炎症性肠病的脑功能MRI研究进展

炎症性肠病(IBD)包括克罗恩病和溃疡性结肠炎。脑-肠轴可通过心理-神经-内分泌-免疫调节在IBD发生、发展中发挥重要作用,通过MRI来观察及研究IBD患者的脑结构及脑功能异常,特别是脑功能异常的观察,有利于更深层次地理解IBD的发病机制,并从神经方向寻找新的治疗方法可能有效减轻肠道炎症或缓解腹痛症状。     

53例初诊儿童炎症性肠病临床分析

目的探讨儿童炎症性肠病(IBD)初诊临床特点,提高对儿童IBD的认识。方法回顾性分析2005年1月至2015年10月于中国医科大学附属盛京医院儿科初诊,并确诊为IBD的53例患儿的临床资料,包括临床表现、实验室检查、影像学、内窥镜和病理组织学结果,以及治疗方案。结果 IBD患儿的临床表现主要以腹痛、腹泻、便血、发热为主。其中,溃疡性结肠炎(UC)患儿较克罗恩病(CD)患儿更易出现腹泻及便血症状(P<0.05),而CD患儿腹痛症状更为明显(P<0.05),同时更易出现肠外表现,34.0%患儿出现生长发育和营养障碍,84.9%患儿存在不同程度的精神状态改变。实验室检查结果以炎症性指标(如白细胞、C-反应蛋白、血沉)升高为主,UC和CD患儿的血清白蛋白比较,差异有统计学意义(P<0.05)。UC和CD患儿,内镜及病理表现明显不同,MRE同时观察到肠壁强化和瘘管及肿块的形成。51例单纯药物治疗,2例联合手术治疗。其中,13例患儿应用了英夫利昔单抗(IFX)治疗,诱导缓解迅速,身高、体质量有所增长。结论对临床出现腹痛、腹泻、便血、发热以及营养状态不佳的患儿,要警惕IBD的发生;需结合生化、影像学、内镜、病理进行综合诊断;MRE无创、无辐射,值得推广;中重度患者,IFX可以迅速缓解病情,促进生长发育。     

飞行人员的理想保健饮品——天羽抗辐射保健液

近日，一种由空军某研究所研制生产的中草药生物制剂——天羽抗辐射保健液已经问世，这是我国第一种抗辐射保健品，现已被国家卫生部正式批准为适合于航空航天等人员使用的具有抗辐射、免疫调节和耐缺氧三种功能的保健食品。     

多层螺旋CT小肠造影和消化内镜对炎症性肠病诊断价值的评价

目的探讨多层螺旋CT小肠造影(MSCTE)和消化内镜在诊断炎症性肠病(IBD)中的价值。方法回顾性分析40例IBD患者的MSCTE表现,主要分析病灶部位、肠壁增厚情况、肠壁强化、肠腔狭窄、肠系膜淋巴结增多、肠系膜血管改变、腹腔脓肿或瘘管形成等,并与消化内镜检查结果进行对比分析。结果 40例IBD患者中,克罗恩病28例,溃疡性结肠炎12例。IBD患者MSCTE主要表现为肠壁增厚(大于4mm)35例(87.5%),肠壁强化38例(95.0%),肠腔狭窄26例(65.0%),结肠带消失5例(12.5%),多节段性病变33例(82.5%),多发炎性息肉3例(7.5%),肠周脂肪间隙模糊1 5例(37.5%),肠系膜血管增生12例(30.0%),肠周淋巴结增多18例(45.0%),腹腔脓肿或瘘管形成6例(15.0%)。MSCTE未显示肠壁溃疡和卵石征,对多发炎性息肉的显示率不高。40例IBD患者消化内镜检查显示肠壁溃疡33例(82.5%),多发炎性息肉10例(25.0%),卵石征1 3例(32.5%),肠腔狭窄28例(70.0%),多节段性病变30例(75.0%),消化内镜未显示肠壁增厚及肠外并发症。结论 MSCTE对显示IBD患者的肠壁增厚、肠壁异常强化及肠外并发症具有优势,但难以显示肠壁溃疡、卵石征,对多发炎性息肉的显示率不高,而消化内镜则易于显示IBD的肠壁溃疡、多发炎性息肉、卵石征。两种检查方法相互结合,有助于全面评价IBD的病变范围、并发症,对于IBD的临床诊断及综合治疗具有重要的指导意义。     

骨保护素在炎症性肠病中的临床应用

炎症性肠病(IBD)是一种慢性非特异性炎性疾病,发病机制目前仍不十分清楚,其诊断也是医学界的一大难题.骨保护素(OPG)是一种生长因子受体,在骨代谢中起着重要作用,且与细胞的增殖、分化、死亡等相关.研究发现OPG能反映IBD的病变程度、部位、类型,能预测溃疡性结肠炎(UC)患儿对糖皮质激素的敏感性,有望成为协助IBD诊断的新指标.本文就OPG参与IBD的发病机制以及OPG在临床上的应用做一综述.     

