炎症性肠病患者中EB病毒感染情况分析

目的 探讨EB病毒在炎症性肠病(IBD)患者中的感染情况.方法 将中国人民解放军空军军医大学第一附属医院收治的628例IBD患者作为研究对象,381例纳入溃疡性结肠炎(UC)组,247例纳入克罗恩病(CD)组.采用酶联免疫吸附试验检测试剂盒分析患者的EB病毒抗体谱指标[抗EB病毒衣壳抗体IgM(EBV-CAIgM)、抗EB病毒早期抗体IgG(EBV-EAIgG)、抗EB病毒衣壳抗体IgG(EBV-CAIgG)、抗EB病毒核抗体IgG(EBNA-IgG)].结果 628例IBD患者中,EBV-CAIgM的阳性率为16.7％(105/628).CD组EBV-CAIgM的阳性率为22.2％(55/247),UC组EBV-CAIgM的阳性率为13.1％(50/381),两组间EBV-CAIgM阳性率比较,差异有统计学意义(χ2=8.99,P=0.003).UC组男性EBV-CAIgM阳性率为9.9％(23/232),女性EBV-CAIgM阳性率为18.1％(27/149),差异有统计学意义(χ2=5.36,P=0.021).患者既往感染占比最高,抗体谱EBV-CAIgG、EBNA-IgG均阳性占比为71.97％(452/628);现症感染中抗体谱EBV-CAIgM、EBV-CAIgG、EBNA-IgG均阳性占比次之(13.69％).结论 IBD患者中具有高的EB病毒既往感染率及现症感染率,临床应加强对IBD患者中EB病毒感染的筛查和监测,为IBD的诊疗提供有价值的思路.     

炎症性肠病患者凝血指标变化及其临床意义研究

目的探讨炎症性肠病(IBD)患者凝血指标的变化,及其与疾病活动程度的关系。方法回顾性分析2012年3月至2015年3月就诊的67例IBD患者及50例健康者血小板计数(PLT)、血小板平均体积(MPV)、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)等指标检测结果,比较患者与健康者的差异,不同病情程度患者之间的差异,以及各指标与疾病活动指数的相关性。结果与健康者相比,IBD患者PLT、PT和FIB升高,MPV下降;不同病情严重程度溃疡性结肠炎患者间PLT、MPV、PT和FIB水平比较差异有统计学意义(P0.05),不同病情严重程度克罗恩病患者间PLT、MPV和FIB水平比较差异有统计学意义(P0.05);PLT和FIB与IBD疾病活动指数呈正相关,MPV与疾病活动指数呈负相关。结论 IBD患者体内凝血功能异常,表现为PLT升高、MPV下降,PT延长及FIB升高,PLT、MPV和FIB或可作为判断IBD疾病活动性的指标。     

炎症性肠病患者食物不耐受的检测及饮食干预进展

<正>炎症性肠病(inflammatory bowel disease,IBD)是一组病因尚不十分清楚的慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD),临床主要表现为反复发作的腹痛、腹泻、黏液脓血便、里急后重等症状[1]。且病程漫长有发生癌变可能,目前尚无特异的治疗方法,该病发生发展多认为受机体免疫影响,且饮食     

炎症性肠病－－炎症性肠病的内镜诊断

结肠克罗恩病与溃疡性结肠炎同属非特异性炎症性肠病 ,二者在病因、临床表现和治疗上有一些共同之处。克罗恩病可发生于胃肠道任何部位 ,虽可发生在结肠 ,但小肠和胃、盲肠的病变更为多见。本病在欧美发病率高 ,东方国家较为少见。1980年北京协和医院等北京四家大医院对手术和病理确诊的14 5例克罗恩病分析的结果表明 ,本病单纯分布于结肠者仅占全部病例的 7 6% ,而合并小肠病变者近半数 ,尤其病变好发于回盲肠。溃疡性结肠炎在西方国家多见 ,北欧和北美的年发病率为 2 / 10万～ 10 / 10万人群 ,高发年龄在 3 0～ 60岁 ,女性略高于男性 ,我…     

55例炎症性肠病诊断及治疗临床分析

收治的溃疡性结肠炎和克罗恩病患者共55例,回顾性分析患者的临床症状、诊断及治疗情况等。28例溃疡性结肠炎患者中,症状完全缓解16例,有效9例,无效3例,有效率为89.3%;27例克罗恩病中完全缓解9例,有效10例,无效8例,有效率为70.4%。结肠镜及病理检查能有效对炎症性肠病做出正确诊断,并且根据患者的实际情况选择内科药物治疗或外科治疗可以提高炎症性肠病的治疗效果。     

