健脾清肠方对脾虚湿热型激素依赖溃疡性结肠炎患者GRα表达的影响

[目的]探讨健脾清肠方治疗脾虚湿热型激素依赖溃疡性结肠炎的作用机制.[方法]选取脾虚湿热型激素依赖溃疡性结肠炎患者60例,随机数字表法分为试验组和对照组各30例.2组均给予强的松基础治疗,试验组加服健脾清肠方,对照组给予补脾益肠丸.疗程为12周.患者采用标准激素减量方法撤减激素.2组于治疗前后分别进行中医证候疗效及激素撤退情况分析.使用免疫细胞化学染色方法检测患者外周血单个核细胞（PBMC）中GRα的表达,比较治疗前后变化情况.[结果]试验组中医证候疗效总有效率为96.7％,对照组为80％,试验组中医证候改善明显优于对照组（P＜0.01）;2组治疗后累积光密度值均明显升高（P＜0.01）,试验组上调GRα表达水平优于对照组（P＜0.01）.[结论]与对照组比较,健脾清肠方可有效改善脾虚湿热型激素依赖溃疡性结肠炎的临床中医证候,上调GRα的表达水平,改善激素依赖状况,具有良好的临床疗效.     

溃疡性结肠炎患者生存质量研究现状与展望

溃疡性结肠炎(ulcerative colitis,uc)是炎症性肠病(inflammatory bowel disease,IBD)的一种,其临床表现多样性,病程迁延难愈,患者不仅在生理功能方面受到影响,而且在心理功能、社会关系、情感功能等领域中均有不同程度的下降.对UC患者生存质量(quality of life,...     

参苓白术散治疗大鼠脾虚湿困型溃疡性结肠炎的机制

目的探讨参苓白术散对脾虚湿困型溃疡性结肠炎(UC)大鼠结肠平滑肌细胞上钙池调控的钙离子通道(SOC)介导的Ca~(2+)内流变化的影响及可能机制。方法 64只Wistar大鼠随机分为正常对照组、模型组、柳氮磺吡啶组、参苓白术散组,每组16只。首先复制脾虚湿困型UC大鼠模型;采用fura-2荧光测定各组细胞外Ca~(2+)内流的变化;用生物信号采集系统记录各组结肠平滑肌收缩张力的变化;用免疫组织化学的方法观察各组结肠平滑肌上瞬时受体电位阳离子通道(TRPC)1蛋白质表达情况。结果 1在无钙4-(2-羟乙基)-1-哌嗪乙磺酸(HEPES)缓冲液中,模型组〔Ca~(2+)〕i低于正常对照组(P<0.05)。在引入两种不同的含钙HEPES缓冲液后,模型组低于正常对照组(P<0.05),而柳氮磺吡啶组与参苓白术散组均高于模型组(P<0.05)。2模型组结肠平滑肌张力低于正常对照组(P<0.05),而柳氮磺吡啶组与参苓白术散组张力高于模型组(P<0.05)。3各组结肠平滑肌上均有TRPC1细胞表达,其中模型组结肠组织TRPC1表达的平均光密度低于正常对照组(P<0.05),而柳氮磺嘧啶组和参苓白术散组高于模型组(P<0.05)。结论参苓白术散通过促进SOC介导的Ca~(2+)内流治疗脾虚湿困型UC,其分子实质是上调TRPC1的表达。     

