Relative incidence of Crohn's disease and ulcerative colitis in six Melbourne hospitals

Information on the relative incidence of Crohn's disease and ulcerative colitis was obtained by a prospective investigation at six Melbourne teaching hospitals. One hundred and eleven patients who presented with chronic inflammatory bowel diseases between 1980-1981 were admitted to the study. Forty (36%) patients were diagnosed as having Crohn's disease and 63 (57%) patients as having ulcerative colitis. The type of chronic inflammatory bowel disease could not be determined in eight (7%) patients. These findings suggest that the relative frequency of Crohn's disease and ulcerative colitis in Melbourne hospitals is within the range that is reported for northern Europe and the United States.     

Fas-670基因多态性与炎症性肠病的相关性研究

目的 :研究Fas基因 6 70位点多态性在中国汉族人群中的分布 ,探讨其与炎症性肠病的相关性。方法 :采用聚合酶链反应 限制性片段长度多态性方法 ,检测 5 0例炎症性肠病患者与 12 4例正常对照者Fas基因 6 70位点基因型及等位基因频率 ,分析该基因多态性与炎症性肠病之间的关系。结果 :炎症性肠病患者Fas基因型及等位基因频率与正常对照组比较无显著性差异。炎症性肠病组GG基因型频率与对照组相比有增高趋势 (2 8%vs 15 % ,P=0 .0 85 6 ) ,但差异无显著性。按性别分层后发现正常男性AA基因型频率显著高于正常女性 (4 0 %vs 19% ,P =0 .0 2 5 8)。溃疡性结肠炎组和克罗恩病组间Fas基因型和等位基因频率无显著性差异。而且Fas基因型与溃疡性结肠炎病变范围无关。结论 :Fas基因多态性与炎症性肠病的易感性无关。正常人群Fas基因型分布存在性别差异     

β-防御素-2荧光素酶报告基因载体及克罗恩突变体的构建

目的：构建人β-防御素-2（hBD-2）荧光素酶报告基因质粒及其克罗恩病（Crohn’s,CD）相关突变体,并检测其在人胚胎肾T细胞（HEK-293T）中的活化．方法：通过基因重组构建包含hBD-2启动子序列的报告基因质粒hBD-2—780-luc,再通过定点突变技术在启动子区（-233位点）引入变异点（G变为C）,构建突变体hBD-2-mut-luc;经酶切及测序验证后,将报告基因质粒和野生型NOD2／CARD15蛋白真核表达载体共转染到HEK一293T中,TNF—α刺激后测定双荧光素酶的表达．结果：酶切和测序证实,构建了重组体hBD-2-780-luc及其突变体hBD-2-mut—luc,两者均能表达荧光素酶活性,且明显高于空载体．结论：hBD-2报告基因质粒hBD-2-780-luc及其CD相关突变体hBD-2-mut—luc构建成功,并在细胞内活化表达荧光素酶．     

Detection of inflammatory bowel disease in adults and children: evaluation of a new isotopic technique

The distribution of radioactivity after the oral administration of sucralfate labelled with technetium-99m was studied in 33 patients with Crohn's disease (13 adults, 20 children), 10 with ulcerative colitis (four adults), and 29 controls (23 with upper intestinal disease, four irritable bowel, one hypolactasia, and one malrotation of the gut). Positive scans were obtained in all patients with ulcerative colitis and 29 of 31 with active Crohn's disease. The scans of two patients with inactive Crohn's disease were negative. There were two false negative scans in patients with Crohn's colitis and one false positive scan. Overall, sensitivity was 95% and specificity 97%. Comparison with radiology in 39 patients showed similar distribution of disease in 24 and more extensive disease in 12. The scan was inexpensive, simple to perform, well tolerated, allowed small and large bowel to be visualised simultaneously, and used a lower dose of radiation than barium studies. It may prove useful as a screening test for inflammatory bowel disease and in the serial assessment of disease activity.     

自噬体基因ATG16L1多态性与炎症性肠病的相关性研究

目的 检测炎症性肠病(IBD)患者ATG16L1基因单核苷酸多态性(SNP)位点rs2241880的等位基因多态性与IBD易感性间的关系.方法 抽取80例IBD患者,其中40例克罗恩病(CD)患者、40例溃疡性结肠炎(UC)患者,50例健康者外周静脉血并提取DNA,根据目的 基因片断设计特异性引物,并应用PCR方法 扩增DNA样本中的目的 基因片断.并对扩增的目的 基因片断进行测序,其测序结果与正常序列进行比较并分析等位基因的多态性与疾病易感性之间的相关性.结果 CD和UC患者与正常对照组之间ATG16L1基因SNP位点rs2241880的等位基凼多态性之间无明显差异(X2=4.94,P=0.293).结论 国外文献报道的与CD相关的易感基因ATG16L1的多态性位点rs2241880,在本组CD患者中并未发现与CD易感性相关,国外发现的与CD易感性相关的ATG16L1基因的SNP位点可能不是中国CD患者的易感性基因位点.     

