溃疡性结肠炎患者外周血淋巴细胞亚群检测的临床价值

目的 探究外周血淋巴细胞亚群检测在溃疡性结肠炎（ulcerative colitis,UC）诊断中的临床价值.方法 随机选择解放军总医院第一附属医院2011年1月至2013年12月溃疡性结肠炎确诊患者70例,健康体检人群39人,检测其外周血CD3、CD4、CD8、CD4/CD8四项免疫学指标.以SPSS16.0进行独立样本t检验,分析各项指标的诊断价值.结果 溃疡性结肠炎患者与健康人群相比,CD3、CD8差别不明显,CD4、CD4/CD8具有明显差别（P＜0.05）.结论 淋巴细胞亚群的检测对溃疡性结肠炎实验室诊断具有重要临床价值.     

溃疡性结肠炎患者血清NGAL检测及意义

目的 探讨溃疡性结肠炎(UC)患者血液中NGAL的含量和意义.方法 使用胶乳增强免疫比浊法检测89例UC患者血清中NGAL含量并与对照组比较.分析NGAL水平与UC患者WBC数量、PLT数量、CRP和Hgb、HCT、ESR、年龄、疾病活动程度(DAI)关系.结果 UC患者血清中NGAL水平显著高于健康对照组,中位数分别为112ng/mL和48.2ng/mL,差异有统计学意义(P ＜0.0001).血清NGAL水平在轻度和中、重度UC患者血清NGAL中位数分别为78.2ng/mL和67.2ng/mL,差异有统计学意义(t=3.981,P=0.006).UC患者血清NGAL水平与WBC数量、PLT数量、CRP和Hgb、HCT、ESR、年龄无关(P＞0.05),与疾病活动程度(DAI)轻度相关(r=0.525,P＜0.0001).结论 溃疡性结肠炎患者血清NGAL水平升高,升高水平与疾病活动程度有关,但是其在疾病中的作用尚需进一步研究.     

溃疡性结肠炎患者的人格特质、心理健康状况和应对方式

目的:分析溃疡性结肠炎患者的人格特质、心理健康状况和应对方式。方法:选取2014年2月至2016年9月于我院就诊的溃疡性结肠炎患者共150例作为调查组,选取体检健康者150例作为对照组,采用艾森克人格简式问卷、症状自评量表(SCL-90)、医用应对问卷(MCMQ)对患者进行评估,以了解溃疡性结肠炎患者的人格特质、心理健康状况和应对方式分析。结果:调查组患者的心理变态量表评分显著高于对照组,差异具有统计学意义(t=6.403,P0.01),调查组患者的总均分(t=7.406,P0.01)、躯体化(t=9.130,P0.01)、强迫症状(t=8.408,P=0.01)、抑郁(t=7.176,P0.01)、焦虑(t=8.128,P0.01)、恐怖(t=9.886,P0.01)和精神病性(t=4.737,P0.01)均显著高于对照组,差异均具有统计学意义,应对方式评分中,回避评分比较调查组显著低于对照组,差异具有统计学意义(t=4.374,P0.01)。结论:溃疡性结肠炎患者心理变态的人格评分,躯体化、强迫症状、抑郁、焦虑、恐怖和精神病性的心理健康评分与健康人有差异,其主要采取回避的应对方式。     

Serum 25-Hydroxy Vitamin D Levels and Association of Vitamin D Receptor Gene Polymorphisms in Vitiligo

BackgroundThe role of vitamin D deficiency and vitamin D receptor (VDR) gene polymorphisms has been established in many autoimmune diseases, including vitiligo, but the result is still controversial.ObjectivesThe aim of this study was to investigate the serum vitamin D levels in vitiligo patients and to compare the association of VDR gene polymorphisms in vitiligo patients and healthy controls.MethodsWe collected the data of age, sex, serum 25-hydroxy vitamin D (25[OH]D) level, thyroid autoantibodies, disease duration, types of vitiligo, family history and the affected body surface area of vitiligo from 172 patients. And we analyzed the VDR gene polymorphisms in 130 vitiligo and 453 age-sex-matched control subjects.ResultsThe mean serum level of 25(OH)D in 172 vitiligo patients was 18.75 ± 0.60 ng/mL, which had no significant difference with a mean serum value of 25(OH)D in the Korean population. However, there were significant differences according to the duration of the disease and family history. Also, there were no significant differences in the genotypic and allelic distributions of 37 examined SNPs of VDR gene between vitiligo patients and healthy controls.ConclusionSerum level of 25(OH)D in vitiligo patients was not significantly different from the mean serum value of the Korean population. Also, there were no significant differences in the genotypic distributions of VDR gene between vitiligo patients and healthy controls.     

