益生菌与炎症性肠病

炎症性肠病(IBD)包括克罗恩氏病(CD)和溃疡性结肠炎(UC)，其病因和发病机制目前尚不清楚。临床研究发现，炎症性肠病患者肠道内存在菌群失调，正常细菌的数鼍减少，若给患者补充正常细菌即益生菌，使肠道内菌群失调得到纠正，可使病情缓解。1992年Fuller将益生菌定义为：经饮食摄取的能促进宿主机体微生态平衡的活微生物。本文就肠道菌群在炎症性肠病发病中的作用、益生菌对炎症性肠病的治疗作用作一简要综述。     

炎症性肠病相关肺间质改变研究进展

炎症性肠病(inflammatory bowel disease,IBD)是一种消化道慢性非特异性炎性疾病,包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn's disease,CD).约有31％的CD患者及43％的UC患者会出现至少一种肠外表现(extraintestinal ma...     

信息支持在炎症性肠病患者中的应用现状

正炎症性肠病(inflammatory bowel disease,IBD)是一组慢性非特异性肠道炎症性疾病,主要分为溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD)两种类型。近20年来,我国IBD发病率迅猛增加,我国UC与CD的患病率分别约为11.6/10万和1.4/10万~([1])。发病高峰介于20~40岁之间,具有发作期与缓解期交替的特点,可能导致各种并发症,需要患者持续服药、频繁就诊以及     

CT小肠造影在炎症性肠病中的诊断价值

目的 探讨结肠镜及CT小肠造影(CTE)在炎症性肠病(IBD)诊断中的价值.方法 选取昆明医科大学第一附属医院消化内科2017年9月至2019年9月经内镜及病理检查确诊的IBD患者为研究对象,其中溃疡性结肠炎(UC)患者68例,克罗恩病(CD)患者37例,回顾性分析所有患者的结肠镜及CTE表现.结果 105例患者均完成结肠镜检查,其中有28例UC患者进一步完成CTE检查,有30例CD患者进一步完成CTE检查.疾病活动性分级为轻度、中度、重度UC患者的改进的Baron分级标准评分比较,差异有统计学意义(F=0.748,P<0.001);疾病活动性分级为轻度、中度、重度CD患者的SES-CD评分比较,差异有统计学意义(F=0.646,P<0.001).UC患者以对称性增厚为主,CD患者以非对称性增厚为主,且CD患者较UC患者更易发现肠管僵直、梳妆征及肠周渗出等(P<0.05).疾病活动性分级为轻度、中度、重度UC患者的CTE下管壁总厚度比较,差异无统计学意义(P>0.05);疾病活动性分级为轻度、中度、重度CD患者的CTE下管壁总厚度比较,差异无统计学意义(P>0.05).结论 CTE能客观评价肠道炎症垂直扩散程度及肠外表现,结肠镜结合CTE有助于IBD的诊断.     

炎症性肠病患者医学应对方式与社会支持的相关性研究

正炎症性肠病(IBD)是一种病因未明的慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎(UC)和克罗恩病(CD)。Wang等[1-3]研究发现,国内UC患病率约为11.6/10万,CD约为1.4/10万。良好的社会支持和积极的应对方式对个体的心理健康有积极影响[4-5]。本研究探讨炎症性肠病患者医学应对方式与社会支持水平的相关性,现报告如下。1资料与方法     

