肠道菌群与溃疡性结肠炎

溃疡性结肠炎（Ulcerative Colitis,UC）的病因和发病机制目前尚不十分清楚,近来愈来愈多的研究认为免疫调节紊乱是关键的直接发病机制,肠道菌群是这种免疫损伤过程的重要激发因素。本文重点介绍肠道菌群在UC的变化以及益生菌在UC中的应用。     

四君子汤对溃疡性结肠炎大鼠肠道菌群调节作用研究

目的:探讨四君子汤对溃疡性结肠炎大鼠肠道菌群的调节作用。方法:制备溃疡性结肠炎大鼠模型,实验分为正常组、模型组、常乐康组和四君子汤组,分组给药7d,检测给药后大鼠肠道菌群的数量。结果:给药7d后,模型组与正常组相比较,模型组双歧杆菌及乳酸杆菌数量减少,肠杆菌及肠球菌数量上升,两者比较具有统计学差异(P0.05)。与模型组相比较,四君子汤组及常乐康组双歧杆菌、乳酸杆菌的数量上升,而肠杆菌及肠球菌数量下降,但四君子汤组较常乐康组作用更明显,且两者比较具有统计学差异(P0.05)。结论:四君子汤能有效调节溃疡性结肠炎大鼠肠道菌群。     

重度溃疡性结肠炎的综合治疗与护理

目的 探讨重度溃疡性结肠炎的综合治疗及护理方法。方法 对34例重度溃疡性结肠炎患者进行内科综合治疗后,加强各方面针对性护理措施,观察临床疗效。结果 34例重度溃疡性结肠炎患者均好转出院,无死亡病人,20例门诊随访,其中16例病情持续缓解。结论 重度溃疡性结肠炎患者在常规内科治疗的基础上加强各方面针对性护理措施,有利于保证治疗效果,改善患者预后。     

强的松与布地奈德治疗重度溃疡性结肠炎的临床疗效

目的比较强的松与布地奈德治疗重度溃疡性结肠炎的疗效。方法选择30例重度溃疡性结肠炎患者,随机分为两组：A组15例,采用强的松60 mg/d,顿服;B组15例,采用布地奈德2 mg加入100 ml生理盐水保留灌肠,1次/d。1周后对A、B两组Southerland评分进行比较。结果两组治疗前后Southerland评分比较差异均有统计学意义（P〈0.05）,治疗后两组比较差异无统计学意义（P〉0.05）。结论布地奈德保留灌肠治疗重度溃疡性结肠炎可以起到与强的松冲击治疗同样的效果。     

溃疡性结肠炎合并中毒性巨结肠1例报告并文献复习

目的：提高对溃疡性结肠炎及合并中毒性巨结肠的认识。方法：报告并分析1例诊断为溃疡性结肠炎及合并中毒性巨结肠的病例，并复习国内外相关文献。结果：引起中毒性巨结肠的原因很多，尽量减少可能的诱发因素，一旦出现病情进展和并发症，应积极治疗。结论：溃疡性结肠炎合并中毒性巨结肠患者病情凶险，死亡率高。     

中西医结合治疗重度溃疡性结肠炎

重度溃疡性结肠炎 (U C)病因不明 ,无理想药物 ,呈慢性病程 ,反复发作 ,重度急性期多伴有较严重的并发症 ,病情复杂 ,世界卫生组织将其列为现代难治性疾病之一。我们采用中西医结合的方法治疗重度 UC,报告如下。1　临床资料1 .1　 UC诊断标准 :1 )血性腹泻每日9次或以上 ;2体温 38℃或以上 ;3脉搏 90次 / m in以上、血红蛋白 <90 g/ L;5血浆白蛋白 30 g/ L 或更低 ;6血沉 >30 m m/ 1 h或 C反应蛋白明显升高 ;7明显消瘦 ,近期体重下降 1 0 %以上或伴有较严重的中毒症状。符合以上7条中至少 3条者入选。1 .2　病例 :1 997年 1月— 2 0 0 2…     

基于溃疡性结肠炎与肠道菌群关系的中医药研究

以溃疡性结肠炎与肠道菌群的关系为切入点,通过运用与分析中医学与微生态学的相通之处,探讨中医药调节肠道菌群以及与其防治溃疡性结肠炎的相关性,为中医药治疗溃疡性结肠炎及其对肠道菌群的影响提供理论依据。     

