溃疡性结肠炎患者血小板活化的检测

溃疡性结肠炎患者血小板活化的检测江学良权启镇刘同亭王要军孙自勤齐风任洪波张维莉张力济南军区总医院消化科山东省济南市２５００３１Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｃｏｌｉｔｉｓ，ｕｌｃｅｒａｔｉｖｅ／ｂｌｏｏｄ；ｐｌａｔｅｌｅｔａｃｔｉｖａｔｉｏｎ；...     

难治性溃疡性结肠炎的治疗

难治性溃疡性结肠炎系指经较长期系统治疗而无明显疗效,或曾一度控制症状,一旦停药,又再次复发的病例。此类病例具有三大特点:①肠道病变广泛而严重,局部和全身并发症多;②激素和水杨酸偶氮磺胺类药物的疗效较差,③具有反复发作倾向。一、溃疡性结肠炎的难治性原因难治性原因十分复杂,因人而异,大致可从以下两方面进行分析。     

难治性溃疡性结肠炎治疗进展

溃疡性结肠炎(ulcerative colitis,UC) 是炎症性肠病(inflammatory bowel disease,IBD) 的一种,虽然病因和发病 机制尚不清楚,但可能与遗传易感性、肠道微生态失衡、环境因素和免疫应答异常有关。因为存在上述不同的发病 机制,预示着存在治疗效果的差异,因此部分UC 成为难治性。难治性溃疡性结肠炎(RUC) 虽经规范化、系统化治疗, 但疗效不佳,不能长期缓解或易反复发作。因此,临床治疗极其困难,给临床医生带来诸多挑战。     

血小板活化在溃疡性结肠炎发病中的作用

目的探讨血小板活化在溃疡性结肠炎(ulcerative colitis,UC)发生、发展中的作用。方法对80例活动期UC患者(UC组)、20例健康对照者(健康对照组)采用ELISA法检测血浆中血小板活化指标D-二聚体、P-选择素、6-酮-前列腺素F1α(6-ketoprostaglandin,6-K-PGF1α)、血栓素B2(thromboxane B2,TXB2)的水平,比较两组、UC不同严重程度和不同分型间的差异。结果与健康对照组相比,UC组血浆中血小板活化指标D-二聚体、P-选择素、6-K-PGF1α、TXB2均明显升高(P0.01);随着UC严重化程度的增加,血小板活化指标升高,且轻度组、中度组与重度组比较,差异有统计学意义(P0.01);慢性复发型及慢性持续型较初发型UC患者各血小板活化指标均明显升高,差异具有统计学意义(P0.01)。结论 UC患者血小板处于活化状态。血小板活化通过释放多种炎性介质维持结肠黏膜炎症,促进UC的发生、发展,这可能为血小板活化拮抗剂治疗UC提供一定的理论基础。     

抗栓灵含片治疗不稳定型心绞痛疗效观察

目的：探讨抗栓灵含片治疗不稳定型心绞痛（UAP）的临床疗效及安全性。方法：选择36例UAP患在内科常规药物治疗基础上加用抗栓灵含片，舌下含服，每次1－2片，每日3次，连用15日，观察用药前、后临床症状改善、心绞痛发作次数，心电图及血液流变学变化。结果：临床疗效：显效率50％，总有效率88.9%；心电图：显效率16.7%，总有效率66.7%；对血液流变学影响：各项测定指标（全血粘度、血浆粘度、血小板聚集指数，血沉、红细胞压积、纤维蛋白原）治疗前、后均有显差异（P＜0.01)。结论：抗栓灵含片治疗UAP疗效肯定，使用简便，安全，不良反应少，值得临床推广使用。     

