阿米巴肠病引发溃疡性结肠炎的频率探讨

国内对阿米巴肠病引发溃疡性结肠炎的频率报道尚未见报。阿米巴肠病是由致病性溶组织内阿米巴寄生于人结肠而引起的特异性结肠炎,在我院近3年多来14 6例诊断阿米巴肠病的患者中有33例同时患有溃疡性结肠炎,与同期诊断无阿米巴肠病的溃疡性结肠炎2 5例进行对比研究,旨在探讨阿米巴肠病引发溃疡性结肠炎的频率及临床特性。1　材料与方法1 1　研究对象　选择2 0 0 0年3月～2 0 0 3年11月消化内科病房及门诊,粪便检出溶组织内阿米巴滋养体并诊断阿米巴肠病患者14 6例中有33例阿米巴肠病经抗阿米巴规则治疗后阿米巴滋养体消失,但症状反复经电子肠…     

溃疡性结肠炎合并肠阿米巴病一例

本研究报道1例溃疡性结肠炎合并肠阿米巴病的病例。患者因腹痛伴黏液血便入院诊治,粪便涂片检查发现可疑阿米巴滋养体,血清学和核酸诊断结果提示溶组织内阿米巴感染,结肠镜和病理检查发现患者合并溃疡性结肠炎。经抗阿米巴和抗炎治疗,患者病情好转。本病例提示临床上遇到黏液血便诊断炎症性肠病的患者,如果抗炎辅以常规抗感染治疗效果不佳,...     

溃疡性结肠炎合并阿米巴感染的诊断及药物疗法应用研究进展

溃疡性结肠炎主要结合患者临床表现、内镜表现以及病理组织学特点进行综合诊断，是一种排除性诊断，但误诊率仍高，主要与各种急性感染性肠炎、单纯阿米巴肠病、克罗恩病等肠道炎性疾病进行鉴别。溃疡性结肠炎合并阿米巴感染的诊断通常在诊断为溃疡性结肠炎后，筛查阿米巴感染情况。筛查阿米巴感染方法有病理组织学检查、粪便相关检查（包括粪便镜检、粪便培养、粪便中检测阿米巴抗原）、血清学检查以及PCR诊断技术等；粪便镜检是溃疡性结肠炎患者最为广泛使用的筛查阿米巴感染方法，但其灵敏度及特异度均较低。阿米巴感染最常见的治疗药物为甲硝唑、替硝唑等硝基咪唑类药物，治愈率可达到90%以上；帕罗霉素等肠腔内药物治疗阿米巴疗效差；其他治疗方法包括5-氨基水杨酸制剂、激素、免疫抑制剂和（或）生物制剂等药物，容易导致机会感染。     

Retrospective study of 404 cases of patients with ulcerative colitis in Zhongnan Hospital of Wuhan university

目的 调查近20年来我院溃疡性结肠炎(UC)住院患者的患病情况和临床病理变化,探讨溃疡性结肠炎的发病情况和临床特征.方法 收集近20年我院确诊为溃疡性结肠炎患者的临床资料,统计患病情况、临床特征、内镜及病理特点、治疗情况、病程与预后.结果 近20年我院溃疡性结肠炎患者明显增多,并呈逐渐上升趋势.404例患者中,男女比例1.23∶1,年龄6～84岁,平均年龄(42.7±14.8)岁,平均病程3.4年.溃疡性结肠炎主要临床表现为血便(80.2％)、腹泻(74.O％).肠外表现17例(4.2％),并发症19例(4.7％).病变以慢性复发型(62.1％)为主,轻、中度病变多见(85.9％),部位以左半结肠为主(68.3％).93.8％的溃疡性结肠炎患者经氨基水杨酸类药物和糖皮质激素治疗有效,手术患者14例(3.5％),死亡1例.结论 近20年来我院溃疡性结肠炎患者患病呈上升趋势,患者年龄偏大,病情较轻,病程较短,肠外表现和并发症少,手术病例少,死亡率低,内科治疗预后较好.     