清肠栓对溃疡性结肠炎大鼠结肠黏膜纤丝状肌动蛋白的影响

[目的]探讨复方中药清肠栓对溃疡性结肠炎(UC)大鼠结肠黏膜纤丝状肌动(F-actin)蛋白的修复作用。[方法]清洁级雄性SD大鼠36只,随机分为正常组,模型组,柳氮磺胺吡啶(SASP)组,清肠栓高、中、低剂量组,每组6只。选用三硝基苯磺酸(TNBS)诱导的UC大鼠模型,采用免疫荧光的方法观察各组大鼠结肠黏膜F-actin蛋白的表达,并运用图像分析软件进行平均光密度测定,观察清肠栓对UC大鼠结肠屏障的修复作用。[结果]UC发病对结肠黏膜细胞骨架系统严重损害,模型组大鼠结肠黏膜F-actin蛋白几乎完全被破坏,荧光染色暗淡。图像分析测其平均光密度较正常组明显降低(P<0.01)。清肠栓能不同程度减轻UC黏膜的破坏,改善F-actin蛋白的分布,并使其表达升高(P<0.01)。[结论]清肠栓能有效地调节肠黏膜屏障功能,有效抑制UC大鼠结肠通透性的升高,改善肠黏膜屏障功能,促进溃疡愈合。     

清肠栓对大鼠溃疡性结肠炎急性期模型CXCR2的影响

[目的]观察清肠栓对大鼠溃疡性结肠炎（UC）急性期模型结肠黏膜CXCR2的影响.[方法]SD大鼠48只,分为正常组、模型组、清肠栓组和SASP组,每组12只.用三硝基苯磺酸（TNBs）诱导大鼠UC急性期模型.造模后第3天开始给药,连续给药7d后处死.Elisa、免疫组化检测病变部位结肠组织中的CXCR2含量及蛋白表达.[结果]模型组CXCR2含量及蛋白表达较正常组明显升高（P＜0.05）,清肠栓及SASP组较模型组均降低（P＜0.05）.[结论]清肠栓通过调节结肠黏膜CXCR2蛋白含量,减少中性粒细胞向病变局部黏膜组织的趋化和激活,从而起到缓解病变部位炎症的作用.     

溃疡性结肠炎脾虚及肝郁脾虚证模型大鼠肠黏膜病理损伤的比较研究

[目的]观察溃疡性结肠炎(UC)脾虚及肝郁脾虚模型大鼠结肠黏膜病理损伤的特点,探讨2种模型客观化证候本质。[方法]建立UC脾虚及肝郁脾虚证动物模型,进行一般情况、结肠组织损伤积分及镜下观察。[结果]2种证候模型的一般表现基本符合证候要点,病理组织形态学均显示出UC特征,大鼠结肠黏膜充血积分、组织损伤评分、肠重系数分均显著上升(P0.01),脾虚组较肝郁脾虚组结肠组织损伤积分显著上升(P0.01)。[结论]UC脾虚及肝郁脾虚大鼠模型中,脾虚组较肝郁脾虚组结肠黏膜组织损伤更为严重,脾虚可能是UC中医的病理基础。     

加味三黄汤灌肠治疗大肠湿热证溃疡性结肠炎的临床注册登记研究

目的:观察加味三黄汤灌肠对活动期大肠湿热证溃疡性结肠炎(UC)患者的近、远期临床疗效、IBD-Q生活质量评分、复发率及安全性。方法:采用注册登记研究方法,纳入76例活动期大肠湿热证UC患者,根据治疗方法分为2组,美沙拉嗪联合中药口服加用加味三黄汤灌肠为观察组(n=42),美沙拉嗪联合中药口服为对照组(n=34)。接受规范治疗12个月,在治疗第1、3、6、9、12个月进行随访,就2组患者中医证候积分及疗效、单项症状积分、IBD-Q生活质量评分、复发率及安全性进行对比。结果:接受规范治疗12个月后,近期疗效观察组总有效率为85.71%,对照组为82.35%,差异无统计学意义。远期疗效观察组总有效率为92.86%,对照组为85.29%,差异有统计学意义(P<0.05)。治疗期间单项症状积分腹泻与腹痛2组比较,差异无统计学意义,黏液脓血便、里急后重症状积分观察组较对照组明显降低,差异有统计学意义(P<0.05)。远期IBD-Q生活质量评分,观察组较对照组显著升高,差异有统计学意义(P<0.05)。治疗期间观察组复发率为16.67%,显著低于对照组的26.47%,差异有统计学意...     

