进行更频繁的结肠镜监测以便早发现、早干预、早治疗。     

精神心理因素在溃疡性结肠炎中作用的研究进展

溃疡性结肠炎(UC)是一种累及结直肠的慢性非特异性炎症性疾病,其病因和发病机制尚未完全明确。多次结肠镜检查以及激素、免疫抑制剂等药物治疗均可对UC患者造成不同程度的精神心理影响。研究发现精神心理障碍是UC发病的危险因素,可影响UC患者的生活质量和社会功能,降低患者对治疗的依从性,进而延长病程,影响预后。本文就精神心理因素在UC中作用的研究进展作一综述。     

溃疡性结肠炎相关腺瘤和结直肠癌回顾性临床病例分析

背景:研究表明溃疡性结肠炎(UC)患者发生结直肠癌的风险明显增加。目的:总结UC相关腺瘤和UC相关结直肠癌(UcCRC)的发病概况和临床病理特点。方法:选取2000年1月～2012年3月南京军区南京总医院住院确诊的UC患者603例,对其中UC相关腺瘤和UcCRC患者的性别、年龄、病程、临床症状、病理表现等临床资料进行回顾性分析经。结果:603例UC患者中,UC相关腺瘤28例,发病率为4.6%(28/603);UcCRC 4例,发病率为0.7%(4/603)。UC相关腺瘤患者的UC中位病程为3年,UcCRC患者的UC中位病程为29年。UC相关腺瘤好发部位依次为直肠/乙状结肠(16处)、降结肠(7处)、横结肠(6处)、升结肠以及回盲部(4处),UcCRC发病部位分别为升结肠(1例)、降结肠(2例)、乙状结肠(1例)。UC相关腺瘤和UcCRC的临床症状与一般UC相似。结论:UC相关腺瘤和UcCRC的发病率随UC病程的延长而增加。长期病程的UC患者应定期行结肠镜检查,对预防和早期检出结直肠癌具有积极意义。     

溃疡性结肠炎患者发生异型增生的诊治研究

目的 探讨对存在异型增生的溃疡性结肠炎患者合理的诊治方法.方法 回顾2000年～2005年我院溃疡性结肠炎患者的临床资料,并对接受结肠镜下治疗的患者进行复查和随访.结果 收集溃疡性结肠炎患者共计353例,有39例存在平坦型异型增生;在76例存在隆起性病变的患者中,21例存在异型增生.异型增生经结肠镜下电灼切除或氩离子凝固法治疗后,复查、随访至今尚无恶性病变发生.结论 结肠镜下活检和治疗是存在异型增生的溃疡性结肠炎患者理想的手段.     

溃疡性结肠炎中腺瘤样和非腺瘤样异型增生相关性病变或肿块

溃疡性结肠炎（UC）患者罹患结直肠癌（CRC）的风险较高。UC相关的异型增生分两种,即腺瘤样异型增生相关性病变或肿块（DALM）和非腺瘤样DALM,后者因恶变风险高,常被建议结肠切除治疗。然而,非腺瘤样DALM与腺瘤样DALM在白光内镜下的表现极其相似,近年来发展了多种内镜新技术有利于两者的鉴别。     

溃疡性结肠炎发生异型增生危险因素的多中心长程随访研究

目的探讨我国UC患者发生异型增生的危险因素。方法前瞻性纳入2012年3月1日至2013年12月30日就诊于空军军医大学西京消化病医院、上海交通大学医学院附属瑞金医院、北京协和医院、上海交通大学医学院附属仁济医院、南方医科大学南方医院、中日友好医院、河北医科大学第二医院东院区、四川大学华西医院、解放军总医院第七医学中心、厦门大学附属中山医院和安徽医科大学第一附属医院共11家医院的154例UC患者,随访至2017年12月1日。所有UC患者均需结肠镜检查并行组织病理学评估。采用t检验和卡方检验进行统计学分析,Cox比例风险模型分析我国UC患者发生异常增生的危险因素。结果最终纳入133例UC患者,年龄为(50.0±11.9)岁,诊断年龄为(35.5±11.6)岁,病程为(14.5±6.7)年,结肠镜检查次数为(3.4±1.6)次。共检出21例异型增生患者,未检出结直肠癌患者。单因素分析筛选出诊断年龄(风险比为1.05,95%CI 1.01～1.10,P=0.009)和广泛结肠型(风险比为2.92,95%CI 0.97～8.79,P=0.057)是差异有统计学意义的变量。多因素分析结果显示诊断年...     