未确定型结肠炎的特征分析

目的通过对未确定型结肠炎（indeterminate colitis，IC）患者的临床特点的分析，加深对该型结肠炎的认识。方法对2000年1月至2005年3月期间住院病历中符合炎症性肠病的217例患者的特点进行回顾性分析。结果未确定型结肠炎22例（10．2％），首发症状为腹泻54．5％，血便54．5％，腹痛31．8％，发热27．3％，有肠外表现59．1％，全结肠病变63．6％，回肠病变36．4％，节段型22．7％，直肠赦免50％，使用免疫抑制剂18．2％，手术31．8％。克罗恩病共60例，首发症状为腹痛76．7％，腹泻33．3％，发热25．0％，血便8．3％，有肠外表现38．3％，全结肠病变18．3％，节段型81．7％，回肠病变58．3％，使用免疫抑制剂11．7％，手术88．3％。溃疡性结肠炎135例，首发症状为脓血便78．5％，腹泻54．8％，腹痛29．6％，发热3．7％，有肠外表现18．5％，全结肠病变56．3％，节段型2．2％，回肠病变3．7％，使用免疫抑制剂的12．6％，手术6．7％。结论与克罗恩病及溃疡性结肠炎相比较，未确定型结肠炎有一些自己的特点，有可能是一个独立病变。     

NOD2/CARD15基因多态性与炎症性肠病遗传易感性关系分析

目的 研究NOD2/CARD15基因与我国汉族人群炎症性肠病遗传易感性的关系.方法 应用聚合酶链反应-序列特异性引物方法对45例克罗恩病NOD2/CARD15基因野生型和C2104T(4外显子处)、G2722C(8外显子处)和3020insC(11外显子处)三个主要碱基突变进行基因分型并测序.另对60例溃疡性结肠炎患者、50名健康献血者、2例克罗恩病患者的21名家系成员、3例溃疡性结肠炎患者的31名家系成员也进行了NOD2/CARD15基因多态性分析.结果 全部被调查人群中均未发现有NOD2/CARD15基因突变者,均携带野生型NOD2/CARD15基因.结论 在西方国家中与克罗恩病显著相关的NOD2/CARD15基因突变与我国汉族炎症性肠病人群无明显相关性,该基因可能不是我国汉族炎症性肠病人群的致病基因.     

自身免疫性胆管炎合并溃疡性结肠炎1例

自身免疫性胆管炎合并炎症性肠病临床上较罕见.本文报道的1例自身免疫性胆管炎合并溃疡性结肠炎患者以尿黄伴皮肤瘙痒为首发症状,经实验室检查及肝穿刺活检诊断为自身免疫性胆管炎.随诊2年后出现腹泻,经肠镜病理活检确诊合并溃疡性结肠炎.本例无典型的溃疡性结肠炎的临床表现,便常规、肠镜及病理检查提高了诊断率.     

人芽囊原虫在腹泻患者中的感染状况及繁殖方式

目的观察人芽囊原虫在腹泻患者中的感染状况及繁殖方式，为进一步研究其生理生化特性及致病机理奠定基础。方法调查腹泻患者临床表现；用生理盐水涂片、碘液染色和铁苏木素染色法在光镜下观察其在粪便标本和培养物及动物模型肠内容物中形态、结构及繁殖方式。结果健康人群和腹泻人群粪便标本中人芽囊原虫检出率分别为0．94％(2／213)和24．73％(46／186)；人芽囊原虫与其它肠道寄生原虫有合并感染；有二分裂、内二芽生殖和裂体增殖3种繁殖方式。结论人芽囊原虫在腹泻患者中有较高的感染率；易与结肠内阿米巴和其他非致病阿米巴合并感染；以3种无性生殖方式繁殖。     

阿米巴肠病和内镜活检及涂片诊断的探讨

我院1986年1月～1991年1月检查纤维结肠镜5234例,经活检及活检组织涂片检出阿米巴肠病66例,检出率为1.3％。儿童阿米巴病并不少见,占16.7％。通过内镜检查,病变主要累及直肠与乙状结肠,占58.5％。这与以前国内文献的报告不一致。本文对阿米巴肠病的诊断及误诊原因进行了探讨。我们认为结肠镜联合应用活检及活检涂片对阿米巴肠病是最有效的诊断手段。     