清肠栓对大鼠溃疡性结肠炎白细胞介素受体表达的影响

[目的]从白细胞介素受体(IL-R)角度探讨中药清肠栓防治溃疡性结肠炎(UC)的作用机制.[方法]三硝基苯磺酸(TNBS)诱导建立大鼠UC模型;41只雄性SD大鼠随机分成6组(正常组,模型组,5-氨基水杨酸栓组,清肠栓大剂量、中剂量、小剂量组),治疗组均分别予肠道给药;1周后处死,ELISA法检测血清、结肠组织可溶性IL-R(sIL-R)2,4、6水平;RT-PCR半定量法检测结肠黏膜IL-2R、IL-4R、IL-6R mRNA的表达.[结果]清肠栓各剂量组sIL-2R、sIL-6R的水平降低,与模型组比较P＜0.01,中、大剂量组IL-2R、IL-6R mRNA表达降低,与模型组比较P＜0.01或＜0.05,清肠栓各剂量组皆有降低IL-4R mRNA表达的趋势,与模型组比较P＞0.05.[结论]清肠栓有效防治UC,其作用机制与降低slL-2R、sIL-6R水平,下调IL-2R、IL-6R mRNA表达,抑制T淋巴细胞活化增殖,减少炎症递质产生有关.     

健脾解毒化瘀方对大鼠实验性溃疡性结肠炎细胞因子的影响

[目的]探讨以益气健脾、清热解毒、活血化瘀为原则组成方剂对溃疡性结肠炎(UC)大鼠细胞因子的影响,探讨其治疗UC的机制.[方法]除15只大鼠作为正常组外,其他大鼠采用TNBS复制UC模型后随机分成模型组、对照组、柳氮磺胺吡啶(SASP)组、中药组,肉眼及镜下观察各组大鼠的组织学损伤,并检测血清中细胞因子的含量.[结果]中药组、SASP组在减轻肉眼及镜下的组织学损伤方面和改善细胞因子方面较模型组、对照组均具有明显效果(P＜0.05);中药组较SASP组疗效更明显(P＜0.05).[结论]以益气健脾、清热解毒、活血化瘀为原则组成方剂对UC治疗有效,其机制可能是提高抗炎因子的含量,降低炎症因子的含量,维持细胞因子之间的平衡,进而调节免疫炎症反应.     

脾虚型慢性结肠炎、溃疡性结肠炎的病机特点及治疗规律

溃疡性结肠炎，又名非特异性溃疡性结肠炎，世界卫生组织称为特发性结肠炎．该病是一种以腹痛、腹泻、粘液便、血便为主要临床表现的非特异性炎症性结肠疾病．本病多发于２０岁～４０岁的青壮年，随着饮食结构、生活习惯和生活节奏的改变，诊检手段的提高（如纤维肠镜的推...     

健脾清热活血方与美沙拉嗪治疗溃疡性结肠炎的对比研究

[目的]评价健脾清热活血方辨治溃疡性结肠炎的疗效。[方法]采用非劣效试验设计,应用随机对照设计,将120例符合诊断标准、纳入标准的溃疡性结肠炎患者随机分为2组,治疗组60例,对照组60例。治疗组予中药复方健脾清热活血方干预12周,对照组予美沙拉嗪干预12周。详细记录治疗前、后患者肠镜及症状变化。[结果]治疗前、后肠镜病变疗效判定,治疗组总有效率为66．66％,对照组总有效率为63．33％,在促进溃疡愈合方面,2组疗效无差异（P〉0．05）;治疗前、后症状积分判定疗效,治疗组总有效率为78．33％,对照组总有效率为61．66％,在改善临床症状方面,治疗组疗效优于对照组（P〈0.05）。[结论]健脾清热活血方具有提高溃疡性结肠炎愈合质量、缓解其临床症状的功效,值得临床推广应用。     

Predictors of health-related quality of life in patients with moderate to severely active ulcerative colitis receiving biological therapy

Abstract

Background and aims: Patients with ulcerative colitis have reduced health-related quality of life compared to the general population. Current treatment strategy aims to reduce patients’ symptoms and increase health-related quality of life. We investigated which symptoms of ulcerative colitis correlate to decreased health-related quality of life.