Infliximab Therapy for Children with Moderate to Severe Ulcerative Colitis: A Step-Up versus a Top-Down Strategy

PurposeWe aimed to investigate clinical outcomes between top-down (TD) and conventional step-up (SU) therapies in pediatric patients with moderate to severe ulcerative colitis (UC).Materials and MethodsAll patients underwent clinical and endoscopic evaluation at diagnosis and 4 months and 1 year after treatment. Patients who started treatment with corticosteroid were grouped in the SU group, while those that initiated early infliximab (IFX) were grouped in the TD group. Among the SU group, patients who eventually changed to IFX treatment due to steroid resistance or dependency were included in the SU(R) group.ResultsIn total, 44 children with moderate to severe UC were included for analysis. Twenty-one patients were included in the SU group, 23 were included in the TD group, and 10 were enrolled in the SU(R) group. Relapse rates were 47.6% (10/21) in the SU group and 17.4% (4/23) in the TD group (p=0.033). Among relapsed patients, the durations from remission to relapse were 17.3 months (0.9–46.9) in the SU group and 24.3 months (1.8–44.9) in the TD group. There was no statistically significant difference in the sustained durations of remission after IFX administration between the SU(R) and TD groups [3.9 (1.4–6.3) and 2.3 (0.3–5.2) years, respectively (p>0.05)].ConclusionAccording to our study, early use of IFX without corticosteroid treatment for children with moderate to severe UC helps to lower relapse rates. We also found that IFX was a very effective treatment for pediatric UC, with a sustained duration of remission similar between TD and SU(R) groups.     

溃疡性结肠炎中西医结合治疗研究

溃疡性结肠炎是由多种病因引起的、发病机制尚不明确的、国际公认的难治病之一,成为近年研究的热点。目前西医、中医治疗该病均取得了较大的进步,但还没得出一个公认、统一、有效的根治方案。黄连素具有抗炎、抗癌、抑菌、降脂、降糖等多种作用,为研究治疗溃疡性结肠炎开展了新局面,现就西医、中医及中西医结合治疗溃疡性结肠炎作一综述。     

溃疡性结肠炎患者外周血Tim-4 mRNA表达水平的变化及意义

目的 探究溃疡性结肠炎患者外周血Tim-4 mRNA的表达变化及临床意义。方法 选取2015年2月~2019年4月我院收治的溃疡性结肠炎患者38例作为观察组,另选取同期来我院体检的健康者30名作为对照组,采用荧光定量PCR测定外周血Tim-4 mRNA表达水平,比较两组Tim-4 mRNA、C反应蛋白（CRP）、红细胞沉降率（ESR）表达水平及观察组Tim-4 mRNA与CRP和ESR的相关性。结果 观察组Tim-4 mRNA、CRP、ESR表达均高于对照组[（0.79±0.37）vs（0.33±0.20）]、[（6.08±3.21）mg/L vs（0.99±0.87）mg/L]、[（19.12±12.13）mm/h vs（5.58±4.10）mm/h],差异有统计学意义（P＜0.05）。观察组外周血单个核细胞Tim-4 mRNA表达水平与CRP呈正相关（r=0.376,P＜0.05）,而与ESR无相关性（r=0.077,P＞0.05）。结论 溃疡性结肠炎患者Tim-4 mRNA异常上调,并与CRP密切相关,可能参与溃疡性结肠炎的致病过程。     

Reduced Plasma Levels of sCD14 and I-FABP in HIV-infected Patients with Mesalazine-treated Ulcerative Colitis

Background: Microbial translocation (MT) is a shared feature of HIV infection and inflammatory bowel disease (IBD). Aims: This study was conducted to assess the impact of IBD (and particularly ulcerative colitis, UC) on plasma markers of MT and immune activation in HIV+ subjects.