小儿炎症性肠病定量CT骨密度测量的研究

目的应用定量CT(QCT)评估小儿炎症性肠病(inflammatory bowel disease,IBD)的骨密度(bone mineral density,BMD)状况,为IBD的治疗提供依据。方法收集我院确诊的IBD患儿27例,同时收集正常人群62例。应用QCT方法测量两组人群骨密度,结果进行统计学分析。同时从中选取学龄儿童(7~12岁)的IBD患儿共12例作为病例组;按照性别、年龄、人数相匹配的原则从正常人群中选取12例作为正常对照组。对这两组的QCT结果进行统计学分析。并观察这两组对照结果的一致性。结果 1)0~14岁27名IBD患儿骨密度从110.9mg/cm3到201.8mg/cm3,骨密度平均值为(165.49±18.93)mg/cm3,与62名正常人群骨密度值的比较(IBD患儿低于正常人群骨密度的平均值(189.65±26.99)mg/cm3,Z=-4.07,P=0.000,P0.05,二者差异有统计学意义;2)克罗恩病(Crohn’s disease,CD)组患儿骨密度平均值(162.26±16.77)mg/cm3,与正常人群骨密度比较(CD组患儿低于正常人群骨密度的平均值(189.65±26.99)mg/cm3,Z=-3.261,P=0.001,P0.05,二者差异有统计学意义。溃疡性结肠炎(ulcerative colitis,UC)组患儿骨密度平均值(171.97±17.11)mg/cm3,与正常人群骨密度比较〔UC组患儿低于正常人群骨密度的平均值(189.65±26.99)mg/cm3〕,Z=-1.908,P=0.056,P0.05,二者差异无统计学意义;3)病例组(12名7~12岁IBD患儿)的骨密度与正常对照组(12名7~12岁正常儿童)骨密度的比较:病例组骨密度平均值为(159.9±15.32)mg/cm3,正常对照组骨密度平均值为(186.96±10.97)mg/cm3,t=-4.97,P=0.000,P0.05,二者差异有统计学意义,且病例组骨密度低于正常对照组的骨密度。结论 IBD患儿骨密度低于同年龄正常人群骨密度;其中CD组和UC组患儿骨密度均低于正常人群骨密度,且CD组患儿比UC组患儿更易出现骨密度下降。使用QCT骨密度测量技术可以精确敏感的评估患儿骨密度情况,指导临床进一步的治疗方案。     

炎症性肠病的MRI进展

炎症性肠病(inflammatory bowel disease,IBD)主要包括2种慢性肠道疾病,即溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn's disease,CD)[1].MRI可采用多平面、多参数、多序列成像方式,除可显示解剖学信息以外还能提供功能学参数,从而能更全面地诊断和评价IBD[1-2].另外,由于其检查无创、无电离辐射,十分适合作为IBD患者长期随访手段.本文就IBD的MRI研究进展进行综述.     

炎性肠病病人的脑结构改变:一项联合VBM和DTI的研究

正摘要目的研究炎性肠病(IBD)病人的脑结构改变。方法对18例IBD病人[年龄(45.16±14.71)岁]及20例年龄匹配的正常对照进行颅脑MRI扫描。采集矢状面FLAIR、高分辨     

抗人类免疫缺陷病毒药物研究进展

近几年 ,抗人类免疫缺陷病毒 (Ｈｕｍａｎｉｍｍｕｎｏｄｅｆｉｃｉｅｎｃｙｖｉｒｕｓ- 1,ＨＩＶ - 1)药物研究取得了巨大的进展 ,尤其是目前联合治疗方面的研究引人注目[1～ 3 ] 。1　临床常用的抗ＨＩＶ药物种类及研究　自齐多夫定 (ＡＺＴ)第一个被ＦＤＡ批准用于获得性免疫缺陷综合征 (ＡｃｑｕｉｒｅｄＩｍｍｕｎｅＤｅｆｉｃｉｅｎｃｙＳｙｎｄｒｏｍｅ ,ＡＩＤＳ)治疗 ,至目前已有 2 1种抗ＨＩＶ药物被批准用于和试用于临床。1 1　核苷类逆转录酶抑制剂 (Ｎｕｃｌｅｏｓｉｄｅｒｅｖｅｒｓｅｔｒａｎｓｃｒｉｐｔａｓｅｉｎｈｉｂｉ…     

靶向增强超声对小鼠炎症性肠病炎症的量化与监测

目的评估在化学因素所致炎症性肠病(IBD)的小鼠模型中使用靶向作用于P-选择素的微泡对比剂(MBP-selectin)的超声检查来量化炎性组织中P-选择素的表达水平和监测的治疗效果方面的作用。材料与方法动物实验过程中     

