我国溃疡性结肠炎人类白细胞抗原-DR基因分型的研究

目的：研究溃疡性结肠炎（UC）患者的人类白细胞抗原－DR（HLA－DR）基因分型,并分析其与抗中性粒细胞胞浆抗体（ANCA）及疾病分型的关系。方法：用接免疫荧光法分别对80例UC患者和123例健康者进行血清ANCA检测,同时用序列特异性引物－聚合酶链反应法（PCR－SSP）对HLA－DR1到第4个基因位点进行分析。结果：UC患者ANCA的阳性率为55．0％,对照组均为阴性;UC患者HLA－DR2及DR15基因阳性率分别为58．8％和40．0％,较对照组30．1％、17．9％显著增高（P均＜0．05）;与ANCA（－）UC患者比较,ANCA（＋）UC的DR15基因阳性率显著增加,而DR16基因阳性率显著降低;慢性持续型UC DR2和DR15基因性率较其他型显著增加。结论HLA－DR2和ANCA在UC中阳性率均显著增加,在ANCA阳性和阴性的UC中,分别由DR15和DR16基因阳性率增加所致;HLA－DR基因分型与临床分型有关。     

Intestinal flora differences between patients with ulcerative colitis of different ethnic groups in China

To determine the differences in intestinal flora between Uygur and Han patients with ulcerative colitis (UC).Microbial diversity and structural composition of fecal bacteria from patients with UC and their matched healthy spouses or first-degree relatives were analyzed using high-throughput sequencing technology.The fecal microbial diversity and abundance index of Uygur patients with UC (UUC) were significantly lower compared with the Uygur normal control group, while there was no significant difference between the Han UC patients (HUC) and the Han normal control group (HN). Compared with their respective control groups, Uygur UC patients and Han UC patients had a different main composition of human intestinal flora (P < .05). The abundance of Burkholderia, Caballeronia, Paraburkholderia in the UUC group were higher compared with the HUC group, while Faecalibacterium, Bifidobacterium, and Blautia in the HUC group were higher than those in the UUC group (P < .05). Veillonella in the UUC group was higher than that in the Uygur normal control group group, while Subdoligranulum and Ruminococcaceae_UCG-002 were significantly lower (P < .05). Prevotella_9 in the HUC group was significantly higher than that in HN group, while Blautia, Anaerostipes, and [Eubacterium]_hallii_group were significantly lower. Moreover, the top 6 species in order of importance were Christensenellaceae_R_7_group, Ruminococcae_ucg_005, Ruminococcae_ucg_010, Ruminococcae_ucg_013, Haemophilus, and Ezakiella.The difference in intestinal microflora structure may be one of the reasons for the clinical heterogeneity between Uygur and Han patients with UC. Christensenellaceae_R_7_group, Ruminococcae_ucg_005, Ruminococcae_ucg_010, Ruminococcae_ucg_013, Haemophilus, and Ezakiella could be used as potential biomarkers for predicting UC.     

Long term results of use of azathioprine in patients with ulcerative colitis in India

INTRODUCTION Immunosuppressive drugs were initially used clinically in the treatment of leukemias and solid organ transplantation. Over time, it was learned that these drugs were capable of long term modulation of the immune system in transplant recipient…     

Long-term results of restorative proctocolectomy for ulcerative colitis

To study the long-term effects of restorative proctocolectomy with J-pouch for ulcerative colitis 100 consecutive patients were examined a mean of 5.6 years after ileal pouch-anal anastomosis (IPAA). Seventythree percent of patients were on steroids and 22% had a preceding severe attack of colitis before IPAA. The overall early and late complication rates were 40% and 33%, respectively. Failure rate was 5% and all failures requiring pouch excision occurred within the first three post-operative years. Pouchitis (36%) was the commonest late complication. A preceding severe attack of colitis was an important prognostic sign of late anastomotic complications, troublesome incontinence and ultimate failure. The daily mean stool frequency varied from 4.5 to 6.9. After a short learning period continence — stabilised and minor incontinence was common (57%). The majority of patients (72%) were either very satisfied or had no problems in daily activities after IPAA. Ten patients were dissatisfied after surgery due to obvious medical reasons in most of them.