Methods: Among 743 patients with moderate to severely active ulcerative colitis receiving biological therapy in a cross-sectional national study, we determined which disease-related symptoms, as measured by the Simple Clinical Colitis Activity Index, worsened health-related quality of life scores across the Short Health Scale dimensions, while adjusting for treatment, age, and clinical manifestation, and stratifying for sex, by means of multiple linear regression.

Results: Patients with active disease had decreased health-related quality of life compared to those with inactive disease (median 5.8 (range 4.5–7.5) vs. 2 (0.8–3.3)). Both sexes had decreased health-related quality of life in all dimensions for the symptoms: bowel frequency during daytime (0.37–0.86 and 0.46–0.84), urgency of defecation (0.54–0.79 and 0.49–0.65) and blood in stool (0.50–0.75 and 0.36–0.54) for men and women respectively. Women were more often negatively affected by bowel frequency during night-time (4 domains vs. 1) and arthritis (5 domains vs. 3). In non-stratified analysis female sex is an independent predictor of lower health-related quality of life for 3 domains (0.38–0.53).

Conclusions: Health-related quality of life was most prominently associated with bowel frequency during daytime, urgency of defecation, and blood in stool. Other symptoms associated for some health-related quality of life dimensions, and appear to vary between the sexes.     

Instruments for quality of life assessment in patients with inflammatory bowel disease

BACKGROUND: Health-Related Quality of Life is an important measure of illness perception on the part of the patient. In this review, the current status of the Health-Related Quality of Life assessment in studies concerning inflammatory bowel disease is examined and the various instruments proposed for this purpose are considered and compared. METHODS: A search was made of the Medline database, for relevant articles since 1980. Standard criteria were used for including studies for further evaluation. RESULTS: All studies on measuring Health-Related Quality of Life in inflammatory bowel disease patients conclude that the instruments used were valid and reliable assessment tools. Valid instruments that have been proposed for the assessment of health-related quality of life are: the Inflammatory Bowel Disease Questionnaire, the Rating Form of Inflammatory Bowel Disease Patient Concerns, an Inflammatory Bowel Disease-specific questionnaire developed in Cleveland, the Ulcerative colitis and Crohn's disease Health Status Scales and a Disease-specific questionnaire developed in the University of Padova. CONCLUSIONS: Assessing health-related quality of life in inflammatory bowel disease patients is an ever-expanding practice, especially in clinical trials. The instruments that, currently, satisfy most demands for simplicity and validity are the Inflammatory Bowel Disease Questionnaire, reflecting primarily disease activity, and the Rating Form of Inflammatory Bowel Disease Patient Concerns which corresponds more to the psychological and social aspects of inflammatory bowel disease from the patient's point of view.     

Clinical and experimental study on treatment of retention enama for chronicnon-specific ulcerative colitis with quick-acting kuijie powder

AIM To study the clinical effect and mechanism of retention enema with quick-acting Kuijie powder(QAKJP) in treating chronic non-specific ulcerative colitis (CUC).METHODS A treatment group of 156 patients treated with QAKJP and a control group of 78 patientstreated with sulfasalazine orally were established randomly and their scores of main symptoms and signs weremeasured and compared before and after treatment. Animal experiments were conducted at the same time.RESULTS The total effective rate in the treatment and control group was 98.7% and 70.5% respectively,the clinical cure rate was 78.2% and 6.4% and the recurrence rate 5.3% and 20.0% respectively. Theeffectiveness of the treatment group was markedly superior to that of the control group, P<0.01.Experimental study showed QAKJB could rapidly alleviate the congestion and edema of intestinal mucosa,promote the healing of ulcer, inhibit spasm of colon and had significant antidiarrheal action and antagonisticeffect against allergic mediator histamine.CONCLUSION Retention enema with QAKJP has good effect on CUC, with low recurrence rate and notoxic or side effect.     

