康复新液保留灌肠联合柳氮磺吡啶治疗溃疡性结肠炎疗效观察

目的探讨康复新液保留灌肠联合柳氮磺吡啶治疗溃疡性结肠炎的疗效观察，寻求较好的药物治疗方式。方法选取2008年8月～2012年8月于我院消化科诊断为溃疡性结肠炎的患者80例，随机分为两组，每组40例。实验组采用康复新保留灌肠联合柳氮磺吡啶治疗治疗，对照组采用柳氮磺吡啶治疗。两组在性别、年龄等因素上均无统计学差异（P>0.05）。比较两组患者的临床有效率和患者的满意度。结果实验组的临床有效率显著高于对照组，且患者的满意度高，两组的结果差异具有统计学意义（P<0.05）。结论康复新液保留灌肠联合柳氮磺吡啶对溃疡性结肠炎的临床效果较好，患者的满意度高，极大的提高了患者的生活质量，有很好的临床意义和推广价值。     

抑郁症患者心理社会因素浅析

应用病例配对方法,研究抑郁症患者的个性特征,生活事件及社会支持,发现病人组艾森克个性问卷神经质分明显高于对照组,生活事件数目及生活事件紧张总值明显高于对照组,而社会支持评分明显低于对照组。     

Ⅱ型糖尿病患者的心理社会因素初步调查

应用病例配对方法研究８０例Ⅱ型糖尿病的个性特征，生活事件及社会支持，发现病人组艾森克个性问卷的神经质分明显高于对照组（Ｐ＜０．０１），生活事件数目，生活事件紧张总值明显高于对照组（Ｐ＜０．０５），社会支持评分明显低于对照组（Ｐ＜０．０５）。     

美沙拉嗪对高龄溃疡性结肠炎患者C反应蛋白及TNF-α的影响

目的 探讨美沙拉嗪对高龄溃疡性结肠炎患者的C反应蛋白、TNF-α的影响及其疗效.方法 选取于成都医学院第一附属医院就诊的高龄溃疡性结肠炎患者150例,并随机分成两组;对照组和观察组,各75例.对照组:接受高龄溃疡性结肠炎的常规治疗.观察组:在接受高龄溃疡性结肠炎的常规治疗的基础上加上美沙拉嗪辅助治疗.结果 治疗后,观察组患者总有效率(90.67％)明显高于对照组总有效率(77.33％),差异具有统计学意义(P＜0.05).观察组患者的血清炎症因子hs-CRP、IL-8以及TNF-α水平明显低于对照组患者,差异具有统计学意义(P＜0.01).观察组患者的MDA水平明显低于对照组患者、而观察组SOD水平则明显高于对照组患者,差异具有统计学意义(P＜0.01).观察组患者的Mayo评分、内镜分级评分明显低于对照组患者,差异具有统计学意义(P＜0.01).结论 美沙拉嗪治疗高龄溃疡性结肠炎疗效佳,因其具有显著的抗氧化的作用,同时能够有效清除自由基、抑制炎性介质的释放.     

IL-10 基因多态性与溃疡性结肠炎易感性的关系及对临床预后的影响

目的:探讨IL-10 多态位点的基因多态性与溃疡性结肠炎的易感性及对临床预后的影响。方法:采用病例对照研究设计,选取80例溃疡性结肠炎患者作为病例组,另外选性别和年龄匹配的健康受试者作为对照组。所有患者治疗前抽取空腹静脉血并提取DNA,设计819 T/ C(rs1800871)、592A/C(rs1800872)、 -1082 G/ A(rs1800896)PCR 引物进行PCR 扩增,扩增产物酶切后进行琼脂糖凝胶电泳以确定基因类型,采用Logistic 回归计算校正相对危险度(OR)和95% 置信区间(95%CI)评价基因多态性与溃疡性结肠炎的易感性,并分析对临床预后的影响。结果:(1) 病例组患者IL鄄10 多态位点rs1800896 基因类型AA、GG 和AG 分布频率与对照组受试者差异具有统计学意义(P<0.01);(2)与rs1800896 基因型AA 比较,基因型为GG 的患者溃疡性结肠炎危险性显著升高(P<0.01),并且临床缓解率显著降低(P<0.01);(3)病例组患者IL-10多态位点rs1800871 基因类型CC、CT 和TT 分布频率与对照组受试者差异无统计学意义(P>0.05);(4)病例组患者IL鄄10 多态位点rs1800872 基因类型AA、AC 和CC 分布频率与对照组受试者差异无统计学意义(P>0.05)。结论:IL-10 多态位点rs1800896 基因类型GG 可增加溃疡性结肠炎的易感性,并且显著降低患者的临床预后。     