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炎症性肠病(inflammatory bowel diseases,IBD)是一组病因不明的慢性肠道炎症性疾病,包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn's disease,CD).前者又称非特异性溃疡性结肠炎,是一种原因不明的直肠和结肠炎症,病变主要限于大肠黏膜与黏膜下层.临床主要表现为腹泻、腹痛和黏液脓血便,多呈反复发作慢性过程.后者为一种慢性肉芽肿性炎症,病变可累及胃肠道各部位,而以末段回肠及其邻近结肠为主,多呈节段性、非对称性分布.临床主要表现为腹痛、腹泻、瘘管、肛门及肛周病变和不同程度的肠外表现.     

Perforation of the colon in unsuspected amebic colitis: Report of two cases

Two cases of amebic colitis that resulted in perforation of the colon, an ominous complication, are presented. The first was diagnosed preoperatively as acute ulcerative colitis with toxic megacolon, and the second as peritonitis complicating acute cholecystitis. In both instances the correct diagnosis was made after operation. The first patient recovered after colectomy and antiamebic therapy, but the second patient died in the early postoperative period, in septic shock. Amebic colitis occurs infrequently in the United States, and the diagnosis is rarely considered. In most cases an initial diagnosis of ulcerative or granulomatous colitis is made and the true diagnosis is recognized only after operation for colonic perforation or hepatic abscess. It is suggested that amebic colitis should be considered more frequently in cases of patients who have diarrhea. Stool examination for ova and parasites is often negative in amebic colitis. The IHA is usually positive in emebiasis, and should be performed early in casesof patients who have bloody diarrhea or other clinical symptons when amebiasis is suspected. Rectal biopsy is also a useful diagnostic approach, but failed to reveal amebae in one of our cases. Finally, it is suggested that operation be performed urgently when fulminating amebic colitis is not reversed by antiamebic therapy, when peritonitis occurs even with antiamebic treatment in progess, and for colonic perforation or toxic megacolon even when antiamebic therapy has not been indicated.     

Perianal skin amebiases

Summary and Conclusions Seven patients with perianal skin amebiasis are discussed; six were men and one was a woman. The ages varied from 28 to 48 years. Grossly, lesions vary from a single ulcer to a massive, fungous, ulcerative lesion; often it may be confused with a simple anal ulcer, lymphogranuloma venereum, condyloma, cancer and other benign anal lesions. Biopsy or scraps of the lesion revealE. histolytica in its trophozoite form. A combination of emetine and other amebicides is the treatment of choice. If untreated, the lesion will grow rapidly and may kill the patient. This happened to one of my patients. In all my cases, the skin infection was due to a previous amebic colitis. Incomplete treatment for amebiasis of the colon may lead to a perianal skin amebiasis. Constipation may be the only symptom. Perianal skin amebiasis is a rare complication of amebic colitis. Read at the meeting of the American Proctologic Society, Minneapolis, Minnesota, June 14 to 16, 1965.     

Metronidazole and amebiasis

Previous reports indicate that metronidazole is highly effective in the therapy of colonic amebiasis and in the treatment of hepatic amebic abscesses when combined with aspiration. A retrospective review of 15 cases of intestinal amebiasis and 12 patients with amebic liver abscesses treated with metronidazole alone is reported. Based on the literature and the clinical response of the patients reported herein, metronidazole is the initial drug of choice in the therapy of amebic colitis because of its ease of administration, efficacy, and low toxicity. In the treatment of hepatic amebic abscesses, metronidazole alone is adequate therapy for most cases, but occasionally there will be progression of the disease despite standard dosages of the drug.     

When should we look for amebae in patients with inflammatory bowel disease?