Survival after colorectal cancer in patients with ulcerative colitis: a nationwide population-based Danish study

OBJECTIVES: Patients with ulcerative colitis (UC) are at increased risk of colorectal cancer (CRC). Little is known about how UC impacts CRC prognosis. In a nationwide population-based study we examined the CRC prognosis in UC patients compared to CRC patients without UC. METHODS: From the Danish Cancer Registry and the Danish Hospital Discharge Registry, we identified all CRC patients and all patients with UC in Denmark from 1977 to 1999. We compared survival in 279 UC patients with CRC to all other 71,259 CRC patients and computed mortality rate ratios (MRR). We also compared stage distribution at time of cancer diagnosis. RESULTS: The mean age at time of CRC diagnosis was 62.6 yr in UC patients and 71.2 yr in patients without UC. Cancer stage distribution for localized cancer, regional spread, and distant metastasis were 46.6%, 30.1%, and 16.5% in UC patients compared to 44.0%, 28.3%, and 19.4% in CRC patients without UC. The overall MRR for UC patients with CRC compared with all other CRC patients were 1.24 (95% CI 1.02-1.51) in the first year and 1.17 (95% CI 1.01-1.36) after 5 yr of follow-up. CONCLUSION: UC patients with CRC have a stage distribution similar to patients with CRC without UC. The prognosis of CRC is poorer for UC patients than for patients without UC.     

Chemoprevention of colorectal cancer in ulcerative colitis

BACKGROUND: Patients with ulcerative colitis (UC) are at greater risk of developing colorectal cancer (CRC) than the general population. Both duration and extent of UC are important risk factors for CRC, as is the presence of primary sclerosing cholangitis, family history of CRC, and (in some studies) early age at diagnosis of UC. Efforts to reduce this risk have focused on colonoscopic surveillance as the best alternative to the more definitive, but less appealing, approach of prophylactic colectomy. However, spurred on by findings in the sporadic CRC literature, there has been a growing interest in a possible role for chemoprevention of CRC in patients with UC. EMPIRICAL STUDIES: Published evidence to date indicates that 5-aminosalicylic acid agents are protective against the development of dysplasia and CRC. Oral, but not topical, steroids also appear to be chemoprotective, but their chronic use cannot be recommended for this indication. Ursodeoxycholic acid has been shown to reduce the risk of neoplasia in UC patients with primary sclerosing cholangitis. Evidence suggests, but does not prove, that folic acid is chemopreventive in patients with UC. Further studies are needed to fully define the chemoprotective role of these and other agents.     

Clinical significance of serum p53 antibodies in patients with ulcerative colitis and its carcinogenesis

BACKGROUND: For early detection of ulcerative colitis (UC)-associated colorectal cancer (CRC), surveillance colonoscopy is recommended in UC patients at high risk. However, poor acceptability deteriorates its effectiveness and a suitable marker for selecting patients at high risk is needed. Here we evaluated clinical usefulness of the measurement of anti-p53 antibodies (Abs) by enzyme-linked immunosorbent assay (ELISA) using sera samples from UC patients. METHODS: Sera from 286 patients with UC, 82 patients with sporadic CRC, and 63 healthy controls (HC) were obtained. Serum anti-p53 antibodies were detected with ELISA. Immunohistochemical detection was also performed in patients who developed dysplasia or CRC. RESULTS: Serum p53 Ab was positive in 15.0% of UC, while it was positive only in 1.6% of HCs. In sporadic CRCs, 52.4% of 82 patients were positive. In UC patients with disease duration equal to or longer than 8 years, positivity of serum p53 Ab was significantly higher than those in patients with shorter duration. Eight of 13 (61.5%) UC patients with CRC or dysplasia were positive for serum p53 Abs, which was significantly higher than that in patients without neoplasia. All UC patients with CRC were positive for p53 staining, while 2 were negative for serum p53 Ab. Finally, levels of serum p53 Ab had fallen in 4 patients with CRC we could monitor after surgery. CONCLUSIONS: This study revealed that p53 Ab developed in the progression of UC-associated CRC but not in all patients with neoplasia, suggesting that serological detection of p53 Abs by ELISA is not suitable in primarily selecting patients at high risk; however, it is helpful in salvaging patients who drop from a surveillance program.     