Methods: A cross-sectional study was conducted in 3 groups of patients: HIV+/UC+(group HIV/UC); HIV+/UC- (group HIV); HIV-/UC+(group UC). Plasma levels of soluble CD14 (sCD14), intestinal fatty acid-binding protein (I-FABP), and endotoxin core antibodies (endoCAB) were measured as plasma markers of MT. Inflammation and immune activation were evaluated by measuring plasma levels of IL-6, IL-21, TNF-alpha, and high-sensitivity C-reactive protein (hs-CRP). T- and B-cells subpopulations were characterized by FACS analysis.

Results: Seven patients were enrolled in group HIV/UC, 9 in HIV, and 10 in UC. All HIV-positive patients had plasma values of HIV-1 RNA < 37 copies/mL for at least 12 months and good immunological recovery. All patients with UC were treated with oral mesalazine. Markers of MT, immune activation, and inflammation were not increased in subjects with HIV/UC. In fact, they had lower levels of I-FABP (p = 0.001) and sCD14 (p = 0.007) when compared to other patients groups. Positive correlations were found between I-FABP and sCD14 (r = .355, p = 0.076). Frequency of T- and B-cell subsets did not differ among groups.

Conclusions: Our results suggest that UC does not worsen MT, inflammation, or immune activation in HIV-infected subjects. The anti-inflammatory activity of chronic mesalazine administration on intestinal mucosa may contribute to this finding.     

Molecular detection of pathogenic bacteria in the colonic biopsies from patients with Ulcerative Colitis

Background/AimUlcerative Colitis (UC) is an inflammatory bowel disease which is common in many areas of the world including Egypt. A lot of controversy regarding the pathogenesis of UC exist. The current study is an attempt to detect some pathogenic bacteria in UC patients.Materials and methodsEndoscopic colonic biopsies obtained from 40 patients with ulcerative colitis and 20 controls were analyzed by means of real-time PCR technique for the presence of Clostridium difficile, Helicobacter Pylori (H. pylori) and pathogenic Escherichia Coli (E. coli) which are positive for KPC and/or OXA-48.ResultsAll patients and control samples were negative for Clostridium difficile. Three of the 40 patient samples (7.5%) and none of the 20 controls were positive for H. pylori with no significant difference between the two groups. KPC-positive E. coli were detected in 11 of the 40 patients (27.5%) and in none of the controls with a significant difference between the two groups (P=0.01). All patients and control samples were negative for OXA-48 positive E. coli.ConclusionAlthough this study does not support the claim that Clostridium difficile and/or H. pylori have a role in UC, it greatly suggests that pathogenic E. coli may be involved in one way or another in the course of UC.     

维生素D在哮喘发病机制中的作用

生素D除了参与钙磷代谢和调节骨骼稳态作用外,还具有调节机体免疫等广泛的生物学调节功能。维生素D不足使免疫细胞增殖和分化偏移而产生异常免疫反应。哮喘是由多种细胞（包括肥大细胞、嗜酸性粒细胞和T淋巴细胞）参与的慢性气道炎症,也是一种由遗传和环境因素共同作用的复杂多基因遗传病。近些年研究表明,维生素D缺乏会增加哮喘易感性和严重程度,与哮喘的遗传和非遗传因素共同参与哮喘的发病。     

Ethnic Manifestations of Gene Polymorphisms of Vitamin D Receptor (VDR) in Adolescents of Western Kazakhstan Region

Background (Objectives)

The objective of the article is studying the connection of VDR gene polymorphisms with bone tissue mineral density and biochemical marker of 25-PO vitamin D in adolescents of both ethnic groups, living in Western Kazakhstan Region.

Vitamin D receptor genetic variants and Parkinson's disease in a Taiwanese population

Patients with Parkinson's disease (PD) have hypovitaminosis D status and genetic variants of vitamin D receptor (VDR) gene are recently shown to be associated with PD in a large-scale genome-wide association study in a Caucasian population. Few studies examined VDR genetic variants in large-scale Asian patients with PD. We therefore genotyped 6 VDR genetic variants in a total of 1492 Taiwanese subjects, including 700 patients with PD and 792 age and/or gender matched control subjects. We did not observe any significant associations between the studied genetic variants of VDR and the risk of PD. Our data suggest that genetic variations of the VDR gene did not play a major role in a Taiwanese PD population. Further studies of VDR and its interaction with serum vitamin D levels are warranted to clarify the potential role of vitamin D in PD pathogenesis.     

pANCA Antibodies in Patients with Anterior Uveitis: Identification of a Marker Antibody Usually Associated with Ulcerative Colitis