英夫力西单抗治疗难治性溃疡性结肠炎

目的分析14例英夫力西治疗难治性中重度溃疡性结肠炎的临床资料,探索英夫力西治疗国人溃疡性结肠炎的效果和安全性。方法对我院2006年-2011年经常规治疗失败的14例难治性中重度溃疡性结肠炎患者,行英夫力西单抗治疗,分别于0、2、6周按5 mg/kg全身用药,以后每8周给药1次,个别患者因用药效果、病情变化等增加了用药剂量或缩短了用药间隔。分析英夫力西单抗治疗8周有效率和缓解率,随访30周、54周缓解率及安全性等。结果治疗8周有效率为42.9%,缓解率为42.9%,无效率为14.3%;随访30周、54周缓解率分别为57.1%和42.3%。有2例患者达到黏膜愈合,至今分别随访35个月和28个月,病情均无复发。不良反应发生率为28.6%,无严重或危及生命的不良反应发生。随访54周,有效组和无效组前两次英夫力西单抗治疗有效者所占比例差异有统计学意义(P=0.015)。结论应用英夫力西治疗14例难治性中重度溃疡性结肠炎,取得了良好的治疗效果,前两次治疗有效可预示远期治疗效果好,近期的药物不良反应不影响程序性治疗的进行。英夫力西单抗可作为国人难治性溃疡性结肠炎的挽救治疗方法。     

百忧解治疗伴有抑郁的溃疡性结肠炎疗效观察

溃疡性结肠炎(UC)是一种原因不明的慢性直肠和结肠炎性疾病。其病因主要为感染、遗传、免疫及精神因素。UC急性发作常以紧张、劳累为诱因，较多患者伴有精神抑郁和焦虑表现。心理治疗在一定程度上有效。本研究主要观察了百忧解对伴有抑郁的轻、中度UC患者的疗效。现报告如下。     

难治性远端溃疡性结肠炎的临床表现和治疗

目的:分析难治性远端溃疡性结肠炎的可能的发病原因及治疗方案.方法:收集我院2005-01/2011-12溃疡性结肠炎中145例DUC患者资料进行回顾性分析.根据对传统治疗的反应,分为有效组和难治组.比较两组患者的临床和实验室检查结果,分析难治DUC可能的原因及进一步治疗方案.结果:145例远端溃疡性结肠炎患者,其中117例符合条件纳入组,117例中有26例[22.2%(26/117)]患者难治.与有效组相比,难治组患者腹痛腹胀明显[42.3%(11/26)vs22.0%(20/91),P=0.038]、白细胞数明显增高[30.8%(8/26)vs12.1%(11/91),P=0.035],而血便、腹泻、肠外表现、C反应蛋白及血沉两组之间无明显差异(P>0.05).117例入组患者内镜下表现为直肠炎43例其中10例难治,直乙状结肠炎74例中16例难治,病变部位差异无统计学意义(P>0.05).26例难治患者仅1例行外科手术治疗,其余的通过激素静脉治疗、加用5-ASA新型剂型、适当的泻药等获得缓解.结论:远端溃疡性结肠炎患者腹泻和血便是临床最常见症状,难治组白细胞数较有效组明显增高,其有望成为评估DUC治疗转归的指标之一.难治性DUC患者可通过强化治疗、加用5-ASA的新型剂型、适当的泻药、手术等方法获得缓解.     

Treatment of severe steroid refractory ulcerative colitis

Although systemic steroids are highly efficacious in ulcerative colitis （UC）, failure to respond to steroids still poses an important challenge to the surgeon and physician alike. Even if the life time risk of a fulminant UC flare is only 20%, this condition is potentially life threatening and should be managed in hospital. If patients fail 3 to 5 d of intravenous corticosteroids and optimal supportive care, they should be considered for any of three options： intravenous cyclosporine （2 mg/kg for 7 d, and serum level controlled）, infliximab （5 mg/kg Ⅳ, 0-2-6 wk） or total colectomy. The choice between these three options is a medicalsurgical decision based on clinical signs, radiological and endoscopic findings and blood analysis （CRP, serum albumin）. Between 65 and 85% of patients will initially respond to cyclosporine and avoid colectomy on the short term. Over 5 years only 50% of initial responders avoid colectomy and outcomes are better in patients naive to azathioprine （bridging strategy）. The data on infliximab as a medical rescue in fulminant colitis are more limited although the efficacy of this anti tumor necrosis factor （TNF） monoclonal antibody has been demonstrated in a controlled trial. Controlled data on the comparative efficacy of cyclosporine and infliximab are not available at this moment. Both drugs are immunosuppressants and are used in combination with steroids and azathioprine, which infers a risk of serious, even fatal, opportunistic infections. Therefore, patients not responding to these agents within 5-7 d should be considered for colectomy and responders should be closely monitored for infections.     