炎症性肠病－－炎症性肠病的外科治疗

炎症性肠道疾病的外科治疗是一个十分复杂的问题 ,虽然Crohn病和溃疡性结肠炎被归为同一类疾病 ,但二者在外科治疗原则和方法上截然不同。如果治疗原则应用不当 ,不但不能取得满意的疗效 ,而且可能导致不可挽回的后果 ,因此在进行外科治疗之前 ,应尽可能明确诊断 ,并了解病变的范围和程度 ,以便采取合理的治疗措施 ,但有时诊断的确立十分困难 ,甚至在手术数年方得以明确 ,这就需要对病人进行积极的随访 ,根据病情的变化调整治疗方案。1　Crohn病　　Crohn病主要发生于斯堪地纳维亚、西北欧、北美和澳大利亚等地 ,亚洲本不属于高发区 ,但近…     

饮食与炎症性肠病关系的研究进展

炎症性肠病(inflammatory bowel disease,IBD)是一种慢性肠道炎症性疾病,包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(crohn’sdisease,CD),这两种疾病组织学上差异较大,但均有腹泻、便血、腹痛等消化道症状。UC的特征是炎症弥漫、反复发作,主要涉及结肠和直肠的黏膜     

加强对炎症性肠病的认识,提高临床诊治水平

炎症性肠病 (inflammatoryboweldiseases ,IBD)包括溃疡性结肠炎 (ulcerativecolitis ,UC)及克罗恩病 (Crohn’sdisease ,CD)。该病在欧美国家较常见 ,UC及CD患病率分别为 5 0 / 10万～ 80 / 10万及 2 0 / 10万～ 10 0 / 10万 ,发病率分别为 3/ 10万～ 10 / 10万及 1/ 10万～ 10 / 10万 ,亚洲国家较少见。近年来我国不少医生在临床工作中感觉到临床诊断IBD的病例数似有增多的趋势。究竟是IBD发病率真的有所上升 ,还是与广大医生对IBD的认识有所提高 ,加上临床诊断手段 (如大肠镜 )的普及使确诊的病例数增多有关 ,目前还无法下结论 …     

炎症性肠病患者病耻感体验的质性研究

目的探索炎症性肠病患者的病耻感体验,揭示患者的病耻感经历及其影响因素,为医护人员开展针对性心理护理提供理论依据。方法采用目的抽样法,选取2017年3月—2019年7月在浙江省3家三级甲等医院消化内科门诊就诊和病房住院的16例炎症性肠病患者为研究对象,采用描述性质性研究的方法,对患者进行面对面半结构式访谈,运用传统内容分析法分析资料。结果分析得出炎症性肠病患者病耻感体验的4个主题,分别为感知病耻感、实际病耻感、内化病耻感及影响病耻感产生的因素。结论受疾病、治疗、自身心理状态及社会风俗文化等因素的影响,多数炎症性肠病患者确诊疾病后存在病耻感体验,但其具体表现形式及程度存在差异。医护人员应在了解患者病耻感体验的基础上,提供个体化的照护,并给予可行的病耻感应对策略。     

炎症性肠病的临床病理诊断

炎症性肠病是一种病因尚不明确的非特异性肠道炎症性疾病,主要包括溃疡性结肠炎(UC)、克罗恩病(CD)以及不确定性结肠炎(IC).该病具有独特的组织学特点,但是部分病例病理表现存在交叉,同时需与感染性疾病、显微镜下肠炎、伪膜性肠炎、缺血性肠病、淋巴瘤等相鉴别.本文就炎症性肠病病理特点、鉴别诊断进行系统性论述.     

Chemiluminescence in inflammatory bowel disease patients: a parameter of inflammatory activity