365例炎症性肠病、缺血性肠炎临床与病理诊断分析

目的探讨炎症性肠病、缺血性肠炎临床与病理诊断的符合率及临床特点,提高临床诊断水平。方法回顾性分析365例符合中华医学会消化病分会制定的炎症性肠病诊断治疗规范标准,临床诊断的溃疡性结肠炎(UC)270例、克罗恩病(CD)55例、缺血性肠炎40例,对其与病理诊断的符合率,发病年龄,临床特征,肠外合并症进行分析。结果3种疾病临床诊断与病理诊断的总符合率252/365(83.6%),UC组符合率最高为99.3%(268/270);CD和缺血性肠炎组分别为40.0%(22/55)和37.5%(15/40),显著低于UC组(P<0.001)。发病平均年龄:UC组(30.5±15.2)岁;CD组(24.5±13.4)岁;缺血性肠炎组(62.9±20.5)岁,缺血性肠炎组显著偏高(P<0.001)。腹痛、腹泻、便血的出现率:UC组88.2%(238/270)、98.2%(265/270)、27.0%(73/270);CD组65.5%(36/55)、10.9%(6/55)、12.7%(7/55);缺血性肠炎组100%(40/40)、20.0%(8/40)、95.0%(38/40)。UC组腹痛、腹泻发生率较高,而缺血性肠炎组便血的发生率较高。肠管外合并症的出现率和种类:UC组34.1%(92/270)、26种肠管外合并症;CD组36.4%(20/55)、20种肠管外合并发症;缺血性肠炎组35.0%(14/40)、6种肠管外合并症。结论CD和缺血性肠炎的病理诊断符合率不高,应提高病理诊断的准确率。发病年龄、临床症状、肠管外合并症对炎症性肠病与缺血性肠炎的诊断有重要的参考价值。     

同伴支持小组教育在炎症性肠病患者中的应用研究

目的 探讨同伴支持小组教育在炎症性肠病患者中的应用效果。方法 采用便利抽样法,选择79例炎症性肠病患者,按分层随机分为观察组42例、对照组37例。对照组实施常规护理,观察组实施常规护理和同伴支持小组教育,比较两组患者干预前及干预后6个月的焦虑、抑郁、自我管理及生活质量情况。结果 单因素协方差分析得出两组患者干预后自我管理、焦虑得分差异具有统计学意义(P<0.001),两组患者在干预后的炎症性肠病生活质量问卷得分及抑郁得分差异有统计学意义(P<0.05)。结论 同伴支持小组教育能够提高炎症性肠病患者的生活质量及自我管理疾病的能力,减轻其焦虑、抑郁程度。     

炎症性肠病－－炎症性肠病的中医治疗

1　何谓“炎症性肠病”　　广义的“炎症性肠病”是指以肠道炎症为主要表现的不同疾病的总和 ;狭义的“炎症性肠病”(inflammatoryboweldisease ,IBD)包含了两个独立的疾病 :溃疡性结肠炎 (ulcerativecolitis ,UC)和克罗恩病 (Crohn’sdisease ,CD ) [1] 。IBD在西方国家相当常见 ,患病率达 40 /10万～ 10 0 /10万 ,在中国发病率比欧美低 ,但近年来该病的发病率有增加的趋势。近 2 0年来CD的增加更为明显 ,与UC的发病率、患病率几乎相当。国内由于过去一直认为本病少见而重视不够 ,但仅近 10年来医学文献报道即己逾千篇 ,累计病例超过…     

炎症性肠病的治疗：消化系统疾病（6）

炎症性肠病(IBD)即指溃疡性结肠炎(UC)和克隆病(CD),新近有作者将胶原性结肠炎、伊红细胞性肠炎、显微镜结肠炎、孤立性直肠溃疡均列入病因未明的非特异性炎症性肠病类。本文主要阐述UC及CD的治疗。     

疫苗在预防炎症性肠病机会性感染中的研究

炎症性肠病(inflammatory bowel disease,IBD)是累及消化道的慢性炎症性疾病 [1],可分为克罗恩病(Crohn's disease,CD)和溃疡性结肠炎(ulcerative colitis,UC),以复发和缓解交替为其主要临床特点,严重影响着患者的生活质量 [2].     

