sCD40L在炎症性肠病中的表达及临床意义

目的:检测炎症性肠病(IBD)患者外周血清中可溶性CD40L(sCD40L)水平,并探讨其在疾病发生过程中的临床意义.方法:收集12例克罗恩病、42例溃疡性结肠炎和34例健康者的外周血,离心分离血清,使用ELISA检测sCD40L水平.患者经有效治疗,待症状控制后,检测外周血sCD40L水平变化,分析sCD40L与疾病发展的关系.结果:CD和UC患者外周血清中sCD40L水平明显高于健康对照组(2456.5±264.3 ng/L,2105.4±238.1 ng/L vs 564.8±188.6 ng/L,均P＜0.005).患者经过有效治疗,发现外周血sCD40L水平明显降低(P＜0.005).进一步分析发现,sCD40L水平与患者的其他生化指标如CRP、肝肾功能指标等之间无相关关系.结论:sCD40L在IBD患者外周血中明显升高,可能作为早期诊断,判断疗效和预后的指标.     

人工智能与炎症性肠病

随着人工智能(artificial intelligence,AI)的发展并逐渐应用到医学领域,给医学发展带来新的思路,其在炎症性肠病(inflammatory bowel disease,IBD)中的研究和应用也日益增多,其中IBD包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(crohn'...     

营养与炎症性肠病

营养和炎症性肠病的发病机制及治疗有密切的关系,深入研究两者的关系对临床有重要的意义。此文对饮食中的营养成分是否和发病有关、如何营养支持等问题作一简要概述。     

昆明市炎症性肠病多中心临床资料分析

目的:回顾性调查昆明市近10年炎症性肠病(IBD)患者的发病状况.方法:调查1998年1月-2007年3月七家综合性医院430例住院IBD患者,其中溃疡性结肠炎(UC)379例,克罗恩病(CD)51例.接受结肠镜、组织病理学和钡剂灌肠检查者在UC和CD患者中分别为98.2%和56.2%、2.6%和72.5%、78.4%和31.4%.对IBD患者的年龄、性别、职业、临床表现、内镜和组织病理学检查结果进行分析.结果:UC患者平均年龄为(46.9±15.8)岁,以30～39岁和50～59岁年龄段患者最多,呈双峰状分布;CD患者平均年龄为(41.6±17.2)岁,以20～29岁年龄段患者最多.UC和CD患者均以男性为主,UC患者中脑力劳动者多见.UC患者以腹泻(302,79.7%)、腹痛(285,75.2%)、血便(290,76.5%)为主.CD患者常见腹痛(44,86.3%)、腹泻(28,54.9%)、体重减轻(28,54.9%).UC患者内镜检查、病理检查、钡剂灌肠诊断符合率分别为88.4%(329/372)、24.4%(52/213)、4/10,CD患者分别为86.5%(32/37)、27.5%(11/40)、75%(12/16).UC患者100%为活动期,其中轻、中、重度分别为38.3%、42.2%和19.5%.CD患者活动期占92.2%,缓解期占7.8%,其中轻、中、重度者分别为15.7%、43.1%41.2%.结论:了解10年来昆明市的IBD发病情况及临床特征将有助于临床诊断和治疗.     

炎症性肠病患者肠黏膜白细胞分化抗原-14的表达及意义

目的: 探讨炎症性肠病患者肠黏膜CD14的表达及与该病的关系.方法: 收集活动性溃疡性结肠炎(ulcerative colitis, UC)患者25例及克罗恩病(Crohn's disease, CD)患者15例;20例对照来自于非炎症性肠病患者手术切除的正常结肠组织(肠镜及肠黏膜病理组织学检查结果均正常).炎症性肠病的临床诊断均依据于常规影像学、内镜学及组织学标准.采用免疫组织化学方法检测肠黏膜组织中CD14表达量.结果: 肠黏膜固有层单个核细胞表达CD14.UC患者CD14阳性细胞百分数高于CD患者,但二者差异无统计学意义(P>0.05);UC患者较正常对照有显著性差异(t=4.404, P<0.01),CD患者较正常对照亦见显著性差异(t=3.324,P<0.01).CD14的表达与疾病活动度(diseaseactivity index, DAI)相关, UC组轻、中、重度比较有显著性差异(F=56.709, P<0.01);CD组轻、中、重度比较亦有显著性差异(F=12.880, P<0.01).结论: CD14参与了炎症性肠病的发病过程, 其表达强度反映了该病的程度.     