Role of smoking in inflammatory bowel disease: implications for therapy

The relationship between smoking and inflammatory bowel disease is now firmly established but remains a source of confusion among both patients and doctors. It is negatively associated with ulcerative colitis but positively associated with Crohn's disease. In addition, it has opposite influences on the clinical course of the two conditions with benefit in ulcerative colitis but a detrimental effect in Crohn's disease. These differences have been the subject of much interest and scrutiny with the hope that they may offer some insight into the pathogenesis of the two conditions and possibly lead to alternative therapeutic options. Nicotine is probably the principal active ingredient in smoking responsible for the association; trials have shown it to be of some benefit in ulcerative colitis, but further research is required to establish its therapeutic role, and the relevant mechanisms responsible for its action. In this article, we review the role of smoking in inflammatory bowel disease and its implication for therapy.     

Association between the promoter polymorphism T/C at position -159 of the CD14 gene and anti-inflammatory therapy in patients with inflammatory bowel disease

Immune response to intestinal bacteria and genetic predisposition seem to play a crucial role in the pathogenesis of inflammatory bowel disease. A single nucleotide polymorphism in the promoter of the lipopolysaccharide-receptor CD14 gene (T/C at position -159) has recently been described. To evaluate the role of the CD14 gene in anti-inflammatory therapy, the functionally relevant T(-159)-->C promoter polymorphism has been genotyped in 72 patients with inflammatory bowel disease and associated with the cumulative steroid dose. Cumulative corticosteroid dose was significantly higher in ulcerative colitis patients with the TT genotype (2447.7 +/- 927.0 mg/yr) compared with the CT genotype (142.3 +/- 142.3 mg/yr, p=0.016) and the CC genotype (391.7 +/- 272.7 mg/yr, p=0.047). In contrast, in patients with Crohn's disease there was no significant difference of the cumulative corticosteroid doses between the various T(-159)-->C promoter CD14 genotypes. An altered immune response to lipopolysaccharides with influence on the anti-inflammatory therapy seems to play a role in the genetic predisposition to ulcerative colitis. Genetic stratification will lead to the development of individualized therapies in inflammatory bowel disease.     

What is the origin of ulcerative colitis? Still more questions than answers

Despite more than a century of existence as a clinical entity, the true origin of ulcerative colitis still remains elusive. Several factors probably contribute to the development of this condition. Recently discovered technologies have clarified the role of bacterial species, which may account for intestinal dysbiosis, as a factor triggering ulcerative colitis. Genetic susceptibility together with abnormal innate immunoreactivity probably comprise the essential prerequisites for the initiation and perpetuation of ulcerative colitis. Although the genetic background has been more clearly recognised in patients with Crohn's disease than in those with ulcerative colitis, some candidate loci associated with ulcerative colitis have also been intensively studied. Additionally, environmental factors may interfere with inherent predispositions to ulcerative colitis, and either suppress or reinforce them. Whatever the origin, the search for the aetiology of ulcerative colitis must have the same goal: the improvement of treatment and the quality of life in patients with ulcerative colitis.     

坏疽性脓皮病6例临床分析

坏疽性脓皮病(Pyoderma gangrenosum)是一种罕见而凶险的以皮肤坏疽性溃疡为特征的皮肤病,国内文献报道近20例,大多为个案报告,现将本院10年来收治的6例报告如下。     

Chronic inflammatory bowel disease, cigarette smoking, and use of oral contraceptives: findings in a large cohort study of women of childbearing age

Since the start in 1968 of the Oxford Family Planning Association contraceptive study 31 women have developed ulcerative colitis and 18 have developed Crohn's disease, giving incidences of 0.15 and 0.09/1000 woman years respectively. The incidence of ulcerative colitis in women who were non-smokers on entry to the study was 0.17/1000 woman years and the incidence in smokers was 0.11/1000 woman years. The findings for Crohn's disease were entirely different, the corresponding incidences being 0.05 and 0.17/1000 woman years respectively. Both ulcerative colitis and Crohn's disease were more common among women currently using oral contraceptives than among those not doing so. Incidences per 1000 woman years for ulcerative colitis were 0.26 in users and 0.11 in non-users; for Crohn's disease the incidences were 0.13 and 0.07 respectively. Though the association between the use of oral contraceptives and chronic inflammatory bowel disease cannot be regarded as established, the effects of smoking have been shown consistently in many studies. This observation provides an important clue to the aetiology of chronic inflammatory bowel disease.     