重度溃疡性结肠炎的护理体会

溃疡性结肠炎(UC)是一种病因尚不十分清楚的直肠和结肠慢性非特异性炎症性肠病,临床表现为腹泻、粘液脓血便、腹痛等,多呈反复发作的慢性病程,据报道,UC的发病率逐步上升.作者统计发现,近几年来人住南京医科大学第一附属医院消化科的UC患者,不仅呈现出人数递增的趋势,也出现病情加重、症状复杂的趋势,因此     

原发性硬化性胆管炎合并溃疡性结肠炎并发结肠癌误诊一例并文献复习

目的探讨溃疡性结肠炎(UC)复杂的临床表现,探讨原发性胆汁性肝硬化(PBC)发展为原发性硬化性胆管炎(PSC)的可能。方法详细阐述1例41岁中年女性PSC合并UC患者的临床表现、诊断和治疗。并复习相关文献,分析PBC发展为PSC的可能。结果本例患者10年前肝脏穿刺诊断为PBC,7年前肠镜检查诊断为UC,因出现直肠阴道瘘,通过相关检查诊断为PSC,通过手术探查,确诊并发结肠癌。文献复习提示PSC易合并UC同时存在,而且,随着UC病程的延长,患者容易并发结直肠癌。结论对UC患者进行结肠镜的定期检查能及早发现结直肠癌,并延长生存期,如果UC患者合并PSC,肠黏膜异型增生及癌变的可能性更大。     

婴儿溃疡性结肠炎1例

溃疡性结肠炎在欧美国家发病率较高,近 10年来,东南亚地区包括我国的发病率呈明显上升趋势,特别是小儿溃疡性结肠炎多呈急骤起病,作者对 1例婴儿溃疡性结肠炎诊治分析如下.     

粪菌移植在溃疡性结肠炎治疗中的临床应用

粪菌移植最早起源于2700年前春秋战国时期,但用于溃疡性结肠炎的治疗目前仍处于起步阶段。其移植流程主要包括供体的选择、菌液制备及粪菌液的导入等。该治疗方式无严重不良反应,相对安全。关于其有效性各研究结论不一,可能与适应证的选择、供体的选择、移植流程等缺乏统一的标准有关。     

Fecal transplantation for ulcerative colitis: current evidence and future applications

ABSTRACT

Introduction: Established evidence suggests that gut microbiota plays a role in ulcerative colitis (UC). Fecal microbiota transplantation (FMT) is clearly recognized as a highly effective treatment for patients with recurrent Clostridium difficile infection and has been investigated also in patients with UC, with promising results.

Areas covered: Literature review was performed to select publications concerning current evidence on the role of gut microbiota in the pathogenesis of UC, and on the effectiveness of FMT in this disorder.

Expert opinion: The randomized controlled trials published investigating the use of FMT suggested a potential role for FMT in the treatment of mild to moderate UC. However, given several unanswered questions regarding donor selection, dose, route of administration and duration of therapy, this is not yet recommended as a viable therapy option. FMT has allowed for more in depth investigation with regards to the role the gut microbiota may be playing in UC. This knowledge is critical to identifying where FMT may appropriately fit in the UC treatment paradigm. As our understanding of the role the microbiome plays in this chronic disease, FMT, and then eventually defined microbes, will hopefully serve in a complementary role to conventional IBD therapies.     

Fecal microbiota transplantation for treatment of patients with recurrent Clostridioides difficile infection

ABSTRACT

Introduction

Recurrent Clostridiodes difficile infection (rCDI) is a growing public health burden, and is associated with poor patient outcomes. Fecal microbiota transplantation (FMT) is a novel therapy with an aim to restore the disrupted microbiota with demonstrated success in the management of rCDI and a favorable safety profile.     

Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level: A case report

BACKGROUNDAcute severe ulcerative colitis (ASUC) is a complication of ulcerative colitis associated with high levels of circulating tumor necrosis factor alpha, due to the intense inflammation and faster stool clearance of anti-tumor necrosis factor drugs. Dose-intensified infliximab treatment can be beneficial and is associated with lower rates of colectomy. The aim of the study was to present a case of a patient with ASUC and megacolon, treated with hydrocortisone and accelerated scheme of infliximab that was monitored by drug trough level.CASE SUMMARYA 22-year-old female patient diagnosed with ulcerative colitis, presented with diarrhea, rectal bleeding, abdominal pain, vomiting, and distended abdomen. During investigation, a positive toxin for Clostridium difficile and colonic dilatation of 7 cm consistent with megacolon were observed. She was treated with oral vancomycin for pseudomembranous colitis and intravenous hydrocortisone for severe colitis, which led to the resolution of megacolon. Due to the persistent severe colitis symptoms, infliximab 5 mg/kg was prescribed, monitored by drug trough level (8.8 μg/mL) and fecal calprotectin of 921 μg/g (< 30 μg/g). Based on the low infliximab trough level after one week from the first infliximab dose, the patient received a second infusion at week 1, consistent with the accelerated regimen (infusions at weeks 0, 1, 2 and 6). We achieved a positive clinical and endoscopic response after 6 mo of therapy, without the need for a colectomy.CONCLUSIONInfliximab accelerated infusions can be beneficial in ASUC unresponsive to the treatment with intravenous corticosteroids. Longitudinal studies are necessary to define the best therapeutic drug monitoring and treatment regimen for these patients.     

溃疡性结肠炎首次拟行粪微生态移植术患者的健康需求

目的了解首次拟行粪微生态移植术(fecal microbiota transplantation,FMT)的溃疡性结肠炎(ulcerative colitis,UC)住院患者对健康教育的需求,以便采用更合理的教育方式。方法 2015年5月至2016年10月,便利抽样法选取在解放军总医院消化内科首次拟行FMT的UC住院患者62例为研究对象,采用自行设计问卷对其进行疾病相关知识的认知状况和健康教育需求调查。结果本组患者对疾病相关知识普遍缺乏了解,72.58%~80.64%的患者对药物治疗、饮食治疗、诱因、并发症不了解,87.10%~96.77%的患者对治疗的不良反应、术后注意事项及治疗效果不了解。91.94%~100.00%的患者强烈需求用药常识、饮食护理、心理指导、FMT不良反应、FMT术后注意事项及FMT的效果等方面的健康教育;82.26%~87.10%的患者强烈需求出院指导、FMT的目的等方面的健康教育。患者选择最多的健康教育方式是床旁个体指导,共54例,占87.10%;而患者对健康教育实施者的选择显示,选择医护合作的53例,占85.48%。结论根据首次拟行FMT的UC患者对相关知识的认知和健康教育需求的情况,给予针对性的健康教育,可确保健康教育工作获得最佳效果。     

Once-daily mesalamine granules for maintaining remission of ulcerative colitis: pooled analysis of efficacy,safety, and prognostic factors

Objectives: A capsule formulation of mesalamine granules (MG) was developed for once-daily dosing and better compliance. The study aim was to evaluate MG efficacy and tolerability in maintaining ulcerative colitis (UC) remission.

Methods: Pooled analysis of 2 identical phase 3, randomized, double-blind trials of once-daily MG 1.5 g or placebo for up to 6 months. The primary endpoint was percentage of patients remaining relapse-free at month 6 versus placebo. Relapse was defined as revised Sutherland Disease Activity Index (SDAI) rectal bleeding score ≥1 and mucosal appearance score ≥2, UC flare, or UC–related adverse event (AE).

Results: Data were pooled for patients receiving MG (n = 373) and placebo (n = 189). Significantly more patients were relapse-free at 6 months with MG (79.4%) than placebo (62.4%; P < 0.001) and across subgroups based on select demographic and baseline characteristics (P < 0.05). Secondary outcome measures including rectal bleeding, physician rating of disease activity, stool frequency, total SDAI score, and relapse-free duration favored MG (P < 0.01). Common AEs with MG and placebo, respectively, were headache (10.9% and 7.6%), diarrhea (7.9% and 7.0%), and abdominal pain (6.3% and 6.5%).

Conclusion: Once-daily MG was more efficacious than and as well tolerated as placebo in maintaining UC remission. ClinicalTrials.gov identifiers: NCT00744016 and NCT00767728.