Inflammatory bowel diseases (IBD) -- critical discussion of etiology,pathogenesis, diagnostics,and therapy

AIMS: Crohn's disease and ulcerative colitis are the most frequent inflammatory bowel diseases (IBD) with a prevalence of approximately one out of 500.Cytokine research opened new and potent treatment options and thus stimulated clinical and basic research.However, the IBD still remain a challenge for patients and physicians,demanding close cooperation between gastroenterologists,radiologists and surgeons.The basic understanding of IBD,which is necessary for efficient diagnostic and therapeutic concepts is reviewed. METHODS: Based upon recent publications and our clinical experience we discuss aspects of etiology,pathogenesis,diagnostics,and therapy of Crohn's disease and ulcerative colitis. RESULTS: A genetically influenced, exaggerated and sustained immune response against the own gut flora seems to be one of the most important factors in the pathogenesis of IBD.Not less important are environmental influences.For instance, cigarette smoking had been judged to have some negative influence on the natural course of Crohn's disease.Now,however, recent studies show that smoking is even a significant independent risk factor in the pathogenesis of IBD. Since IBD and especially Crohn's disease can effect the whole body, detailed analysis of inflammatory organ involvement is necessary before therapy.For instance, the MRI enteroclysis technique adds a necessary diagnostic tool for the exploration of those parts of the small bowel that cannot been reached by routine endoscopy like the upper ileum and the lower jejunum. In terms of therapy, a change of paradigms can be observed: patients will no longer be treated only when symptoms arise, but will early be integrated into a therapeutic concept, which is determined by site and extent of the disease and adapted to the abilities and needs of the patient.Furthermore,immunosuppressive agents like azathioprine and 6-mercaptopurine will establish as central concept in the medical treatment of IBD. DISCUSSION: IBD-therapy should rather be adapted to the patient's individual inflammatory pattern than be oriented to schematic treatment rules.New endoscopic and radiologic techniques provide the necessary diagnostic tools.     

Development of radioimmunotherapeutic and diagnostic antibodies: an inside-out view

Only a handful of radiolabeled antibodies (Abs) have gained US Food and Drug Administration (FDA) approval for use in clinical oncology, including four immunodiagnostic agents and two targeted radioimmunotherapeutic agents. Despite the advent of nonimmunogenic Abs and the availability of a diverse library of radionuclides, progress beyond early Phase II radioimmunotherapy (RIT) studies in solid tumors has been marginal. Furthermore, [¹⁸F]fluorodeoxyglucose continues to dominate the molecular imaging domain, underscored by a decade-long absence of any newly approved Ab-based imaging agent (none since 1996). Why has the development of clinically successful Abs for RIT been limited to lymphoma? What obstacles must be overcome to allow the FDA approval of immuno-positron emission tomography (immuno-PET) imaging agents? How can we address the unique challenges that have thus far prevented the introduction of Ab-based imaging agents and therapeutics for solid tumors? Many poor decisions have been made regarding radiolabeled Abs, but useful insight can be gained from these mistakes. The following review addresses the physical, chemical, biological, clinical, regulatory and financial limitations that impede the progress of this increasingly important class of drugs.     

蜂产品对放射性损伤的防治研究进展

在军事、医疗和公共卫生方面,辐射暴露是一个持续而严重的威胁。针对辐射引起的损伤需要有效的预防或缓解治疗,但是目前这些问题尚未得到解决。临床上少数食品药品监督管理局（FDA）批准的辐射防护剂副作用大,限制其广泛使用。据报道,一些天然的无毒化合物（如蜂产品）可通过减轻辐射引起的氧化应激、细胞凋亡和DNA损伤来预防和治疗辐射引起的口腔黏膜炎、食管炎、皮肤损伤、肝损伤、肠道损伤和造血系统的损伤等。这表明这些蜂产品有作为辐射防护剂的潜力。本文就蜂产品对防治放射性损伤的实验及临床研究进行综述。     

Significance of proteinuria in patients with acute ischemic brain disease]

Brain vascular diseases are ranked the third as the cause of morbidity and mortality in majority of the countries of the world. In about 80% of the cases of vascular brain diseases, it is ischemic brain disease (IBD). Atherosclerosis of main cerebral arteries is most frequently responsible for the occurrence and development of IBD. In recent years it was reported for the first time of the association of atherosclerosis and/or its complications and proteinuria. Assuming that there exists the significant association between the degree of proteinuria and clinical parameters of IBD, the aim of this study was to investigate the frequency and patterns of the association of proteinuria and clinical IBD parameters. The study was performed in 180 patients with IBD of atherothrombotic origin and 60 patients with the diseases of non-vascular origin, as the control group. In all patients quantitative determination of proteinuria was performed, and in the patients with IBD was determined the degree of IBD and afterwards the degree of functional and neurologic impairment prior to and at the end of treatment in acute phase using the standardized scales. The results of the study revealed the existence of significant frequency of proteinuria in the patients with IBD, as well as the significant association between the degree of proteinuria and severity of IBD. It was concluded that proteinuria in patients with IBD was probably associated with the atherogenic processes and physiopathologic processes of IBD, respectively, which could have predictive value for the outcome of the disease in the early stage.     