炎症性肠病与感染

炎症性肠病的病因和发病机制尚不明确,涉及环境、遗传、免疫失调等因素。长期以来,多种方法证实许多病原微生物与炎症性肠病发病有关,且对其致病机制作了深入的研究。此文就此作一综述。     

炎症性肠病与肠道细菌研究进展

炎症性肠病(inflammatory bowel disease,IBD)包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn's disease,CD).其发病机制至今仍不清楚,可能的病因包括由基因决定的宿主易感性、黏膜免疫和肠道微生态环境三者的相互作用.近年来随着微生态学的发展,肠道菌群与IBD发病的关系日益受到关注.关于肠道病原微生物在IBD发病机制及其引起的一系列免疫学、微生态学、病理生理等方面的变化出现了研究和报道,同时微生态制剂在肠道免疫调节、控制炎症反应等方面的优点已有许多动物实验及临床应用证明,其中微生态制剂之一益生菌在IBD应用较普遍,本文就IBD与肠道菌群研究进展及益生菌制剂治疗IBD作一综述.     

炎症性肠病结肠镜检查的评价

随着结肠镜对炎症性肠病镜下和活检病理形态改变的认识不断加深 ,它的使用价值也不断提高。Ｆｒ櫣ｈｍｏｒｇｅｎ总结过去 10年经验 ,发现对溃疡性结肠炎确诊率达 93.9% ,对克罗恩病达 77.3%。因此 ,近年来有倾向 ,结肠镜应列为诊断炎症性肠病的常规检查。结合我院过去 2 0年中炎症性肠病所见的形态改变 ,对其使用价值进行讨论。　　炎症性肠病在结肠镜下的形态 ,首先表现为分布方式和累及部位不同。溃疡性结肠炎呈连续性分布 ,并且疾病初期往往先累及直肠 ,逐渐向近端结肠蔓延 ,严重者累及整个结肠 ,仅有极少数倒灌性肠炎者可达回肠末端近…     

缺血在炎症性肠病发病机制中的作用

炎症性肠病是一种以肠道慢性炎性反应为特征的疾病,主要包括溃疡性结肠炎和克罗恩病,其病因和发病机制尚不明确,可能有多种因素共同参与。临床上炎症性肠病和缺血性肠病之间存在诸多相似之处,此文就血管因素和肠道缺血在炎症性肠病发病机制中的作用作一综述。     

炎症性肠病858例临床分析

目的总结分析炎症性肠病（IBD）的临床特点,探讨诊治策略。方法对1998年1月至2009年7月354例炎症性肠病住院患者和2003年1月至2009年7月504例炎症性肠病门诊患者资料进行回顾性分析。结果本组资料显示我院近12年来IBD发病呈逐年上升趋势,溃疡性结肠炎（UC）明显多于克罗恩病（CD）。本组IBD患者中男女之比为1.28∶1。IBD平均发病年龄（41.07±16.07）岁。UC发病高峰年龄为30～49岁,CD发病高峰年龄为20～39岁。本组住院患者中UC和CD两组民族构成比较无统计学差异。肠镜检查中UC以直肠和乙状结肠病变为主,CD以回盲部及回肠末端病变为主。本组患者IBD病理组织学检出率为41.5%,UC误诊率为17.0%,CD误诊率为25.0%。治疗以氨基水杨酸类及类固醇激素为主。结论炎症性肠发病数呈逐年上升趋势;IBD诊断主要依靠内镜及病理。IBD呈慢性复发性发作过程,应长期维持治疗。     

炎症性肠病患者血浆TRAF1的表达及其临床意义

目的比较炎症性肠病患者血浆肿瘤坏死因子受体相关因子-1（tumor necrosis factor receptor-assoc iated factor-1,TRAF-1）水平和正常对照者的差异,分析血浆TRAF1水平对炎症性肠病的诊断价值以及与内镜下疾病活动性的相关性。方法共纳入62例克罗恩病患者、64例溃疡性结肠炎患者和56例正常对照者。应用酶联免疫吸附试验（Enzym e-linked immuno-sorbent assay,ELISA）分析炎症性肠病患者和正常对照者血浆中TRAF1蛋白的表达,受试者工作特征曲线（rece iver-operating characteristic,ROC）分析血浆TRAF1水平对克罗恩病和溃疡性结肠炎的诊断价值,应用Pearson相关分析研究血浆TRAF1水平与内镜下疾病活动性的相关性。结果克罗恩病患者（P=0.000）和溃疡性结肠炎患者（P=0.000）血浆TRAF1水平显著高于正常对照者,同时TRAF1对区分克罗恩病患者和正常对照者（P=0.000）以及区分溃疡性结肠炎患者和正常对照者（P=0.000）具有显著的诊断价值。克罗恩病患者血浆TRAF1表达水平和内镜下疾病活动指数呈较低的负相关（r=-0.260,P=0.041）,而溃疡性结肠炎患者血浆TRAF1水平与内镜下疾病活动程度无显著相关性（r=0.029,P=0.821）。结论炎症性肠病患者血浆TRAF1水平增高,血浆TRAF1水平对区分炎症性肠病患者和正常对照者具有诊断价值,但血浆中TRAF1的水平不能反应内镜下疾病活动程度。     