Background: Reactive oxygen species (ROS) are produced in excess in the inflamed mucosa and peripheral blood of patients with inflammatory bowel disease. These species have emerged as a common pathway of tissue injury in a wide variety of inflammatory and other disease processes. The present study was conducted to assess ROS production and to correlate this with parameters of inflammatory activity. Methods: In 25 patients with Crohn's disease (CD), 20 patients with ulcerative colitis (UC) and 65 age- and sex-matched healthy volunteers ROS production was measured using the whole blood luminol enhanced chemiluminescence assay (LECA). Disease activity was assessed using the Crohn's disease activity index and the Ulcerative Colitis Symptoms Score (UCSS) for CD and UC, respectively. Furthermore, the effect of various scavengers, enzymes and enzyme inhibitors on LECA was studied to assess the contribution of different ROS. Results: LECA was significantly higher in CD and UC patients compared with healthy controls (7.1±4.7 and 9.8±6 vs. 5.2±2.8×10³ counts per minute (cpm), p<0.05 and <0.001). In CD, relative LECA (patient/control) was correlated with the Crohn's disease activity index and C-reactive protein (CRP) (r=0.54, p=0.001 and r=0.51, p=0.01). In UC, CRP but not LECA was correlated with the Ulcerative Colitis Symptoms Score (C-reactive protein: r=0.42, p=0.01). Addition of azide, superoxide dismutase, deferoxamine and dimethylthiourea resulted in a decrease of LECA values. Conclusion: Whole blood LECA is increased in patients with CD and UC. This parameter is correlated with disease activity in CD. The observed chemiluminescence is probably due to generation of superoxide and the hydroxyl radical.     

炎症性肠病患者自我形象改变体验的质性研究

目的：了解炎症性肠病患者自我形象改变体验,以期为改善患者自我形象制定合理的干预策略提供参考。方法：采用现象学研究方法对天津市某三级甲等医院收治的11例炎症性肠病患者进行半结构式深入访谈,运用Colaizzi 7步分析法对资料进行整理分析。结果：共归纳提炼4个主题,存在多种负性情绪、难以有所追求、不被理解接受、患病后有所收获。结论：炎症性肠病患者存在积极自我形象和较为严重的负性自我形象,医护人员应注重负性自我形象患者心理疏导,加强健康教育,协助社会力量,改善其自我形象,促进疾病康复。     

Treatment of inflammatory bowel disease by leukocytapheresis

Studies about leukocytapheresis have emerged with the need of search for alternatives to conventional treatment in inflammatory bowel diseases (IBD). Leukocytapheresis is a novel non-pharmacologic approach for active ulcerative colitis (UC) and Crohn’s disease (CD), in which leukocytes are mechanically removed from the circulatory system. Patients with active IBD treated with leukocytapheresis using a Cellsorba E column between 2012 and 2015, were enrolled in Turkey. In our experience, the results of leukocytapheresis therapy in 6 patients with CD and 20 patients with active UC were overviewed. Leukocytapheresis (10 sessions for remission induction therapy, 6 sessions for maintenance therapy) was applied to the patients with their concomitant medications. Intensive leukocytapheresis (≥4 leukocytapheresis sessions within the first 2 weeks) was used in 30% patients with active severe UC. The overall clinical remission rate in patients with UC was 80%, and the mucosal healing rate was 65%. Patients were followed for an average of 24 months. It was observed that clinical remission has continued in 65% of patients with UC. Mild relapse was observed in 3 patients with UC during follow up period. In 5 patients with CD significant clinical remission was achieved except only one patient. Surgical needs were disappeared in 3 patients with obstructive type Crohn’s disease. Adverse events were seen in only 4.3% of 416 sessions. Any concomitant medications did not increase the incidence of adverse events. Our results indicate that leukocytapheresis is efficacious in improving remission rates with excellent tolerability and safety in patients with IBD.     

炎症性肠病患者失能测评工具的研究进展

对国内外IBD失能现状、测评工具和影响因素进行阐述,为全面准确评估炎症性肠病的失能状况提供依据。     

MR colonography in inflammatory bowel disease

Colonography based on magnetic resonance imaging (MRI) appears to be a promising technique for polyp assessment in the colon. Several studies have evaluated this method for colonic assessment in patients with inflammatory bowel disease. We briefly review different methodologies such as dark lumen and bright lumen techniques for abdominal MRI. In addition, recently published studies concerning the sensitivity and accuracy in detecting inflammatory bowel changes in inflammatory bowel disease using MRI are discussed.     

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。     

炎症性肠病患者焦虑和抑郁管理的证据总结

目的:检索和分析炎症性肠病患者焦虑和抑郁管理的相关证据,并对最佳证据进行总结。方法:计算机检索BMJ Best Practice、JBI循证卫生保健中心数据库、UptoDate、美国指南网、英国国家临床医学研究所指南库、苏格兰校际指南网、世界胃肠病组织网、PubMed、Cochrane Library、Embase、C...     