HIV/AIDS人员心理卫生状况与心理社会影响因素

目的 :研究HIV/AIDS (艾滋病毒感染者 /艾滋病患者 )人群的心理卫生状态与心理社会因素的影响。方法 :采用病例对照研究方法。病例组与对照组两组对象均接受一般情况问卷、症状自评量表(Symptomchecklist 90 ,SCL -90 )、生活事件量表 (LifeEventScale ,LES)、生活质量综合评定问卷 (GenericQualityofLifeInventory -74,GQOLI -74)、自我接纳问卷 (Self -AcceptanceQuestionnaire ,SAQ )五个量表的测查。结果 :(1)病例组的SCL -90各个因子分高于对照组 (P <0 0 0 1) ;(2 )病例组总生活事件和负性生活事件得分高于对照组 (P =0 0 0 1) ;(3 )病例组自我接纳得分低于对照组 (P =0 0 0 1) ;(4 )病例组生活质量综合评定得分低于对照组 (P <0 0 0 1) ;(5 )多因素逐步回归分析 ,SCL -90总因子分相关因素主要为躯体症状严重程度 (负向评分 )、负性生活事件和自我接纳因子 ,躯体症状严重程度与SCL -90总因子分呈负相关 ,负性生活事件得分与SCL -90总因子分呈正相关 ,自我接纳得分与SCL -90总因子分呈负相关。结论 :HIV/AIDS组较对照组心理健康状态有明显差异 ,有较多的负性生活事件 ;自我接纳得分低于对照组 ;生活质量低于对照组。     

卡文治疗溃疡性结肠炎患者的疗效分析与临床意义

目的 探讨卡文治疗溃疡性结肠炎患者的疗效与临床意义.方法 选取2016年10月至2017年10月本院收治的溃疡性结肠炎患者140例,随机分为观察组(n=70)和对照组(n=70),对照组患者给予常规治疗和护理干预,观察组患者在此基础上给予卡文治疗,观察患者治疗疗效;检测患者治疗前后血清中肿瘤坏死因子-α(tumor necrosis factor alpha,TNF-α)、干扰素-γ(interferon-γ,IFN-γ)和白细胞介素-10(interleukin-10,IL-10)的水平.结果 与对照组相比,观察组患者应用卡文治疗溃疡性结肠炎后,临床治疗的有效率显著提高,临床不良反应发生率显著下降,具有统计学差异(P＜0.05).与对照组治疗后相比,观察组患者应用卡文治疗溃疡性结肠炎后,患者体内TNF-α和IFN-γ水平显著降低,IL-10水平显著升高,差异具有统计学意义(P＜0.05).溃疡性结肠炎患者体内TNF-α和IFN-γ水平与疾病程度存在显著的正性相关关系(P＜0.01);溃疡性结肠炎患者体内IL-10水平与疾病程度存在显著的负性相关关系(P＜0.01).结论 卡文辅助治疗溃疡性结肠炎具有较好的临床疗效,可有效缓解患者血清炎症因子的表达情况.     

整体护理对溃疡性结肠炎患者治疗效果的影响

目的：观察整体护理干预对溃疡性结肠炎患者治疗效果的影响。方法将295例溃疡性结肠炎患者随机分为护理组167例与对照组128例。两组均给予止泻、灌肠、维持水电解质平衡等常规药物治疗治疗，对照组给予常规护理措施，干预组在此基础上给予整体护理干预，观察两组护理效果。结果护理组总有效率为96.4%高于对照组的78.9%，差异有统计学意义(<0.05)。结论整体护理干预用于溃疡性结肠炎患者可明显改善患者的临床症状，缓解腹痛、腹泻，促进结肠粘膜恢复，从而提高治疗效果，值得临床推广应用。     

冠心病患者行为类型,应激,情绪与血脂改变相关性研究

本文对４６例冠心病患者和健康对照者进行了Ａ型行为，生活事件及焦虑和抑郁的评定。结果显示，病例组Ａ型行为者，应激性生活事件数目及焦虑和抑郁评分，明显高于对照组；病例组血清胆固醇水平与Ａ型行为，负性生活事件及焦虑和抑郁评分程正相关，血清甘油三酯水平与Ａ型行为和焦虑分呈正相关，揭示社会心理因素在冠心病发病机制中起重要作用。     