血清学抗体检测对炎症性肠病的诊断价值

目的 测定抗酿酒酵母菌抗体（ASCA）、抗胰腺腺泡抗体（PAB）、抗小肠杯状细胞抗体（GAB）、抗中性粒细胞胞浆抗体（pANCA）在炎症性肠病（IBD）中的表达,探讨其对溃疡性结肠炎（UC）和克罗恩病（CD）的诊断价值.方法 2006年1月至2011年7月收集天津市人民医院住院患者510例,分成UC组、CD组及对照组,UC组358例,男192例,女166例,平均年龄（45.7±15.8）岁,CD组31例,男20例,女11例,平均年龄（42.8±19.2）岁,对照组121例,男69例,女52例,平均年龄（56.8±13.2）岁.空腹采集静脉血2ml,采用间接免疫荧光法检测血清中IgA型和IgG型ASCA、PAB、GAB和pANCA 4种抗体的表达.结果 ASCA-IgA和IgG 1种以上亚型阳性在CD组、UC组和对照组阳性率分别为12.9％、3.6％、1.7％,CD组与后两组比较差异有统计学意义.PAB各组无一例阳性表达.GAB在UC组和CD组比较差异无统计学意义.pANCA在UC组中阳性率为54.7％,显著高于CD组（3.2％）和对照组（2.5％）,UC组和后两组比较差异有统计学意义.ASCA（＋）诊断CD的敏感性、特异性、阳性和阴性预测值分别为12.9％、96.4％、23.5％、92.7％,pANCA（＋）诊断UC的敏感性、特异性、阳性和阴性预测值分别为54.7％、96.8％、99.5％、15.6％.结论 IBD相关抗体检测的特异性较高,但敏感性低.pANCA对于诊断UC较有价值,同时检测IgA型和IgG型ASCA可提高CD诊断的敏感性,PAB对于诊断IBD意义不大.     

酿酒酵母菌抗原在炎症性肠病结肠组织中的表达及意义

目的研究酿酒酵母菌抗原在炎症性肠病(IBD)结肠黏膜组织中的表达,评价酿酒酵母菌抗原在IBD诊断中的作用,初步探讨其在IBD发病中的意义。方法随机抽取航天中心医院2003年1月至2009年4月47例有完整临床资料的IBD患者的蜡块标本,其中克罗恩病(CD)22例、溃疡性结肠炎(UC)25例,另取非IBD结肠炎患者的蜡块标本20例作对照组。采用免疫组织化学法对标本石蜡切片进行染色,检测酿酒酵母菌抗原在肠黏膜组织中的表达,采用χ2检验分析酿酒酵母菌抗原在不同肠病中表达的差异性。结果免疫组织化学分析表明酿酒酵母菌抗原在CD阳性表达率为86.4%(19/22),在UC中为80.0%(20/25),在非IBD结肠炎中为70.0%(14/20),三组之间的阳性表达率差异无统计学意义(χ2=1.716,P=0.424)。结论酿酒酵母菌抗原在IBD中的表达无疾病特异性,暂不能作为诊断及鉴别诊断IBD的指标;酿酒酵母菌抗原在CD、UC患者及非IBD结肠炎患者结肠黏膜内的较广泛表达,也提示此类抗原蛋白在IBD的发生发展中发挥着不确定的作用。     

Diagnostic value of the serum platelet-activating factor acetylhydrolase activity in inflammatory bowel disease

Platelet-activating factor acetylhydrolase (PAF-AH) is an enzyme hydrolyzing platelet-activating factor (PAF), a potent inflammatory mediator, but the relationship between this enzyme and inflammatory bowel disease (IBD) is not fully elucidated. The aim of the present study was to examine the usefulness of the serum PAF-AH activity in order to differentiate ulcerative colitis (UC) from Crohn's disease (CD). The serum PAF-AH activity was measured in 57 patients with IBD (39 UC and 18 CD patients) and 13 control subjects by a spectrophotometric method. The serum PAF-AH activity was thus found to be significantly lower in patients with CD (median 265.5 U/l) than in those with UC (355 U/l) or control subjects (374 U/l). This marker at a cutoff level of 386 U/l demonstrated a sensitivity of 46%, a specificity of 100%, and a positive predictive value of 100% regarding its ability to distinguish UC from CD. Moreover, the marker responded inversely to the changes in the disease activity of IBD. These results suggest that measuring the serum PAF-AH activity is a useful diagnostic modality for making a differential diagnosis between UC and CD.     