Major depressive disorders in patients with inflammatory bowel disease and rheumatoid arthritis

BACKGROUNDVarious immune-mediated inflammatory diseases consisting of inflammatory bowel disease (IBD) and rheumatoid arthritis (RA), are found to have a substantial societal burden, increased healthcare costs, and progressive disability. Studies suggest that patients with vs without comorbid depression have a more significant disability, a lower likelihood of remission, and reduced adherence to therapy. Elevated interleukin (IL)-1β, tumor necrosis factor-α, and IL-6 contribute to developing depression by the impaired physiological responses to stress, resulting in increased pain, fever, fatigue, and lack thereof of interest, and thus poor long-term outcomes. This study emphasizes the timely recognition of the prevalence of major depressive disorder (MDD) in patients with RA and IBD combined, thus preventing disability.AIMTo identify the prevalence level and temporal trends of depression in hospitalized IBD-RA patients.METHODSAll adult hospitalized patients from January 2000 to December 2019 in the nationwide inpatient sample (NIS) were captured. The study population included all patients with a primary or secondary IBD-RA overlap disease using corresponding international classification of diseases (ICD)-9 and ICD-10 codes. IBD includes Crohn’s disease and ulcerative colitis. The study population was divided into IBD-RA without MDD (controls) and IBD-RA with MDD (cases). For group comparison between MDD vs no MDD, we used Student''s t-test for continuous variables and Rao-Scott Chi-square tests for categorical variables. For univariate analyses, we used logistic regression, and for multivariate analysis, we used a weighted multi-level mixed-effects model. We attested all hypotheses with two-tailed significance level of 0.05 (P < 0.05 was considered significant). The outcome is to examine the temporal trends and prevalence of depression in patients with IBD-RA by gender, race, and age.RESULTSA total of 133315 records were identified with IBD-RA overlap, of which 26155 patients (19.62%) had MDD. Among the IBD-RA patients, those who had MDD were younger [mean age of 56 years (SD ± 15)] to IBD-RA without MDD patients with a P < 0.0001, more females (80% among cases vs 73% among controls) than males with a P < 0.0001, frequent in the white race (79% among cases vs 73% among controls) than black race. Over the 19 years, the number of patients with MDD in IBD-RA increased from 153 (the year 2000) to 2880 (the year 2019) in weighted NIS, representing a 1782% increase compared to the year 2000 with a P < 0.001. Factors associated with higher MDD included younger age, female gender, white race, alcohol, opioids, esophageal disorders, peptic ulcer disease, chronic pancreatitis, paralysis, dementia, menopausal disorders, obesity, nutritional deficiencies, diabetes mellitus with chronic complications, and osteoarthritis.CONCLUSIONThere is a rise in the prevalence of depression in younger patients with IBD-RA combined compared to their counterparts. These patients are also at higher risk for the increased cost of care and poor treatment compliance. It is crucial to educate the involved clinicians to identify the early signs and symptoms of depression in patients with IBD or RA or IBD-RA combined and treat them to have a better overall prognosis.     

63例炎症性肠病经腹超声检查与结肠镜的对比分析

目的:探讨经腹超声检查在炎症性肠病诊断中的临床实用价值。方法:对临床诊断明确的克罗恩病17例,溃疡性结肠炎46例,与30例大肠癌对比观察超声图像特点,同步比较结肠镜所见。结果:炎症性肠病与大肠癌声像图上,肠壁均有不同程度的增厚,肠壁增厚≥1.2 cm的阳性例数比较,克罗恩病组明显高于溃疡性结肠炎组,差异有统计学意义(χ2=20.93,P<0.05),和大肠癌组比较差异无统计学意义(χ2=0.17,P>0.05);克罗恩病组肠管正常结构消失的比率明显高于溃疡性结肠炎组,差异有统计学意义(χ2=7.47,P<0.05),肠间淋巴结肿大例数克罗恩病与溃疡性结肠炎组和大肠癌组比较差异均无统计学意义(2χ=3.13,P>0.05,χ2=1.93,P>0.05);肠间积液例数克罗恩病与溃疡性结肠炎组和大肠癌组比较差异有统计学意义(2χ=8.74,P<0.05,χ2=8.57,P<0.05);而粘连包块多见于克罗恩病组,假肾征仅见于肠癌组。各肠段病变定位符合率:回盲部和升结肠为91.30%,降结肠和乙状结肠为86.49%,直肠71.43%,横结肠35.71%。结论:腹部超声检查简便易行,在声像图上克罗恩病和溃疡性结肠炎的表现有其各自特点,对于提示炎症性肠病存在、部位和性质有一定的临床实用价值。