Risk of colorectal cancer in ulcerative colitis in India

BACKGROUND: The risk for colorectal cancer (CRC) in ulcerative colitis (UC) in India is not known. METHOD: Retrospective cohort from a tertiary level hospital in South India. Analysis of archived records of all patients with UC who underwent colonoscopy and segmental biopsies over the last 25 years. Incidence densities and risk of developing high grade dysplasia or CRC was calculated and chi-squared test was performed for risk factors of interest. RESULTS: Complete records were available for 532 patients, 336 (63.2%) male. The mean (+/- SEM) duration of illness was 6.04 +/- 0.29 years. In total, 234 patients (44%) had pancolitis, 121 (22.7%) had left-sided colitis and 177 (33.3%) had proctitis or proctosigmoiditis. Overall, five (0.94%) patients developed carcinoma and one (0.19%) patient had high grade dysplasia. The incidence density and risk of developing either CRC or high grade dysplasia was zero in the first 10 years of disease. In those with disease duration of 10-20 years, incidence density was 2.34 per 1000 person years' duration (PYD) for all patients with colitis and 4.5 per 1000 PYD for patients with pancolitis alone. This corresponded to risks of 2.3% and 4.4%, respectively. For those with disease duration longer than 20 years, incidence density was 2.73 per 1000 PYD for all patients and 4.9 per 1000 PYD for patients with pancolitis. This corresponded to risks of 5.8% and 10.2%, respectively. Duration of disease beyond 10 years and extent of colitis were the only risk factors significantly associated with CRC. CONCLUSIONS: The risk of developing CRC is Indian patients with UC is lower than that reported from the West. Strategies for cancer surveillance in Indian patients with UC need to be tailored accordingly.     

The risk for cancer or dysplasia in ulcerative colitis patients with primary sclerosing cholangitis

OBJECTIVES: Recent studies have implicated primary sclerosing cholangitis (PSC) as a risk factor for colorectal cancer (CRC) in ulcerative colitis (UC). Our study was designed to define both the risk and the risk factors for CRC or dysplasia in a large UC cohort with PSC. METHODS: Patients with UC and PSC were compared with a random sample of UC controls without PSC. Patients were analyzed from the inception of disease until an outcome or censor. RESULTS: Thirty-three (25%) of 132 UC patients with PSC developed CRC or dysplasia compared with 11 (5.6%) of 196 controls (adjusted relative risk 3.15, 95% confidence interval 1.37-7.27). Possible risk factors were chronic disease activity and lack of folate supplementation. Of 17 CRCs in the PSC group, 76% occurred proximal to the splenic flexure and 35% presented at an advanced stage, compared with one of five (20%) CRCs in controls being proximal and none being advanced. Six (4.5%) PSC patients, and no controls, died of CRC (p < 0.01). CONCLUSIONS: UC patients with PSC are at increased risk of developing CRC or dysplasia. Chronically active disease may be a risk factor, whereas folate could have a protective effect. CRCs associated with PSC are more likely to be proximal, to be diagnosed at a more advanced stage, and to be fatal.     

Increased risk of colorectal cancer in ulcerative colitis patients diagnosed after 40 years of age.

BACKGROUND: The association between ulcerative colitis (UC) and colorectal cancer (CRC) is well established. Retrospective data show a 5.4% CRC incidence rate among patients with pancolitis and suggest that cancer surveillance should be provided to patients following eight to 10 years of extensive UC. AIM: To identify premalignant risk factors for UC patients and to determine whether current recommendations for cancer surveillance need reviewing. PATIENTS AND METHODS: A retrospective audit was conducted of adult patients with UC who were diagnosed with CRC between 1991 and 2002 in five hospitals in Edmonton, Alberta. RESULTS: Thirty-one cases of CRC (68% male) were identified. In this group, the mean ages at diagnosis were 44.4 years for UC patients and 60.1 years for CRC patients. For patients in whom the initial data of diagnosis of UC could be determined (n=29), the median duration of UC at the time of CRC diagnosis was 16 years. Patients diagnosed with UC after 40 years of age (n=15, mean age 64 years) progressed more rapidly to CRC than patients diagnosed before 40 years of age (n=14, mean age 23 years). The median durations of UC before development of CRC were 22 years and 10 years, respectively, for patients with a diagnosis of UC before and after 40 years of age (OR 11.5, 95% CI 2.41 to 20.16; P=0.00029). Only four patients (13%) were enrolled in an appropriate cancer-screening program. Nine of these UC patients (29%) who were older than 40 years of age developed CRC before the 10-year point. CONCLUSIONS: In the present study, patients diagnosed with UC after 40 years of age developed CRC more rapidly than those diagnosed before 40 years of age. This finding suggests that patients who are diagnosed with UC after 40 years of age should undergo CRC surveillance earlier than current recommendations.     