Amebic colitis can mimick Crohn's disease of the colon and ulcerative colitis. Inflammatory bowel disease (IBD) patients can also be carriers of amebae. Since steroids can provoke amebic activity and even cause a fulminating colitis, it is necessary to determine that amebae do or do not exist. Furthermore, amebae can be easily eliminated by drug therapy but it is hard to eradicate IBD. Despite the above, diagnostic modalities for IBD are as effective as those for amebiasis, particularly for Crohn's disease with ileal involvement. Problems in differential diagnosis arise with IBD grossly limited to the colon. In these cases, false negative stool studies are increased by diarrhea and preparation for examinations, and both stool studies and serologies are compromised by steroids. If the clinical course of IBD is downhill, the clinician is justified in starting steroids even if evaluation for amebiasis incomplete. If, however, the index of suspicion is high, concomitant treatment with Metronidazole would be reasonable.     

Combination Therapy for Intestinal Amebiasis Using an Anti-amebic Drug and Total Parenteral Nutrition —Report of Two Cases—

Abstract: In this study we report on two cases of amebic colitis treated in our hospital. On admission both patients were in a severe state of malnutrition due to intermittent diarrhea which had continued for one month. Both patients suffered from amebic colitis presumably transmitted by homosexual intercourse. A definite diagnosis of amebic colitis was made from both fecal examination and colonoscopic biopsy. After the diagnosis was made, the patients were treated with metronidazole. This medication can eliminate Entamoeba histolytica, although it was insufficient for the treatment of the patients’malnutrition. Therefore we used total parenteral nutrition to treat their malnutrition. It was successful and resulted in their recovery and discharge. These two cases indicate that total parenteral nutrition therapy is useful for supporting the recovery of patients with amebiasis.     

The prevalence of invasive amebiasis is not increased in patients with AIDS.

OBJECTIVE: To determine whether the frequency or severity of invasive amebiasis is increased in patients with AIDS. DESIGN: A case-control sampling approach, based on an autopsy registry. SETTING: General Hospital of Mexico City, Mexico, a large government-supported, tertiary care medical institution. PATIENTS, PARTICIPANTS: Ninety-four patients with AIDS and 335 historical and contemporary, age- and sex-matched controls who were defined as dying, but not because of AIDS. RESULTS: The odds ratio (OR) for mortality from invasive amebiasis was the same for cases and controls (0.7; 95% confidence interval, 0.07-7.2). By contrast, the OR for other diseases, such as miliary tuberculosis, cytomegalovirus infection, Pneumocystis carinii pneumonia and toxoplasmosis was greatly increased. Only one patient with AIDS had amebiasis of the common amebic ulcerative colitis type, without extraintestinal involvement. CONCLUSION: In conclusion, we show that the frequency and severity of invasive amebiasis is not increased in Mexican patients with AIDS.     

不同剂量双歧杆菌四联活菌片对轻、中度活动期溃疡性结肠炎患者肠道菌群失调的影响

目的研究不同剂量双歧杆菌四联活菌片对轻、中度活动期溃疡性结肠炎患者肠道菌群失调的影响。 方法采用前瞻性、随机、开放、对照研究的试验方法，选择2018年6月至2022年2月山东中医药大学第二附属医院消化中心就诊，明确诊断为伴有Ⅱ度肠道菌群失调的溃疡性结肠炎患者，随机分为A、B两组，A组应用常规剂量双歧杆菌四联活菌片联合美沙拉嗪治疗，B组应用双倍剂量双歧杆菌四联活菌片联合美沙拉嗪疗，主要观察终点为治疗4周后2组肠道菌群失调变化，次要观察终点为治疗4周后2组腹泻症状缓解情况、临床总疗效、内镜下黏膜愈合率及不良反应。 结果66例患者纳入研究，直肠炎22例，左半结肠炎有44例，轻度27例，中度39例，两组患者基线期临床特征基本相似。主要观察终点肠道菌群失调改善情况：B组(正常菌群25例，Ⅰ度菌群失调6例，Ⅱ度菌群失调2例)显著优于A组(正常菌群16例，Ⅰ度菌群失调12例，Ⅱ度菌群失调5例，P<0.05)。次要观察终点：腹泻症状缓解情况，与A组比较，B组患者腹泻症状恢复正常时间[(7.5±4.9)d比(11.8±4.8)d]及黏液脓血便消失时间[(8.8±5.8)d比(13.3±4.7)d]明显缩短(P<0.05)。临床总疗效：B组(临床缓解25例，临床应答6例，无效2例)显著优于A组(临床缓解16例，临床应答12例，无效5例，P<0.05)。内镜下黏膜愈合率：A组48.6%，B组76.7%(P<0.05)。不良反应：A组上腹部不适、大便次数增多1例，B组胃灼热、肠鸣音亢进1例，未见其他不良反应。两组肝肾功能正常。 结论双倍剂量的双歧杆菌四联活菌片治疗4周对轻、中度活动期溃疡性结肠炎肠道菌群失调的改善情况优于常规剂量双歧杆菌四联活菌片。     