白细胞介素-25在炎症性肠病患者中的表达及临床意义

目的 通过检测白细胞介素(IL)-25在炎症性肠病(IBD)患者肠黏膜及血清中的表达水平,探讨其在IBD发病过程中的作用及意义.方法 收集12例溃疡性结肠炎(UC)患者、16例克罗恩病(CD)患者及13例对照者的内镜肠黏膜活检标本,采用荧光定量PCR技术检测肠黏膜内IL-25 mRNA的表达情况,免疫组化技术分析IL-25在肠黏膜中的原位表达;同期收集20例UC、24例CD患者及20名健康对照者血清标本,采用酶联免疫吸附测定(ELISA)检测血清中IL-25水平.结果 与健康对照组相比,UC及CD患者肠黏膜组织内IL-25 mRNA表达显著降低(P＜0.05),UC及CD组间的表达量差异无统计学意义(P＞0.05).免疫组化分析显示IL-25阳性细胞在正常肠黏膜固有层内有较多表达,同时黏膜内的肠上皮细胞也存在IL-25低表达,UC及CD患者肠黏膜IL-25蛋白表达量显著降低(P＜0.05),UC及CD组间的表达量差异无统计学意义(P＞0.05).ELISA显示UC及CD患者血清中IL-25表达量显著低于健康对照组(P＜0.05).结论 IL-25在IBD患者肠黏膜及血清中表达显著降低,提示IL-25表达缺陷与IBD的发生发展密切相关,IL-25有可能成为IBD治疗的新靶点.     

Clinical significance of cytomegalovirus infection in patients with inflammatory bowel disease

Cytomegalovirus(CMV) infection is common in humans.The virus then enters a "latency phase" and can reactivate to different stimuli such as immunosuppression.The clinical significance of CMV infection in inflammatory bowel disease is different in Crohn’s disease(CD) and ulcerative colitis(UC).CMV does not interfere in the clinical course of CD.However,CMV reactivation is frequent in severe or steroid-resistant UC.It is not known whether the virus exacerbates the disease or simply appears as a bystander of a severe disease.Different methods are used to diagnose CMV colitis.Diagnosis is classically based on histopathological identification of viral-infected cells or CMV antigens in biopsied tissues using haematoxylin-eosin or immunohistochemistry,other tests on blood or tissue samples are currently being investigated.Polymerase chain reaction performed in colonic mucosa has a high sensitivity and a positive result could be associated with a worse prognosis disease;further studies are needed to determine the most appropriate strategy with positive CMV-DNA in colonic mucosa.Specific endoscopic features have not been described in active UC and CMV infection.CMV colitis is usually treated with ganciclovir for several weeks,there are different opinions about whether or not to stop immunosuppressive therapy.Other antiviral drugs may be used.Multicenter controlled studies would needed to determine which subgroup of UC patients would benefit from early antiviral treatment.     

Vaccinations in patients with inflammatory bowel disease

Treatment of inflammatory bowel disease (IBD) frequently requires administration of immunosuppressive therapies, which increases susceptibility to a number of infectious pathogens. However, many infections can be prevented by correct and appropriate utilization of vaccinations. While several guidelines have been published on vaccination schedules in patients with IBD, vaccination rates remain suboptimal and even lower than those in the general population. This is due to many factors including poor awareness of the importance of vaccines by gastroenterologists and general practitioners as well as potential prejudices of patients regarding the safety and benefits of vaccines. With the aim of increasing awareness about the key role of immunization in the management of patients with IBD, the present review examines the existing literature relating to the main vaccinations and their application in these patients. We also summarize current evidence in order to provide clinicians with an easy source of reference for the principal recommendations for prevention of infectious diseases in patients with IBD. In addition, the recommendations about traveling for IBD patients are briefly explored. Lastly, since it is important for gastroenterologists to be aware of recommendations on vaccination, we recommend implementing educational programs to ensure compliance with current guidelines.     

Long-term clinical outcome after infliximab discontinuation in patients with inflammatory bowel disease

Abstract

Objectives: We investigated the long-term clinical outcome and risk factors for clinical relapse in inflammatory bowel disease (IBD) patients after stopping infliximab (IFX).

Materials and methods: We retrospectively reviewed the medical records of IBD patients who were treated with IFX in four university hospitals in South Korea. Among them, patients who discontinued scheduled IFX therapy with a favorable disease course were enrolled. Clinical relapse was defined as an increase in disease activity, addition of new drugs, or abdominal surgery.