溃疡性结肠炎黏膜的白细胞亚群和肿瘤坏死因子—α的表达

目的：揭示溃疡性结肠炎（UC）结肠黏膜肿瘤坏死因子－α（TNFα）的表达以及与溃疡性结肠炎不同时期浸润的炎细胞免疫表型之间的关系。方法：应用抗T淋巴细胞（CD45RO）、抗B淋巴细胞（CD20）、抗巨噬细胞（CD68）表面抗原的单克隆抗体、对50例溃疡性结肠炎结肠黏膜活检标本（32例活动期,18例非活动期）及5例癌旁正常组织作为对照进行了淋巴细胞亚型和分析,应用原位杂交技术,对上述病例进行了TNFα的检测分析。结果：T淋巴细胞数量在活动期高于非活动期及对照组（P＜0．01）。而固有层内B淋巴细胞数量在三组之间差异无显著性。巨噬细胞的数量在活动期高于非活动期及正常对照组（P＜0．01）。细胞因子TNFαmRNA的表达在活动期高于非活动期。结论：TNFα在溃疡性结肠炎发病机制中起到了重要作用。其可作为炎症介质,介导结肠黏膜的病理性损伤。     

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。     

不同程度溃疡结肠炎患者心理状态分析及心理干预

目的:调查分析不同程度溃疡结肠炎患者的心理现状,并简析心理干预的应用效果。方法:回顾性选取2013年4月-2016年4月笔者单位收治的80例溃疡结肠炎临床资料,其中轻度31例、中度32例、重度17例,分析在不同程度溃疡结肠炎患者中的心理现状,对所有患者均采取心理干预措施,比较干预前后溃疡结肠炎患者心理状态变化。结果:在不同程度溃疡结肠炎患者的心理状态调查显示特质焦虑、抑郁量表及焦虑、抑郁自评量表(TAI、SAI、SAS、SDS)评分方面比较,重度溃疡结肠炎患者中度轻度,差异均有统计学意义(F=37.63,34.61,21.18,21.08;P=0.0000)。干预后,溃疡结肠炎患者的TAI、SAI、SAS、SDS评分均较干预前得到显著的降低,差异存在统计学意义(t=29.1375,27.1578,22.4438,24.7114;P=0.0000)。患者经心理干预后,在躯体化、人际关系、抑郁、焦虑、强迫、恐怖、偏执等评分方面均较干预前降低,差异显示出统计学意义(t=14.3982,10.9765,23.5446,34.2703,15.5054,17.8607,20.4028;P=0.0000)。结论:随着溃疡结肠炎程度的加深,患者心理焦虑、抑郁等情绪加深,采取有效合理的心理干预,可良好改善患者心理现状。     

A method for the detection of eosinophilic granulocytes in colonoscopic biopsies from IBD patients

Eosinophilic granulocytes were found to be autofluorescent when Giemsa-stained sections were stimulated with indirect light fluorescence (ILF). The frequency of autofluorescent eosinophils was assessed in areas with diffuse and focal inflammation in 76 consecutive colonoscopic biopsies from patients with inflammatory bowel disease (IBD), Crohn's disease (CD = 32), ulcerative colitis (UC = 30), and collagenous colitis (CC = 7). All IBD cases had moderate to severe pancolitis. In areas with diffuse inflammation, severe eosinophilia was recorded in 39.6% or in 38 of 96 high power fields investigated in patients affected by CD, and in 3.3% or in 3 of 90 high power fields examined in patients with UC. In areas with focal inflammation, the mean percentage of eosinophils in CD was 57% (range 44-70%), and 9% in UC (range 6-26%). No focal inflammation was present in CC. In the submucosa of some CD patients, a large number of autofluorescent eosinophils and many autofluorescent cell-free granules were seen. It was inferred that these autofluorescent granules had been released from eosinophils, and that the eosinophilic granulocytes from which these granules had originated were no longer discernible. Focal eosinophilic mucosal infiltration in CD is more common than epithelioid cell granulomas, and emerges as an important parameter in the histologic differential diagnosis between colonic CD and UC.     