The differential diagnosis of intestinal amebiasis

Differential diagnosis of intestinal amebiasis (106 patients), acute Flexner's dysentery (105 patients) and nonspecific ulcerative colitis (31 patients) based on the clinical data and rectoromanoscopic findings is described. Rapidly and gradually progressing in the first 7 days intestinal amebiasis is characterized by a gradual onset, normal t0 with mounting general weakness, celiectasia, diarrhea with hyaloid mucus, focal catarrh-hemorrhagic changes and appearance of individual oval transversal ulcers on the colon mucosa.     

Sweet's syndrome--an extraintestinal manifestation in inflammatory bowel disease

BACKGROUND/AIMS: Sweet's syndrome (SS) is a severe dermatosis that may be an extraintestinal manifestation of inflammatory bowel disease (IBD). Worldwide, 35 cases of SS associated with IBD have been reported. We present the first case of severe, recurrent SS in combination with amebic infection and ulcerative colitis complicated with multiple other extraintestinal manifestations. METHODS: Disease course was monitored by serum YKL-40 and C-reactive protein (CRP), white blood cell count, albumin and the Simple Clinical Colitis Activity Index (SSCAI). The amebic infection was diagnosed by direct microscopy of wet mount scrapings sampled by repetitive sigmoidoscopies. RESULTS: The patient was diagnosed with left-sided ulcerative colitis and SS combined with extraintestinal manifestations: arthropathies, iridocyclitis and erythema nodosum. Cysts of Entamoeba histolytica were detected in the stools in two separate periods of time. Serum YKL-40 increased prior to CRP and correlated with disease activity, SCCAI, CRP, white blood cell count and inversely with serum albumin. CONCLUSION: This case gives further support for SS being an extraintestinal manifestation of ulcerative colitis. YKL-40 may be useful in monitoring the disease course of IBD.     

Prevalence and Importance of Amebic Infestation in Patients with Ulcerative Colitis in Two Regions in Turkey

We investigated the prevalence of amebiasis in patients with ulcerative colitis residing in two geographical regions with different socioeconomic status and climatic conditions, and its effect on the age of onset, duration, localization, and activity of disease. Ninety patients from a high socioeconomic location (group I) and 28 cases from a low socioeconomic location (group II) were enrolled. Median age at disease onset was significantly higher in group I compared with in group II. Prevalence of amebiasis in group I was significantly lower than in group II. A considerably number of patients with amebiasis in group I had a history of travel to the cities with a lower socioeconomic level, mainly located in the east of Turkey. There was a strong relationship between presence of amebiasis and history of travel to eastern parts of Turkey among residents from the northwestern part of Turkey. Median age and age at time of diagnosis were significantly lower in patients with amebiasis compared with those without infection. In patients with mild disease activity, prevalence of amebiasis was significantly lower compared with those with moderate or severe disease activity. In conclusion, prevalence of amebiasis was markedly higher in the southeast compared to the northwest of Turkey. Travel to regions with low socioeconomic status may be considered a risk factor for amebiasis in patients with ulcerative colitis. Amebiasis enhances disease activity in ulcerative colitis.