Colonic Crohn's disease and use of oral contraception

The prevalence of use of oral contraception before the onset of disease was established in 100 consecutive women attending follow up clinics for inflammatory bowel disease. A significant excess of women with Crohn's disease confined to the colon had taken oral contraceptives in the year before developing symptoms (10/16 (63%] compared with women with small-intestinal Crohn's disease (12/49 (24%); p less than 0.02) and women with ulcerative colitis (3/35 (9%); p less than 0.0005). When the patient groups were matched for age and year of onset of disease usage of oral contraception before the onset of disease was still more common among women with isolated colonic Crohn's disease (9/12, 75%) than among those with ulcerative colitis (2/12 (17%); p less than 0.02) and was also more common than would be expected from reported figures for oral contraception in England and Wales (31.4% of women aged under 41; p less than 0.005). A survey of current patient records showed that isolated colonic disease was at least twice as common among women with Crohn's disease (63/218, 29%) compared with men (25/181, 14%; p less than 0.001). These data support the suggestion made previously that oral contraceptives may predispose to a colitis that resembles colonic Crohn's disease.     

Medical treatment of inflammatory bowel disease: new therapies, new drugs.

Ulcerative colitis, ulcerative proctitis and Crohn's disease are chronic inflammatory conditions that affect the gastrointestinal tract. Conventional treatment has stressed the role of anti-inflammatory agents to suppress the inflammatory response. New compounds that can deliver 5-aminosalicylic acid to the colon have recently been released in Canada. Metronidazole and azathioprine may also be of benefit in Crohn's disease. Therapy with cyclosporine and clonidine should be based on the results of further clinical trials. The use of nutritional support as primary therapy in Crohn's disease appears promising. At present, both pharmacologic and nutritional therapies should be considered in the treatment of inflammatory bowel disease.     

Sweet's syndrome in association with Crohn's disease

A case of Sweet's syndrome in association with Crohn's disease in a young woman is reported. Sweet's syndrome is a rare extraintestinal manifestation of Crohn's disease and ulcerative colitis.     

炎症性肠病患者淋巴毒素α、白介素1受体拮抗剂基因多态性与肿瘤坏死因子α,可溶性白介素2受体以及白介素6产量的关系

测定中国炎症性肠病患者淋巴毒素α基因和白介素１受体拮抗剂基因多态性与肿瘤坏死因子α、可溶性白介素２受体以及白介素６产量的关系。２２例炎症性肠病患者（２０例溃疡性结肠炎，２例克隆病）和１０例健康对照者参加研究。淋巴毒素α基因和白介素１受体拮抗剂基因片段由基因组ＤＮＡＰＣＲ扩增而来，采用ＥＬＩＳＡ法测定周围血单个核细胞肿瘤坏死因子α，可溶性白介素２受体以及白介素６产量。结果：炎症性肠病淋巴毒素α基因型１和２杂合子略高于正常对照组（１１／１２对１／１０，Ｐ＝００４９）；而且淋巴毒素α等位基因２与周围血单个核细胞诱生的高水平肿瘤坏死因子α产量有关。白介素１受体拮抗剂基因多态与炎症性肠病无显著性相关。认为：中国人群炎症性肠病患者淋巴毒素α基因可能对肿瘤坏死因子α产量起一定作用。     

巨细胞病毒感染与炎症性肠病相关性研究

目的:从CMV基因水平观察巨细胞病毒(cytomegalovirus,CMV)感染与炎症性肠病(inflammatory bowel disease,IBD)的相关性。方法:我们从2007～2010年.对76例溃疡性结肠炎(ulcerative colitis,UC)52例,克罗恩病(Crohn’s disease,CD)24例的成人患者进行研究,研究CMV感染者肠道病理标本及其血液的分子水平、肠道组织标本免疫组化,以40例非炎症性肠病者作为对照组。结果:免疫组化着色显示CMV抗原阳性9例(7例是UC、8例是严重IBD病例),对照组CMV抗原均阴性。PCR-CMV基因在全部IBD肠组织标本、血液中均阳性有23(30.3%)例,16(30.8%)例为UC,7(25.9%)例为CD。此外,5(6.6%)例IBD中(2例UC,3例CD)在肠道组织检测到CMV基因,而在血液中未检测到。在对照组,5(12.5%)例血液中检测到CMV基因,仅1例(2.5%)在肠道组织检测到CMV基因。结论:UC与对照组相比,更易检测到CMV(在血液和肠道组织样本)(P=0.034和P<0.0001),而CD患者与对照组相比,更易在肠道组织标本检测CMV基因(P=0.002),在血液或肠道检测到CMV基因与IBD持续时间明显相关(P=0.004和0.03),但与年龄、性别、疾病的严重程度、结肠镜下的活动性、全结肠炎、需要特殊治疗和外科手术无关。在本研究中,检测到肠道CMV基因或抗原常与IBD有关。     