Risk factors for ulcerative colitis-associated colorectal cancer in a Hungarian cohort of patients with ulcerative colitis: results of a population-based study

BACKGROUND: There is an increased risk of colorectal cancer (CRC) in ulcerative colitis (UC). The prevalence of UC-associated CRC is different in various geographic regions. The risk depends primarily on the duration and extent of disease. The aim of this study was to identify the risk factors for and the epidemiology of CRC in Hungarian patients with UC. METHODS: We retrospectively evaluated the relevant epidemiological and clinical data of all patients with UC in Veszprem province in our 30-year IBD database (723 patients with UC; male/female, 380/343; non-CRC related colectomies, 3.7%). RESULTS: CRC was diagnosed in 13 patients (13/8564 person-year duration) during follow-up. Age at diagnosis of CRC was at a median of 51 (range 27-70) years. Eight patients are still alive, 4 died of CRC, and 1 died of an unrelated cause. Longer disease duration, extensive colitis, primary sclerosing cholangitis, and dysplasia found in the biopsy specimen were identified as risk factors for developing CRC. The cumulative risk of developing CRC after a disease duration of 10 years was 0.6% (95% confidence interval [CI] 0.2%-1.0%); 20 years, 5.4% (95% CI 3.7%-7.1%); and 30 years, 7.5% (95% CI 4.8%-10.2%). CRC diagnosed at surveillance colonoscopy was associated with a tendency for longer survival (P = 0.08). CONCLUSIONS: The cumulative risk of CRC was high in our patients with UC; however, it was lower compared with that reported in Western European and North American studies. CRC developed approximately 15 years earlier compared with sporadic CRC patients in Hungary. Longer disease duration, extensive colitis, dysplasia, and primary sclerosing cholangitis were identified as important risk factors for developing CRC.     

Aminosalicylate therapy in the prevention of dysplasia and colorectal cancer in ulcerative colitis.

BACKGROUND & AIMS: Aminosalicylates have been suggested as chemopreventive agents for colorectal cancer (CRC) in ulcerative colitis (UC). We studied the effect of aminosalicylate use on dysplasia and CRC risk in chronic UC. METHODS: UC patients with dysplasia or CRC were matched with controls by disease duration, extent, and age at diagnosis. The total amount of aminosalicylates over the duration of the disease and the mean daily amount of drug was calculated. Conditional logistic regression was used to examine the relationship of aminosalicylates to the risk of neoplasia; potential confounders were controlled in a multivariable model. RESULTS: Twenty-six cases (8 CRC, 18 dysplasia) were matched with 96 controls. Cases and controls were similar in age (median, 43 vs 42.5 y), age at diagnosis of UC (median, 29.5 vs 30.5 y), duration of UC (median, 11.5 vs 9 y), and extent of disease (58% pancolitis), sex, family history of UC, history of primary sclerosing cholangitis, and smoking history. Cases were more likely to have a family history of CRC than controls (27% of cases, 9% of controls, P = .036). Conditional logistic regression adjusted for disease duration, age at diagnosis, and family history of CRC showed that aminosalicylate use of 1.2 g/day or more was associated with a 72% reduction in the odds of dysplasia/CRC (odds ratio, 0.28; 95% confidence interval, 0.09-0.85). As the total dose of aminosalicylates increased, the odds of dysplasia/CRC decreased (P = .056). CONCLUSIONS: This case-control study shows a significant risk reduction of dysplasia and CRC in UC patients exposed to aminosalicylate therapy.     

Motion - colonoscopic surveillance is more cost effective than colectomy in patients with ulcerative colitis: Arguments for the motion.

Patients with ulcerative colitis (UC) are at increased risk for colorectal cancer (CRC), especially those with longstanding disease, pancolitis or primary sclerosing cholangitis. The incidence of colitis- associated cancer is increasing, and the mortality rates from CRC are higher in UC patients than in the general population. Case control studies have demonstrated that surveillance colonoscopy reduces the risk of dying from CRC. A well conducted decision analysis found that surveillance colonoscopy decreases cancer-related mortality and increases life expectancy. The results with surveillance programs were almost as good as with prophylactic colectomy. A subsequent cost effectiveness analysis using the same model found that, compared with a policy of no surveillance, colonoscopic surveillance was more effective at preventing death from CRC and was less costly. The best strategy appears to be to perform colonoscopies every three years. The analysis also showed that colectomy should be recommended in patients with low-grade dysplasia. Patients at very high risk for CRC should undergo yearly colonoscopy, and patients who are concerned about the limitations of this technique should be offered prophylactic colectomy.