Effects of mind-body therapy on quality of life and neuroendocrine and cellular immune functions in patients with ulcerative colitis

BACKGROUND: The aim of this study was to investigate the effects of mind-body therapy on neuroendocrine and cellular immune measures, health-related quality of life and disease activity in patients with ulcerative colitis (UC) in remission. METHODS: Thirty UC patients in remission or with low disease activity were randomly assigned to an intervention group (n = 15) or a usual-care waiting control group (n = 15). Intervention consisted of a structured 60-hour training program over 10 weeks which included stress management training, moderate exercise, Mediterranean diet, behavioral techniques and self-care strategies. Quality of life, perceived stress and disease activity were assessed with standardized questionnaires (IBDQ, SF-36, PSS, CAI). In addition, the distribution of circulating lymphocytes and lymphocyte subsets as well as the beta-adrenergic modulation of TNF-alpha production in vitro were analyzed. Urine catecholamines and plasma cortisol, prolactin and growth hormone were measured pre- and postinterventionally, and were compared with a healthy control group (n = 10). RESULTS: In response to therapy, patients in the intervention group showed significantly greater improvement in the SF-36 scale Mental Health and the Psychological Health Sum score compared with changes observed in the usual-care waiting control group. Patients in the intervention group showed significantly greater improvement on the IBDQ scale Bowel Symptoms compared with the control group. However, no significant group differences in circulating lymphocyte subsets or endocrine parameters were observed in response to therapy. In addition, no significant effects of intervention on either the basal levels of TNF-alpha or the suppressive action of the beta-adrenergic agonist isoproterenol on TNF-alpha production were observed. CONCLUSION: Mind-body therapy may improve quality of life in patients with UC in remission, while no effects of therapy on clinical or physiological parameters were found, which may at least in part be related to selective patient recruitment.     

Ulcerative colitis--contemporary morphological criteria

Regular bioptical examinations of patients with ulcerative colitis (UC) performed in recent years show that the inflammatory changes of the mucosa of the large intestine are not necessarily diffuse, and that their extent may vary in the course of the disease. To establish the diagnosis of UC and to assess the treatment efficacy it is important to examine histologically multiple mucosal specimens from different levels of the large intestine. In our series of 27 patients with ulcerative colitis (18 men and 9 women at the age of 17 to 76 years), active or active and inactive pancolitis was diagnosed in 25 cases (93%). In 11 of these, the whole of the large intestine was affected. Two patients showed diffuse pancolitis without caecal involvement, in 5 cases there was inactive inflammation in the rectum or in the sigmoid colon. Seven patients had active colitis of the rectum and sigmoid. In another 2 patients (7%), the inflammation was limited to several segments of the large intestine only (the descending colon, and the descending and transverse colon). On bioptical examination of 6 patients repeated after 2-29 months (mean 14 months), there were changes in the distribution and appearance of the inflammation. Thus our findings correspond with the results of previous studies: UC does not always affect the mucosa of the large intestine diffusely. Further, the extent and distribution of inflammatory changes vary in the course of the disease.     

溃疡性结肠炎患者血清IL-23和IL-17的水平变化及意义

目的:探讨溃疡性结肠炎(UC)血清IL-23和IL-17的水平变化及其临床意义。方法:收集经临床明确诊断的UC患者54例,并选择同期健康体检者30例作为对照组。采用酶联免疫吸附法(ELISA)检测两组血清IL-23和IL-17的水平。结果:UC组患者血清IL-23和IL-17水平明显高于对照组,差异有显著统计学意义(t=18.76,21.48,P<0.01)。在轻度、中度、重度UC患者血清中,IL-23和IL-17的浓度水平均呈逐渐升高趋势,重度患者高于中度患者,中度患者高于轻度患者,三组间比较存在显著差异(P<0.05或0.01)。IL-23和IL-17在溃疡性结肠炎患者血清中的表达呈正相关(r=0.548,P<0.01)。结论:IL-23与IL-17的高表达可能参与了UC的慢性炎症形成过程;两者表达水平有密切相关性,IL-23可能通过诱导IL-17的产生而使后者在UC的发病中发挥作用。     

Structural shifts of mucosa-associated lactobacilli and Clostridium leptum subgroup in patients with ulcerative colitis

To understand the role of mucosa-associated microbiota in the pathogenicity of ulcerative colitis (UC), paired biopsies were obtained during colonoscopy from the ulcerated and nonulcerated gut mucosa of 24 patients with UC. Denaturing gradient gel electrophoresis analysis was employed to profile the composition of the dominant bacteria (16S rRNA gene V3 region) and three important groups: lactobacilli, the Clostridium leptum subgroup, and Bacteroides spp. The Pearson coefficient was used to estimate similarities between the bacterial communities of the paired biopsies for each patient. The average similarity values of bacterial composition between the paired samples were 94.8 +/- 3.8% for dominant bacteria, 59.9 +/- 26.1% for lactobacilli, 79.2 +/- 22.6% for the Clostridium leptum subgroup, and 88.7 +/- 16.4% for Bacteroides spp. The data revealed that lactobacilli and the Clostridium leptum subgroup were significantly different between the ulcerated and the nonulcerated regions. It also was noted that for lactobacilli, the composition varied significantly between biopsy sites irrespective of the location of UC in the gut but that the composition of the Clostridium leptum subgroup showed significant differences between paired samples from UC in the rectum and not in the left colon. Localized dysbiosis of the mucosa-associated intestinal microflora, especially for lactobacilli and the Clostridium leptum subgroup, may be closely related to UC.     