粪便钙卫蛋白在肠易激综合征和炎症性肠病鉴别诊断中的意义分析

目的 探讨粪便钙卫蛋白(fecal calprotectin,FC)在肠易激综合征(irritable bowel syndrome,IBS)和炎症性肠病(inflammatory bowel disease,IBD)鉴别诊断中的意义.方法 选择2018年1月～7月江苏省中医院门诊及病房收治的IBS患者38例,IBD患...     

Potential role of soluble angiopoietin-2 and Tie-2 in patients with inflammatory bowel disease

BACKGROUND: Angiogenesis has been suggested to play an important role in inflammatory bowel disease (IBD). The aim of the study was to evaluate the serum markers of angiogenesis angiopoietin-2 (Ang-2) and soluble angiopoietin receptor Tie-2 in patients with ulcerative colitis (UC) and Crohn's disease (CD). MATERIALS AND METHODS: Serum Ang-2 and Tie-2 serum levels were measured in 160 IBD patients (79 UC and 81 CD) and in 80 matched healthy controls using commercially available enzyme-linked immunosorbent assays. Serum Ang-2 and Tie-2 levels were correlated with the disease activity, as well as the type, localization and treatment of the disease. RESULTS: Median serum Ang-2 and Tie-2 levels were significantly higher in both the UC patients and the CD patients compared with the healthy controls (P < 0.05 and P < 0.001, respectively). The IBD patients with early disease (diagnosis < 2 years) had significantly higher (P = 0.04) median serum Ang-2 levels but significantly lower (P = 0.02) median serum Tie-2 levels as compared with IBD patients with late disease (diagnosis > 2 years). The CD patients with active disease had significantly higher levels of Ang-2 compared with non-active disease (P = 0.02). Serum levels of both Ang-2 and Tie-2 were not correlated with laboratory markers such as ESR, CRP, white blood cell count, platelet count and albumin. CONCLUSIONS: Serum Ang-2 and Tie-2 levels are elevated in patients with IBD. These markers may mediate angiogenesis and vascular permeability in the mucosa of patients with IBD.     

载脂蛋白M在炎症性肠病中的测定及意义

目的 探讨血清载脂蛋白M (apolipoprotein M,apoM)在炎症性肠病(inflammatory bowel disease,IBD)患者血清中的表达及意义。方法 采用双抗夹心酶联免疫吸附法(enzyme-linked immuno sorbent assay,ELISA)检测101例IBD患者及69例健康对照组的血清apoM和肿瘤坏死因子a(tumor necrosis factor-a,TNF-α)水平,分析其与IBD疾病活动度的相关性。结果 溃疡性结肠炎(ulcerative colitis,UC)组、克罗恩病(Crohn＇s disesse,CD)组和健康对照组的血清apoM水平分别为(13.5±8.8) mg/L,(10.2±5.8) mg/L和(2.0±1.3) mg/L,且UC组血清apoM水平高于CD组,差异有统计学意义(P＜0.05);UC和CD患者血清apoM水平均随着疾病活动度的增加而升高,各等级间差异有统计学意义(P＜0.05);IBD组血清apoM水平与血清TNF-α水平呈正相关(r=0.314,P=0.001),以CD组为著(r=0.365,P=0.010)。结论 UC、CD患者血清apoM水平与疾病活动度相关,在评估IBD疾病活动度上有潜在的运用价值。     