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Résumé Afin d'étudier les effets à long terme de la procto-colectomie avec rétablissement de la continuité par une poche en J en cas de colite ulcéro-hémorragique, 100 patients consécutifs ont été examinés en moyenne à 5,6 ans après l'anastomose iléo-anale. Avant l'intervention chirurgicale, 73% des patients étaient soumis à un traitement aux stéroïdes et 22% avaient présenté une poussée aiguë de colite. Le taux global de complications précoces et tardives est respectivement de 40 et 33%. Le taux d'échec était de 5% et la totalité des échecs ayant nécessité une excision de la poche sont survenus au cours des trois premières années post-opératoires. La pouchite (36%) constitute la complication tardive la plus fréquente. Une poussée aiguë de colite avant la chirurgie représente un important signe pronostique d'un risque de complications anastomotiques tardives, d'incontinence, voire d'échec thérapeutique. La fréquence quotidienne des selles varie de 4,5 à 6,9. Après une période d'apprentissage de la continence, la situation se normalise et une incontinence mineure est observée chez 57% des patients. La majorité des patients (72%) était soit très satisfaite, soit n'avait aucun problème dans leurs activités quotidiennes. Dix patients étaient mécontents après la chirurgie pour des raisons médicales de manière évidente dans la plupart des cas.

     

Endothelial dysfunction in patients with ulcerative colitis

BACKGROUND: Human intestinal microvessels from chronically inflamed ulcerative colitis (UC) show microvascular endothelial dysfunction. Whether generalized endothelial dysfunction could associate with UC has not been explored yet. Our aim was to assess the endothelial function in the patients with different UC activity and to hypothesize about the relationship of endothelial function to activity-related extraintestinal complications (AREC) of UC. METHODS: Twelve patients with mild UC, 14 patients with moderate UC, 16 patients with severe UC, and 24 healthy subjects were included in the study. The activity of UC is calculated according to the Seo Index. Endothelial functions of the brachial artery were evaluated by using high-resolution vascular ultrasound. Endothelial-dependent dilatation (EDD) was assessed by establishing reactive hyperemia and endothelial-independent dilatation (EID) was determined by using sublingual isosorbide dinitrate. RESULTS: EDD was significantly worse in patients with severe UC as compared with patients with mild UC (8.7 +/- 1.6% versus 17.3 +/- 5.6%, P < 0.05) and even in patients with moderate UC as compared with patients with mild UC (13.1 +/- 3.2% versus 17.3 +/- 5.6%, P < 0.05). EDD was not significantly worse in patients with mild UC as compared with healthy subjects (17.3 +/- 5.6% versus 18.1 +/- 8.1%, P > 0.05). EID was significantly worse in patients with severe UC compared with patients with moderate UC (10.5 +/- 2.9% versus 13.4 +/- 3.7%, P < 0.05) and even in patients with mild UC compared with healthy subjects (20 +/- 6.7% versus 31.1 +/- 12.6%, P < 0.05). EDD and EID were significantly worse in patients with AREC compared with patients with no AREC (9.5 +/- 2.5% versus 14.9 +/- 5.1%, P < 0.05; 11.6 +/- 4.3% versus 16 +/- 6.1%, P < 0.05, respectively). CONCLUSIONS: Increased activity of UC is associated with significant endothelial dysfunction, which may relate to the pathophysiology of AREC of UC.     

Steroid complications in patients with ulcerative colitis

Physicians treating patients with ulcerative colitis are confronted with the difficult task of deciding whether medical or surgical treatment is best for their patients. There are no definitive criteria to indicate when medical therapy should be exchanged for definitive surgery. Even in patients who respond well to glucocorticoid treatment, the side effects of these drugs may necessitate surgery. We reviewed the steroid complications of our operative cases retrospectively. Although ulcerative colitis was usually in remission, severe steroid complications were no longer tolerable and definitive surgery was required. We also reviewed the literature regarding the adverse effects of steroid. Because of advances in sphincter-preserving surgery, re-evaluation of the treatment of ulcerative colitis is necessary. Although conservative treatment remains the first choice, tolerance of irreversible side effects (especially in children) no longer seems to be justified. In such patients, early definitive surgery may offer more than it appears to sacrifice.     

Surgery for ulcerative colitis in 1,000 patients

Background and aims  

Ileal pouch–anal anastomosis (IPAA) has become the standard treatment for patients with ulcerative colitis (UC) who ultimately require a colectomy. Herein, we report results of our 24-year experience with that surgical method at our hospital.     