心理干预对中职卫校新生心理健康状况的影响

目的:探讨心理干预对中职卫校新生心理健康状况的影响。方法:对646名卫校新生,采取心理讲座、心理咨询和心理宣传等方式进行干预1学期,用症状自评量表(SCL-90)进行测评,比较干预前、后心理健康状况的变化。结果:本组卫校新生第1学期末SCL-90评定,总分≥160、阳性项目数≥43、单项因子分≥3均显著低于入校时(χ~2=40.970,43.613,54.370;P均0.001),SCL-90各因子分(除精神病性因子外)和阳性项目数也显著低于入校时(t=18.333,16.307,12.809,23.609,20.064,43.270,10.142,3.454,21.642;P≤0.001)。结论:心理干预可显著改善卫校新生心理健康状况。     

粪菌移植治疗溃疡性结肠炎临床缓解率的影响因素分析

目的系统评价影响粪菌移植(fecal microbiota transplantation,FMT)治疗溃疡性结肠炎(ulcerative colitis,UC)临床缓解率的因素。方法通过计算机联机检索国内外文献数据库,应用Meta分析的方法对FMT治疗UC的研究进行整合分析,再进一步进行亚组分析以确定FMT治疗UC临床缓解率的影响因素。采用NICE质量评价清单对所纳入的文献进行质量评价。经异质性检验后选择合适的效应模型进行统计量的计算合并。结果最终筛选出11篇文献,共133名UC患者。Meta分析结果显示,FMT治疗UC的临床缓解率为28.6%(38/133),合并缓解率为30.4%(95%CI:22.6%~39.4%)。亚组分析结果显示,经下消化道输送的合并缓解率为29.8%(95%CI:20.2%~41.6%),经上消化道输送的合并缓解率为27.5%(95%CI:16.1%~42.9%),两组缓解率比较,差异无统计学意义(χ~2=0.002,P=0.963)。FMT治疗次数为1次的合并缓解率为28.2%(95%CI:20.5%~43.3%),治疗次数至少为2次的合并缓解率为28.9%(95%CI:20.1%~39.7%),两组缓解率比较,差异无统计学意义(χ~2=0.020,P=0.887)。结论 FMT在治疗UC方面具有一定疗效,但仍需通过开展大规模的多中心、大样本的随机对照试验研究来规范FMT治疗。     

Patterns of colonic involvement at initial presentation in ulcerative colitis: a retrospective study of 46 newly diagnosed cases

Studies have shown that rectal sparing and patchiness develop in treated and longstanding ulcerative colitis (UC), making the distinction from Crohn colitis increasingly difficult after treatment is initiated. However, no histologic studies of the incidence of rectal sparing in adults at UC onset have been performed. Colectomy specimens from 46 patients with classic UC histologic features and no Crohn disease features were identified. Biopsy specimens obtained before medical therapy were retrieved and examined blindly by 2 pathologists, along with appropriate control samples. Slides were scored for chronicity (crypt branching, subcryptal plasma cells, lamina propria plasma cells) and activity (cryptitis, crypt abscesses, epithelial injury). In 28 cases, only rectal biopsy specimens were taken; for 16, rectal and at least 1 proximal biopsy specimen were taken. All cases showed rectal involvement; none had rectal sparing at initial biopsy. Of 16 cases with rectal and more proximal biopsy specimens, 5 (31%) showed relative rectal sparing (lower scores in rectum than in more proximal sites). In 16 cases with rectal and more proximal biopsy specimens, chronicity and activity scores were higher in the rectum than in more proximal sites (P = .01; chronicity and activity). The mean overall chronicity score decreased in a linear manner from rectum to cecum. The rectum is involved and shows evidence of chronicity and activity at disease onset in UC, using colectomy as the gold standard for diagnosis. Because rectal sparing at UC onset has been reported, a prospective study using uniform biopsy protocols is needed to establish the true incidence of rectal sparing at presentation.