武汉市603例炎症性肠病并发症的临床调查

目的:分析武汉市炎症性肠病(IBD)并发症的临床特点,探讨其与病变程度、范围及治疗方式的关系。方法:回顾性收集1990-2005年武汉市5家医院经结肠镜及病理诊断为IBD病例共603例,其中溃疡性结肠炎(UC)521例,克罗恩病(CD)82例,分别观察各种并发症的发生频率及并发症与其他因素的关系。UC与CD间的差异及相关分析用χ2检验。结果:521例UC中,并发症34例(6.5%),82例CD中,并发症40例(48.8%)。重度UC和全结肠炎患者中并发症的发生率显著高于非重度和远端结肠炎患者(分别25.8%比3.9%,12.8%比4.9%,P<0.01)。有并发症的CD患者的手术史发生率显著高于无并发症患者(57.5%比14.3%,P<0.01),但CD病变范围与并发症的发生无相关性(P>0.05)。结论:CD并发症的发生率高于UC。UC的并发症与疾病病变程度和范围有关,而CD与手术方式有关。     

Raised titres of anti-klebsiella IgA in ankylosing spondylitis, rheumatoid arthritis, and inflammatory bowel disease

Serum titres of IgA are raised in ankylosing spondylitis and increased titres of antibodies to klebsiella have also been reported. The humoral response was investigated in ankylosing spondylitis and other inflammatory disorders. IgA antibodies to klebsiella pneumoniae K43 were measured in patients with ankylosing spondylitis, Crohn's disease, ulcerative colitis, and rheumatoid arthritis and in controls. Significantly raised median titres of anti-klebsiella IgA, measured as optical density at 405 nm with an enzyme linked immunosorbent assay (ELISA), were seen among the patients with ankylosing spondylitis (0.7), Crohn's disease (0.8), rheumatoid arthritis (0.6), and ulcerative colitis (0.8) compared with controls (0.4). Activity of disease in ankylosing spondylitis and titres of anti-klebsiella IgA were not correlated. In contrast, titres of anti-klebsiella IgM were significantly lower in patients with ankylosing spondylitis and ulcerative colitis. The increase in the titres of anti-klebsiella IgA may be due to increased permeability of the gut to bacterial antigens, leading to an increased IgA response in the gut mucosa and permitting the release of IgA into the circulation. As the increased antibody titres were seen in Crohn's disease and rheumatoid arthritis as well as in ankylosing spondylitis the response may be nonspecific, occurring because of possible underlying inflammatory bowel disease in these conditions.     

Surgical morbidity after ileostomy in New South Wales

While there have been several overseas studies on the quality of life after proctocolectomy, data concerning patients who have undergone ileostomy and proctocolectomy in Australia are limited. For this reason, a questionnaire was sent to all members of the New South Wales Ileostomy Association. Of the 354 who replied, the indication for ileostomy had been ulcerative colitis in 82%, Crohn's disease in 10%, familial polyposis in 4%; and 4% had undergone proctocolectomy and ileostomy for some other reason. Ages ranged from 15 to 93 years. Most subjects, of whom 51% were female, had had their ileostomy for a median of 9.4 years. Immediate postoperative complications related to the ileostomy occurred in 23% of patients, the most common causes being obstruction and sepsis. The rate of readmission to hospital for complications of ileostomy was a high 48%; 25% had further surgery. In view of these results, the need for continued efforts to develop alternative methods is emphasized.     

Ulcerative colitis in Malaysians: a review of 23 patients

Twenty-three patients with ulcerative colitis are reported from Kuala Lumpur, Malaysia. Sixteen were newly diagnosed over a six-year period between 1982 and 1987. The disease was commoner in men (16 men : 7 women). The peak age of onset was in the third decade. The ethnic distribution of the patients was 10 Malays, eight Indians and five Chinese making the disease relatively commoner amongst Indians. The extent of colonic involvement varied and six (26%) had a total colitis. Extra-intestinal manifestations were seen in seven patients. Diagnosis was delayed for over 10 years in four. Colorectal cancer was not seen. There was no mortality. Ulcerative colitis remains an uncommon disease amongst Malaysians. During the same period, only four male patients with Crohn's colitis were seen.