保留灌肠治疗溃疡性结肠炎疗效观察

[目的]观察10%鸦胆子乳联合地塞米松保留灌肠治疗溃疡性结肠炎的临床疗效.[方法]10%鸦胆子乳50 ml加地塞米松5 mg混合充分摇匀,用18～20号肛管每晚经肛门插入保留灌肠2 h,1个月为1个疗程.如未治愈可进行第2个疗程治疗.疗程结束后均经结肠镜复查.[结果]48例患者经1个疗程治愈38例(78.5%),其中轻度32例,中度6例;好转10例(21.5%),其中中度6例,重度4例.伴腺瘤息肉2例,炎性息肉5例.1例腺瘤息肉经2个疗程灌肠治疗,腺瘤脱落,另1例腺瘤息肉者行肛肠科手术;5例炎性息肉经治疗均消失.其余病例均获临床治愈,其治愈率为97.5%.[结论]该疗效理想而可靠,简便易行,值得临床尝试和推广.     

Long-term results of ileorectal anastomosis in ulcerative colitis in Stockholm County

The long-term results of ileorectal anastomosis in patients with ulcerative colitis in Stockholm County over a 30-year period, 1955 to 1984, were investigated. During this time, 486 patients underwent colectomy and ileorectal anastomosis was performed in 60 of those patients (12 percent). A retrospective histologic examination of the slides of the operative specimens in the latter group revealed that nine patients had Crohn's disease. Of the 51 remaining patients with ulcerative colitis, the colectomy and ileorectal anastomosis was performed as an elective procedure in 44 cases (86 percent) and as a one-stage procedure in 48 patients (94 percent). Complications occurred in 7 of 43 patients (16 percent) undergoing an elective, one-stage procedure. There were two postoperative deaths (4 percent). There were 22 patients (43 percent) who had their ileorectal anastomosis in function at the time of follow-up, with a mean time of observation of 13 years. The cumulative probability of having the ileorectal anastomosis in function at 10 years was 51 percent. The causes of rectal excision were recurrent inflammation in the retained rectum (N=23), dysplasia (N=3), and postoperative complications (N=3). No rectal carcinoma occurred. Patients with preoperative mild rectal disease had a better outcome (ileorectal anastomosis in function at time of follow-up) compared with patients with moderate rectal disease (P <0.001). The functional outcome of ileorectal anastomosis was, if anything, better than what is stated in the literature following pelvic pouch procedure.Supported by grants from the Swedish Society of Medicine.     

Surveillance colonoscopy in ulcerative colitis patients in Germany

It has been assumed that cancer surveillance colonoscopy in patients with ulcerative colitis is not conducted according to the guidelines in Germany. An inquiry of the self-help organisation German Crohn's Disease/Ulcerative Colitis Association (DCCV) among organisation members belonging to colorectal cancer risk groups confirmed that the number of biopsies taken during colonoscopy is less than that proposed by the guidelines. Only with 9.2 % of the risk group did a guideline-conformal colonoscopy take place. In more than 50 % of the cases less than 10 biopsies were taken.     

In vitro tetraploidy in patients with ulcerative colitis

One hundred and seven patients (57 patients with ulcerative colitis and 50 controls) were investigated for in vitro tetraploidy (IVT) in dermal fibroblast monolayer cultures. There was no difference in incidence of IVT between patients with ulcerative colitis and controls. We advance the hypothesis that the genetic background of the colorectal cancer type found in ulcerative colitis differs from that found in the colon cancer syndromes and in non-hereditary colorectal cancers. Colorectal cancer in ulcerative colitis is probably only dependent on the degree of inflammatory lesions of the colonic mucosa.     

溃疡性结肠炎患者肠神经内分泌细胞的观察

目的：观察溃疡性结肠炎患者肠切除标本中神经内分泌细胞的变化。方法：应用免疫组织化学和形态计量学方法。结果：病变肠组织VIP能神经，S-100蛋白及神经特异性烯醇化酶免疫阳性神经元、神经纤维形态异常，其线密度（Lv％）、体密度（Vv％）增高（分别P＜0．01）。生长抑素、血清素免疫阳性细胞及肠嗜银细胞数量明显减少（分别P＜0．01）。结论：肠神经内分泌细胞的异常可能参与溃疡性结肠炎的发生和发展。