Management of refractory ulcerative colitis

Opinion statement A physician’s approach to patients with ulcerative colitis (UC) who are refractory to standard first-line therapies must be thoughtful and systematic and include the individual’s physical and emotional state as the physician examines the various dietary, medical, and surgical options currently available. It is of foremost importance to confirm that the refractory patient’s symptoms are not simply due to dietary indiscretion, concomitant bowel infection (especially with Clostridium difficile), an incorrect diagnosis (eg, colitis due to infection, NSAIDs, ischemia, diverticulitis, or Crohn’s disease), or even a concomitant diagnosis (eg, celiac sprue, pancreatic insufficiency, functional bowel disorder, laxative or sorbitol intake). The ability to quickly assess the status of the colonic mucosa with flexible sigmoidoscopy aids in the ability to distinguish patients with refractory inflammation from those with other diagnoses. The initiation and optimization of the long-term purine analogues azathioprine (AZA) or 6-mercaptopurine (6-MP) remain the backbone of medical therapy for patients with refractory UC. For those unresponsive to corticosteroids, quicker induction of remission may necessitate infliximab, cyclosporine, or tacrolimus. Successful induction and maintenance with AZA, 6-MP, and/or infliximab should be followed by long-term therapy with these agents. Cessation of therapy often leads to relapse. Novel therapies under investigation hold the promise of offering more options for both the induction and maintenance of remission in refractory UC patients. Discussions of surgical intervention should not be put off as a last resort but rather included in the overall treatment plan offered to the patient.     

Infliximab for patients with refractory ulcerative colitis

Conventional treatment options for patients with severe corticosteroid-refractory ulcerative colitis (UC) include intravenous cyclosporine, which is frequently limited by toxicity, or colectomy. The efficacy of infliximab was investigated in the treatment of 16 patients with severely active UC refractory to conventional therapy; 7 of these patients were considered for colectomy pending medical failure. All patients received a single infusion of infliximab, 5 mg/kg; 6 of 16 patients (38%) received a second infusion approximately 5 months later. Efficacy was assessed by clinical response (defined as the lack of symptoms) as well as endoscopic and histologic outcomes. Clinical, endoscopic, and histologic improvement was observed in 14 of 16 patients (88%) after treatment with infliximab. Surgery was avoided in six of seven surgical candidates (86%). Clinical remission was maintained in 14 of 16 patients (88%) for > or = 4 months, and 4 of 16 patients (25%) for 7-10 months. Most of the treated patients were completely withdrawn from corticosteroid therapy. Treatment with infliximab induced endoscopic remission at 30 days and a significant improvement from baseline in mean histologic score (p < 0.001). In conclusion, infliximab improved clinical, endoscopic, and histologic outcomes in patients with severely active UC refractory to conventional therapy, allowing corticosteroid sparing and reducing the need for colectomy.     

Infliximab for refractory ulcerative colitis

Eight patients with active ulcerative colitis (UC), refractory to usual combination medical therapy, were treated with a single i.v. dose of chimeric monoclonal antibody to recombinant human tumor necrosis factor alpha; many of these patients were scheduled for surgical colectomy because of their active disease. All patients responded extremely well to a single 5 mg/kg infusion of infliximab, with marked improvement after the infusion clinically, colonoscopically, and histologically on colonic biopsy. There were no significant complications or side effects; mean duration of remission has not been determined because none of the patients have relapsed. Infliximab appears to be a potent agent for inducing remission in refractory patients with ulcerative colitis.     

顽固性溃疡性结肠炎治疗的新方法

顽固性溃疡性结肠炎患者,传统治疗效果不理想,本文介绍应用干细胞治疗或者英夫利西作为过渡,加用黏膜修复药物,待病情完全缓解且可停用激素后,继续以免疫抑制剂或者氨基水杨酸类药物维持.采用这种限时加速的序贯治疗,可更快诱导缓解,并维持更长时间缓解及内镜下黏膜愈合,从而减少住院率和手术率,为难治性溃疡性结肠炎患者治疗提供新的治疗手段.