介入治疗溃疡性结肠炎的临床观察

目的：观察介入疗法治疗溃疡性结肠炎的临床疗效。方法：溃疡性结肠炎患者52例，分为两组。介入组32例，常规美沙拉嗪治疗基础上行介入治疗，经肠系膜上、下动脉药物灌注治疗；对照组20例，常规美沙拉嗪治疗。观察其临床症状和结肠镜下病变改善情况。结果：治疗后两组症状均有明显的改善（P〈0．05），且介入组患者治疗后1d，排便次数即明显减少，随访4～8周观察各项临床症状改善情况均较对照组治疗效果明显。介入组结肠镜下病变明显改善，且优于对照组；其治疗后的完全缓解率和总有效率也高于对照组。结论：肠系膜上、下动脉药物灌注是一种溃疡性结肠炎切实有效的治疗方法．     

姜连清肠煎治疗慢性溃疡性结肠炎42例

[目的]探讨姜连清肠煎在治疗慢性溃疡性结肠炎中的疗效。[方法]采用姜连清肠煎对42例慢性溃疡性结肠炎患者进行临床观察。[结果]治愈16例,好转24例,无效2例,总有效率95.2%。[结论]本病多病程长,本虚标实多见。姜连清肠煎采取标本同治,故有较好疗效。     

美沙拉嗪口服联合灌肠治疗溃疡性结肠炎剂量选择

目的在控制美沙拉嗪总给药量不变的情况下通过改变口服和灌肠联合用药的剂量来选择治疗溃疡性结肠炎的最佳给药剂量。方法120例活动期溃疡性结肠炎患者随机分为A、B、C3组,各40例。每组分别给予不同剂量的口服美沙拉嗪缓释片(艾迪莎)和美沙拉嗪灌肠剂(莎尔福灌肠剂)。比较治疗8周后3组患者的疗效和不良反应发生率。结果治疗8周后,3组患者的疗效间差别有统计学意义(P<0.01);且3组患者疗效间两两比较,差别均有统计学意义(P<0.01)。3组患者不良反应发生率间差别无统计学意义(P>0.05)。结论小剂量多次联合给药可以增加药物的治疗效果。在总用药量不变的情况下,最佳的治疗剂量为口服美沙拉嗪缓释片1g,4次/d,灌肠1g/100ml,2次/d,联合治疗不少于8周。     

血清C反应蛋白和D-二聚体联合检测在溃疡性结肠炎病情活动性判断中的价值

目的通过检测溃疡性结肠炎(UC)患者的血清C反应蛋白(CRP)及D-二聚体水平,探讨二者在UC患者病情活动及严重程度判断中的应用价值。方法分别采用胶乳增强免疫比浊法与免疫扩散比浊法检测64例活动期UC患者、45例缓解期UC患者及40例健康对照者血清CRP及D-二聚体水平,并对活动期患者行肠镜及病理组织学检查,评价病情程度。结果(1)活动期UC组患者血清CRP及D-二聚体水平与缓解期UC组及对照组比较,差异均有统计学意义(P<0.01);缓解期UC组CRP水平与对照组比较,差异有统计学意义(P<0.05),而D-二聚体水平与对照组比较,差异无统计学意义(P>0.05)。(2)重型UC患者血清CPR及D-二聚体水平与轻、中型患者比较,差异有统计学意义(P<0.05)。结论血清CRP及D-二聚体水平可作为评价UC患者病情活动性及严重程度的良好指标。     

Perception and clinical decisions from inflammatory bowel diseases’ specialists towards positioning of new therapies in Crohn's disease and ulcerative colitis: A national web-based survey from the Brazilian IBD study group (GEDIIB)

BackgroundIn the last decade, new therapies with different mechanisms of action have been approved for the treatment of moderate to severe Crohn's disease (CD) and ulcerative colitis (UC). Due to the lack of comparative head-to-head trials, the ideal positioning of agents as the most appropriate first- or second-line therapies remains to be defined.ObjectiveThis survey aimed to evaluate the perception and decisions of Brazilian Inflammatory Bowel Diseases (IBD) specialists in positioning of new therapies (vedolizumab [VEDO], ustekinumab [UST] and tofacitinib [TOFA]) in the management of IBD in different clinical scenarios.MethodologyAn anonymous national web-based questionnaire was used to determine the positioning of treatment options in different clinical scenarios (using Google Forms platform), which involved different age ranges, phenotypes, clinical situations and previous exposure to anti-TNF agents (14 scenarios for CD and 10 scenarios for UC). In CD, physicians could choose between UST or VEDO, whilst in UC, between UST, VEDO or TOFA. Six reasons for the specific choice were proposed, such as mechanism of action, safety, method of administration or onset of action. Statistical analysis was carried out with chi-square and t-tests.ResultsA total of 150 out of 672 GEDIIB IBD specialists (22.32%) responded to the survey. In CD scenarios, UST was the most dominant choice (11/14 scenarios), with VEDO dominating only 3 clinical situations. In UC scenarios, VEDO was the dominant choice (8/10), with UST being chosen for scenarios that included extraintestinal manifestations. Among the reasons for specific choices, the most commonly chosen were the higher efficacy due to the intrinsic mechanism of action and safety profile.ConclusionsUST was the dominant choice as compared to VEDO in CD in most scenarios, especially due to its mechanism of action and safety. VEDO was the dominant choice as compared to UST and TOFA in UC scenarios, mainly for reasons also related to its mechanism of action and safety profile. Comparative studies including patient outcomes are needed to better define the positioning of new IBD therapeutic options in our country.