Results: In total, 28 ulcerative colitis (UC) patients and 17 Crohn’s disease (CD) patients were enrolled. The median duration of follow-up after discontinuation was 41 months (range: 8–109 months) in UC patients and 141 months (range: 66–262 months) in CD patients. The cumulative probability of relapse at 12 months was 32.1% in UC patients and 30.7% in CD patients. Fewer IFX infusions and a shorter duration of mesalamine treatment after IFX discontinuation were risk factors for relapse after IFX discontinuation in UC patients (p?=?.04 and .01, respectively). In CD patients, a higher erythrocyte sedimentation rate and CRP at IFX discontinuation and a shorter duration of azathioprine treatment after IFX discontinuation were risk factors for relapse (p?=?.03, .03 and .01, respectively).

Conclusions: Approximately 30% of IBD patients who responded to IFX therapy experienced relapse within 1 year after discontinuation. We identified several risk factors for relapse. Further studies should identify factors predictive of the disease course after discontinuing IFX maintenance therapy.     

Methotrexate induces clinical and histologic remission in patients with refractory inflammatory bowel disease

STUDY OBJECTIVE: To determine whether methotrexate has anti-inflammatory activity in refractory inflammatory bowel disease. DESIGN: Nonrandomized, open-label, preliminary trial of methotrexate along with standard medications for 12 weeks. SETTING: Referral-based gastroenterology practice. PATIENTS: Twenty-one patients with refractory inflammatory bowel disease (14, Crohn disease; 7, chronic ulcerative colitis); 17 taking variable doses of corticosteroids and 14 on sulfasalazine or metronidazole. Of the 21 patients, 10 had previously failed azathioprine or 6-mercaptopurine trials. INTERVENTIONS: Sulfasalazine and metronidazole were continued and prednisone dose was tapered according to clinical response. Methotrexate was given as a 25-mg intramuscular injection weekly for 12 weeks, then switched to a tapering oral dose if a clinical and objective improvement was noted. MEASUREMENTS AND MAIN RESULTS: Sixteen of twenty-one patients (11 of 14 patients with Crohn disease, 5 of 7 patients with chronic ulcerative colitis) had an objective response as measured by disease activity indices (modified Crohn's Disease Activity Index, 13.3 to 5.4 [P = 0.0001], Ulcerative Colitis Activity Index, 13.3 to 6.3 [P = 0.007]). Prednisone dosage decreased from 21.4 mg +/- 5.6 (SEM) to 5.5 mg +/- 2.0; P = 0.006 and 38.6 mg +/- 6.35 to 12.9 mg +/- 3.4; P = 0.01, respectively. Five patients with Crohn colitis had colonoscopic healing and 4 had normal histology at 12 weeks. In contrast, none of the 7 patients with ulcerative colitis had normal flexible sigmoidoscopies, despite histologic improvement in 5. Side effects included mild rises in transaminase levels in 2 patients, transient leukopenia in 1, self-limited diarrhea and nausea in 2 patients, and 1 case each of brittle nails and atypical pneumonitis. CONCLUSIONS: Although this pilot study is encouraging, further work is needed before methotrexate can be recommended for inflammatory bowel disease.     

Communicating with patients with inflammatory bowel disease

Ulcerative colitis and Crohn's disease, the two main forms of inflammatory bowel disease (IBD), are chronic illnesses that affect hundreds of thousands of Americans. Patients with IBD suffer chronically from diarrhea, abdominal pain, gastrointestinal bleeding, malabsorption, and weight loss requiring continuous medical and surgical attention. Despite recent advances in therapy, IBD follows a course of exacerbations and remissions with approximately 25-50% of patients relapsing annually. Hence, these diseases are readily encountered in primary care and gastroenterology clinics. Though medical and surgical treatment options have improved significantly, little has been written about the psychosocial aspects of IBD. Currently, there is a paucity of data concerning effective communication methods enabling physicians to develop stronger rapport with patients suffering from IBD, the care of whom requires a multidisciplinary approach involving primary care physicians, gastroenterologists, and colorectal surgeons. Because IBD has a high morbidity, it is worthwhile to further investigate those social factors that will improve patients' quality of life. In this paper, we summarize some of the common problems that emerge when taking care of patients with IBD and provide initial guidelines based on the world literature regarding the management and education of patients with IBD. Both primary care physicians and specialists (gastroenterologists, colorectal surgeons) need to be aware of the questions and concerns of IBD patients and to be capable of dispensing the information in a clear and concise manner. Using the case scenario format, we review the most common aspects of communication for health care professionals taking care of IBD patients and suggest ways to establish and maintain long-term doctor-patient relationships. The two most significant interventions that dramatically improve quality of life and patient-physician relationships are proper patient education and appropriate treatment of concurrent depression and anxiety. We hope that our review will form a framework by which different members of the medical team learn their roles in the complex management decisions affecting IBD patients.