A pANCA autoantibody (antineutrophil cytoplasmic antibody, perinuclear pattern) has been described in uveitis patients, but its correlation with systemic illnesses and the specific type of pANCA has not been defined. The goals of this study were to determine the (1) frequency of pANCA autoantibodies in uveitis, (2) systemic associations in the pANCA+ uveitis patients, and (3) type of pANCA antigen recognized by the uveitis-associated autoantibody. Serum was obtained from 59 patients with anterior uveitis or panuveitis and from nonuveitis controls. A detailed medical and family history was obtained from each subject at the time of phlebotomy. Sera were screened by neutrophil ELISA to determine the frequency of ANCA positivity. Immunofluorescence assays were then used to differentiate cANCA from pANCA. The specificity of the pANCA+ antibodies was further characterized by DNase 1 sensitivity and granule antigen ELISAs. ANCA antibodies were detected in 29% of all patients with panuveitis or anterior uveitis. In 41% of these ANCA+ patients, serum antibody detected a perinuclear antigen that was sensitive in all cases to DNase 1. The majority of pANCA+ uveitis patients were either HLA-B27 positive or had systemic evidence of immune-mediated diseases. Two pANCA+ patients had no medical or family history of other immune-mediated diseases. This study identifies a subset of uveitis patients distinguished by expression of a specific pANCA marker antibody, The characteristics of this antibody are similar to the pANCA antibody present in most patients with ulcerative colitis. Expression of the pANCA autoantibody in uveitis patients is a susceptibility marker for other immune-mediated diseases.     

维生素D_3对缺乏维生素D的多囊卵巢综合征患者晚期糖基化终末产物受体的影响

目的研究维生素D3摄入对缺乏维生素D的多囊卵巢综合征(PCOS)患者血清AMH和sRAGE的影响。方法 54例患者分为25例缺乏维生素D合并PCOS的观察组和29例仅缺乏维生素D的对照组,给予口服8周维生素D3,检测口服前和口服8周后血清25-羟基维生素D(25 OH-D),AMH和sRAGE浓度。结果观察组和对照组摄入维生素D3后血清25 OH-D升高,且观察组血清sRAGE水平上升,AMH水平下降。结论缺乏维生素D合并PCOS患者摄入维生素D3可以通过增加sRAGE抑制AGEs的活性起到保护性作用。此外,维生素D3促进观察组患者血清AMH水平降低,改善卵泡生长发育环境。     

Association of Polymorphisms in the Vitamin D Receptor Promoter with Idiopathic Short Stature

The genetic alterations of vitamin D receptor (VDR) are related with the growth of long bone. There were a lot of reports regarding an association of polymorphisms in the VDR promoter with many disorders, but not with idiopathic short stature (ISS). We investigated the association of them with ISS. A total of 50 subjects, including 29 ISS patients and 21 healthy controls with their heights within the normal range was recruited. We selected two single nucleotide polymorphisms (SNPs) from VDR promoter (rs11568820 at the Cdx-2 binding site upstream of exon 1e and rs4516035 at -1012 upstream of exon 1a) as candidates, respectively. In genotype analysis, the frequency of A/A genotype at the Cdx-2 binding site locus (rs11568820) upstream of exon 1e of VDR was decreased to 6.9% in ISS patients (28.6% in controls) (P = 0.027). The genetic variation at the Cdx-2 binding site of VDR promoter can be a contributing factor of growth of height.     

穴位埋线疗法联合口服美沙拉嗪治疗溃疡性结肠炎的 护理分析

目的 分析探讨护理干预对穴位埋线疗法联合口服美沙拉嗪治疗溃疡性结肠炎患者的作用。 方法 选取我院2010年8月～2013年3月诊治的位于UC缓解期1周的患者62例,随机分为美沙拉嗪组32例与美沙拉嗪联合穴位埋线治疗组(30例)联合治疗组(30例)采用穴位埋线疗法并予美沙拉嗪口服,同时给予实施综合护理干预。观察美沙拉嗪组及联合治疗组12个月后的缓解时长、复发率以及不良反应情况。结果 美沙拉嗪组、联合治疗组复发率分别为13（40.6％）、5（16.7％）,两组相比较P<0．05;联合治疗组的缓解时间(260±67) d比美沙拉嗪组的缓解时间(219±77) d相对较长,差异有统计学意义（P<0．05）。结论 护理干预对穴位埋线疗法同时使用美沙拉嗪来治疗溃疡性结肠炎有积极意义,有利于减少病情复发,提高患者的生活质量。     