Hepatic yttrium-90 radioembolotherapy in metastatic colorectal cancer treated with cetuximab or bevacizumab

Yttrium-90 microspheres have been recently approved by the Food and Drug Administration and have become available to physicians in the United States for the treatment of hepatic neoplasia. Published results regarding the benefits of 90Y radioembolotherapy within the rapidly evolving landscape of systemic therapies for advanced unresectable colorectal cancer are limited. In that context, outcomes in patients who have received the recently approved biologic agents bevacizumab and cetuximab in addition to chemotherapy are unknown. This report briefly describes the authors' treatment experience with this cohort of patients.     

Acute treatment for ischemic stroke in 2004

The last decade witnessed significant and unprecedented advances in the treatment of acute ischemic stroke. Intravenous tissue plasminogen activator and defibrinogenating agent are both now approved by the Food and Drug Administration for treatment of acute ischemic stroke within 3 h of symptom onset. Trials involving intra-arterial thrombolysis have demonstrated clinical benefit in patients treated within 6 h of symptom onset. The future for the development of new and better treatment for ischemic stroke looks very promising. Currently, induced hypothermia, laser evaporation, mechanical thrombectomy, angioplasty with stent placement, the combination of neuroprotective agents with thrombolysis, and the combination of intravenous with intra-arterial thrombolysis are being investigated.     

Simultaneous administration of111In-human immunoglobulin and99mTc-HMPAO labelled leucocytes in inflammatory bowel disease

Technetium-99m hexamethylpropylene amine oxime (HMPAO) labelled leucocytes and indium-111 polyclonal immunoglobulin (IgG) were simultaneously injected into a group of 27 patients routinely referred for the investigation of inflammatory bowel disease (IBD). Ten-minute anterior abdomen and tail on detector views were obtained at 30 min, 4 h and 24 h p.i. of both tracers. The diagnosis of IBD was obtained in all cases by endoscopy with biopsy and/or surgery. Images were blindly evaluated by two experienced observers who only knew of the clinical suspicion of IBD. IBD was confirmed in 20 patients (12 with Crohn's disease and eight with ulcerative colitis). Sensitivity, specificity and accuracy were 100%, 85% and 96% respectively for labelled leucocytes and 70%, 85% and 74% for IgG. Both IgG and leucocyte scans were normal in six out of seven patients in whom a diagnosis of IBD was excluded; the remaining patient, with ischaemic colitis, was falsely positive with both agents. As far as disease extension is concerned, the IgG study localized 27 diseased segments, whereas 49 were seen with the leucocyte study. Eighty-four segments were normal and 25 showed tracer uptake with both agents. Twenty-four were positive only with the leucocyte study and two were positive only with the IgG study. Agreement between the agents was 80.7%. These results confirm that¹¹¹In-human polyclonal scintigraphy is less sensitive than^99mTc-HMPAO scintigraphy both for the diagnosis of IBD and in the evaluation of disease extension. Nevertheless, if leucocyte labelling is not available, labelled IgG can be used only for diagnostic purposes.     

Clinical applications of radiolabeled blood elements in inflammatory bowel disease.

This work discusses the main clinical features of inflammatory bowel disease (IBD) and the methods to obtain an accurate diagnostic. Nuclear medicine procedures are deeply analyzed, with special emphasis in those where clinical experience is larger and that are available for clinical practice in most countries. In the opinion of the authors 99mTc-HMPAO is the first choice agent, while 111In-oxine could be considered as the gold standard for evaluation of new agents. In the context of IBD, the WBC scintigraphy is useful for its diagnosis (early and accurate) and the evaluation of disease extension (whole bowel examination, without patient preparation and negligible risk). The evaluation of disease severity deserves further experiences.     

Advanced multimodality imaging of inflammatory bowel disease in 2015: An update

The diagnosis and effective management of inflammatory bowel disease (IBD) requires a combination clinical, endoscopic, histological, biological, and imaging data. While endoscopy and biopsy remains the gold standard for diagnosis of IBD, imaging plays a central role in the assessment of extra mural disease, in disease surveillance and in the assessment of response to medical treatments, which are often expensive. Imaging is also vital in the detection and diagnosis of disease related complications, both acute and chronic. In this review, we will describe, with illustrative images, the imaging features of IBD in adults, with emphasis on up-to-date imaging techniques focusing predominantly on cross sectional imaging and new magnetic resonance imaging techniques.