Advances in clinical laboratory tests for inflammatory bowel disease

Inflammatory bowel disease (IBD) is a generic term that refers to Crohn's disease and chronic ulcerative colitis (UC). The CD and UC are considered to be distinct forms of IBD; but there is a subgroup of CD with a UC-like presentation. The genetic factors play a significant role in IBD. IBD is associated with a strong familial pattern. Recent studies support the hypothesis that IBD patients have a dysregulated immune response to endogenous bacteria in the gastrointestinal tract. The serologic responses seen in Crohn's disease include antibodies to Saccharomyces cerevisiae, mycobacteria, bacteroides and E. coli. The pANCA antibody seen in UC and CD has been demonstrated to react with epitopes of H1 histone, Bacteroides caccae (Ton-B linked outer membrane protein), Pseudomonas fluorescens-associated bacterial protein I-2, mycobacterial histone 1 homologue called Hup B. In recent years, several serologic markers have been found to be useful for the diagnosis and differentiation of CD and UC. These markers include the following antibodies: (a) pANCA, (b) ASCA, (c) anti-pancreatic antibody, (d) OmpC antibody and (e) I-2 antibody and antibodies to anaerobic coccoid rods. The application of a panel of markers with the use of an algorithm (i.e. IBD First Step) can identify specific subtypes of IBD that have different clinical courses and progression of the diseases. The serologic markers are useful for the diagnosis and management of CD and UC patients.     

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.     

血小板相关参数对评估炎症性肠病活动性的临床意义

目的探讨血小板相关参数评估炎症性肠病(IBD)活动性的价值。方法回顾性收集2010年1月至2019年6月九江学院附属医院消化内科住院的溃疡性结肠炎(UC)及克罗恩病(CD)患者共206例,另选取于九江学院附属医院健康体检50例健康人员作为对照;收集研究对象临床资料,并依据病史、Myao活动指数、蒙特利尔分级及克罗恩病活动指数(CDAI)对患者进行分组及疾病严重程度分级。收集患者首次诊断时的血常规检测指标。结果IBD患者的血小板相关参数除P-LCR外与对照组比较均有明显差异(P<0.05);CD患者PCT及PLT显著高于UC(P分别0.007、<0.001);IBD活动期患者血小板参数与对照组存在显著差异(P<0.05);且UC患者病情与血小板参数存在相关性,重度患者PLT高于轻度患者(P<0.05)、MPV低于轻度患者(P=0.001);将MPV、PDW、P-LCR、PCT、PLT联合诊断IBD的活动性,得到AUC=0.857,95%CI 0.803~0.912,P<0.05。结论MPV、PDW在IBD活动期降低;PLT、PCT则增高;血小板相关参数联合诊断可较好反映IBD活动性。     

Tumor necrosis factor-alpha in serum of patients with inflammatory bowel disease as measured by a highly sensitive immuno-PCR.

BACKGROUND: The significance of serum concentrations of tumor necrosis factor-alpha (TNF-alpha) in the pathogenesis of inflammatory bowel disease (IBD) is uncertain. We measured TNF-alpha in serum from IBD patients by immuno-PCR to analyze the relationship between TNF-alpha and pathophysiologic state in IBD. METHODS: Serum samples were collected from 54 healthy blood donors, 29 patients with ulcerative colitis (UC; 46 samples), and 7 patients with Crohn disease (CD; 8 samples). DNA label was generated by PCR amplification using biotinylated primer and was bound with streptavidin to biotinylated third antibody. TNF-alpha sandwiched by antibodies was detected by PCR amplification of the DNA label. RESULTS: TNF-alpha could be measured in all samples. The median serum concentration in IBD patients overall was approximately 390-fold higher than in healthy donors (median increase, 380-fold for UC, 640-fold for CD). The median serum TNF-alpha concentration was 1.7-fold higher in the active stage of UC than in the inactive stage (P <0.05), and this difference could be detected in individual patients. CONCLUSIONS: Sensitive measurement of serum TNF-alpha could provide an important pathophysiologic marker for the presence and activity of IBD.