溃疡性结肠炎患者外周血CD4+CD25+Treg细胞的表达及其意义

探讨CD4 CD25 Treg细胞在溃疡性结肠炎(UC)发病中的作用及其与疾病活动性的关系。采用三色流式细胞术检测52例UC患者,30例其它肠病患者和30名对照者。UC患者中活动期的30例,稳定期的22例,使用和未使用激素和/或免疫抑制剂活动期UC患者分别为18例和12例。对以上各组外周血中CD4 CD25 Treg细胞亚群的百分率进行测定。结果显示,活动期UC患者外周血CD4 CD25 Treg细胞比例明显低于其他肠病和对照组(P<0.001);疾病活动期UC患者外周血CD4 CD25 Treg细胞比例明显低于疾病稳定期患者(P<0.001);活动期UC患者中使用激素和/或免疫抑制剂与未使用激素和/或免疫抑制剂结果差异有统计学意义;UC患者外周血CD4 CD25 Treg细胞表达率与疾病活动指数评分呈负相关性,提示UC患者外周血CD4 CD25 Treg细胞异常表达,可能参与疾病的发生发展,与疾病的活动性密切相关。     

河南省1～7岁健康儿童血清25(OH)D水平分析

目的 了解河南省1～7岁健康儿童维生素D营养状况,为儿童合理补充维生素D、防治维生素D缺乏提供科学依据.方法 采用分层整群随机抽样法,选取河南省六个地区的妇幼保健院和社区卫生服务站进行体检的1～7岁健康儿童392名,采用化学发光法检测血清25 (OH)D水平,比较不同年龄段、不同性别儿童维生素D不足与缺乏情况.结果 392名1～7岁健康儿童血清25(OH)D平均水平为42.7±15.8nmol/L,不足与缺乏率达59.4％ (233/392),男女童之间差异无统计学意义(=0.500,P=0.618;x2 =0.051,P=0.822);不同年龄组维生素D平均水平及其不足与缺乏比例差异具有统计学意义(F=12.748,P＜0.001;x2=37.077,P＜0.001);维生素D水平随年龄增长而降低,不足与缺乏比例随年龄增长而升高.结论 河南省1～7岁健康儿童维生素D营养状况较差,且与年龄密切相关,应适当增加儿童日照时间,加强合理补充维生素D的科普宣传.     

甲状旁腺素对血糖控制不良的糖尿病患者维生素D水平的反应性

目的探讨甲状旁腺素对血糖控制不良的糖尿病患者维生素D水平的反应性。方法选取2016年6月至2017年5月就诊于四川大学华西医院的2型糖尿病患者463例作为研究对象,收集每位患者的糖化血红蛋白(HbA1c)、25(OH)D、PTH、Ca、Mg、P数据进行分组分析。结果按照HbA1c的水平将纳入对象分为三组,HbA1c<6.5%,6.5%≤HbA1c<8.4%和HbA1c≥8.4%。在这三组中,PTH、维生素D差异有统计学意义。在HbA1c<6.5%组中,PTH和维生素D水平的相关系数为-0.261(P<0.05);在6.5%≤HbA1c<8.4%组中,PTH和维生素D水平的相关系数为-0.143(P<0.05),在HbA1c≥8.4%组中,PTH和维生素D水平的相关系数为-0.126(P<0.05)。PTH和维生素D的交互作用在糖化血红蛋白较低组(HbA1c<6.5%)有更大的作用(P<0.05)。结论2型糖尿病患者血糖控制不佳时,维生素D水平降低,PTH的水平与维生素D呈现负相关趋势,但这种趋势在较高的糖化血红蛋白组中有所下降。PTH和维生素D的交互作用在血糖控制较好组发挥更大作用。糖尿病患者的糖化血红蛋白水平越高,PTH对维生素D缺乏的反应性越弱。这可能对指导糖尿病人更好的进行血糖控制,有一定的指导意义。     

维生素D受体基因多态性与骨代谢疾病研究进展

维生素D受体(VDR)与骨代谢密切相关,在维持机体骨钙平衡中起着重要作用。对VDR基因型与骨钙代谢相关性研究,有助于推断骨质疏松、佝偻病等骨代谢疾病和遗传因素之间的关系,并且为从基因水平认识疾病的发病机理提供重要线索。