不同证型活动期与缓解期溃疡性结肠炎患者自然杀伤T细胞的表达差异研究

[目的]探讨自然杀伤T细胞（NKT）在不同证型活动期与缓解期溃疡性结肠炎（UC）患者中的差异表达及其临床意义.[方法]将UC患者分为以下4组：湿热型活动期组（A）、湿热型缓解期组（B）、脾肾阳虚型活动期组（C）、脾肾阳虚型缓解期组（D）,各25例;选取20例行肠镜检查的健康体检者作为对照组.采集以上5组的外周血及结肠黏膜组织,采用流式细胞术检测NKT及其细胞因子γ干扰素（IFN-γ）和肿瘤坏死因子α（TNF-α）的频率.[结果]①NKT：外周血及结肠频率均呈现A＜B＜C＜D的顺序,且A显著低于B,C显著低于D,A显著低于C,B显著低于D（均P＜0.05）;每组结肠NKT频率均显著低于外周血（P＜0.05）.②细胞因子：外周血与结肠频率大体呈现A＜B＜C＜D,且组间差异有统计学意义,且每组结肠NKT频率均显著低于外周血（P＜0.05）.[结论]NKT及其细胞因子频率降低在湿热证型及活动期UC发病机制中起到关键作用.     

Oral budesonide therapy improves quality of life in patients with collagenous colitis

Introduction Collagenous colitis is an idiopathic microscopic colitis characterised by watery diarrhoea. The impact of collagenous colitis on quality of life has not been assessed. Our aim was to assess quality of life in patients with this condition and compare the effect of treatment with budesonide capsules or placebo on this parameter.Methods Patients with chronic diarrhoea and histologically-proven collagenous colitis were randomised to receive either budesonide controlled-release capsules (Entocort capsules, AstraZeneca, Lund, Sweden), 9 mg/day, or placebo for 6 weeks. Quality of life was measured using the validated Gastrointestinal Quality of Life Index (GIQLI) at baseline and after 6 weeks. With the GIQLI, scores range from 0 to 144, with higher scores representing better quality of life.Results Complete quality of life assessment was available in 29 patients (budesonide: n=17; placebo: n=12). At baseline, quality of life was low in patients with collagenous colitis (mean 76). After 6 weeks of treatment, the mean GIQLI score increased significantly in the budesonide group (from 67 to 92, p<0.001), but remained unchanged in the placebo group (86–88). The mean score of the dimensions symptoms (p=0.001), emotional functioning (p=0.003) and physical functioning (p=0.017) increased significantly in the budesonide group compared with the placebo group. A significantly larger proportion of patients in the budesonide group experienced improved stool consistency (p<0.01) and a significant reduction in the mean stool frequency compared with those in the placebo group (p<0.01).Conclusion Quality of life is seriously reduced in patients with collagenous colitis. Six-week treatment with oral budesonide controlled-release capsules significantly improves quality of life and clinical symptoms compared with placebo in these patients.     

自拟止痢汤联合艾灸对溃疡性结肠炎患者的疗效及相关生化指标的影响

溃疡性结肠炎(UC)是一种累及结肠和直肠的非特异性慢性炎症疾病,该病病程长、易反复发作,已被世界卫生组织(WHO)列为现代难治疾病之一.近年来,我国UC发病率呈持续上升的趋势,严重影响患者的生活质量[1-2].美沙拉嗪是治疗UC常见药物之一,具有显著的抗炎效果,但该药单独使用时部分患者存在药物耐受、恶心呕吐等不良反应....