IL-23／IL-17炎症轴在溃疡性结肠炎中的作用

目的探讨IL-23／IL-17炎症轴在溃疡性结肠炎（UC）中的变化及意义。方法按照2007年济南标准选择UC组患者20例,对照组16例。利用细胞内细胞因子染色和四色荧光抗体流式细胞术对肠黏膜固有层单个核细胞作表型分析,比较Th1、Th2、Th17比例的改变。Westernblot检测肠黏膜IL-17、IL-23表达。数据以中位数和四分位间距即M（QR）形式表示,行相关统计。结果（1）肠黏膜中Th17的比例在UC组中较对照组明显增加（P〈0．05）,为3．75％比1．25％,且重度活动较轻度活动患者增加明显（P〈0．05）,为8．30％比1．20％。肠黏膜中Th1的比例在UC组和对照组中分别为13．60％和9．10％,Th2的比例在UC和对照组中分别为1．10％和1．15％,差异均无统计学意义（P〉0．05）,不同活动度患者间差异亦无统计学意义（P〉0．05）。（2）UC组患者肠黏膜中IL-17表达较对照组明显升高（P〈0．05）,为0．20％比0．10％,且IL-17表达与UC患者疾病评分呈正相关（r=0．50,P=0．02）。（3）IL-23表达在UC组和对照组分别是0．13％和0．07％,差异有统计学意义（P〈0．05）。结论IL-23／IL-17炎症轴在溃疡性结肠炎的发病中具有重要作用,它可能成为UC治疗的有效靶点。     

原发性硬化性胆管炎27例临床病理特点分析

目的 总结原发性硬化性胆管炎(PSC)的临床病理特点,提高临床医师对该病的认识.方法 回顾性分析27例PSC患者的临床资料并随访患者当前情况.临床资料主要包括各项肝功能指标、自身抗体及免疫球蛋白,影像学及病理学检查结果将PSC患者分为大胆管型或小胆管型;治疗措施包括药物、内镜及手术治疗,治疗3～6个月后,ALT≤1.5倍、Tbil≤2倍、ALP≤2.5倍正常上限为有效.大胆管型PSC与小胆管型PSC的疗效比较采用非参数检验CMH法,P＜0.05为差异有统计学意义.结果 27例PSC患者中,男性7例,女性20例,平均年龄47.6岁.大胆管型PSC 18例,小胆管型PSC 9例.主要临床表现为黄疸(85.2%)、瘙痒(48.1%)、乏力(68.4%)、腹痛(40.7%)及发热(14.8%);常见体征包括:肝大(44.4%)、脾大(48.1%)、腹水(14.8%)等;胆红素升高10倍以上者占30.8%,IgG异常率81.8%、抗核抗体阳性率69.6%、抗中性粒细胞胞浆抗体阳性率52.9%;合并溃疡性结肠炎者占22.2%,干燥综合征患者占22.2%.经药物、内镜或手术治疗后,部分病例病情缓解,3例死亡;小胆管型PSC的疗效优于大胆管型PSC(66.7%比33.3%,x2=4.173,P=0.041).结论 本组少数PSC患者合并溃疡性结肠炎.小胆管型PSC治疗效果优于大胆管型PSC,提示早期诊治的必要性.     

C反应蛋白检测对溃疡性结肠炎活动性的评价

目的探讨12反应蛋白（CRP）检测对溃疡性结肠炎活动性的评估价值。方法分析41例活动期和17例缓解期溃疡性结肠炎患者血清CRP,比较临床病情程度对CRP的影响。结果活动性UC患者的血清CRP水平为（8．58±2．43）mg／L,其中重度UC患者CRP水平为（14．38±4．46）mg／L,中度UC患者CRP水平为（6．68±2．35）mg／L,轻度UC患者CRP水平为（4．94±1．21）mg／L,而缓解期UC患者CRP水平为（3．05±0．88）mg／L。活动期溃疡性结肠炎患者血清CRP表达率明显高于缓解期患者,差异有统计学意义（x^2=18．72,P〈0．05）;重型溃疡性结肠炎患者血清CRP表达率高于中型溃疡性结肠炎患者,差异有统计学意义（P〈0．05）;中型溃疡性结肠炎患者血清CRP表达率亦高于轻型溃疡性结肠炎患者,差异有统计学意义（x^2=8．16,P〈0．05）。结论CRP水平升高能反映活动期溃疡性结肠炎患者临床病情严重程度,为临床诊治提供重要理论依据。     

细胞毒性T淋巴细胞相关抗原4启动子区-1722基因多态性与溃疡性结肠炎的相关性研究

目的:探讨CTLA4基因启动子区-1722 T/C(rs733618)多态性与中国湖北汉族人群溃疡性结肠炎(UC)的相关性。方法:采用PCR-限制性片段长度多态性方法(PCR-RFLP),对471例中国汉族人群(UC:143例,对照者:328例)进行CTLA4基因-1722位点多态性检测。结果:UC患者CTLA4基因-1722位点C等位基因和T/C+C/C基因型频率与正常对照组相比,差异无统计学意义(34.6%比35.2%,P=0.860,OR=1.027,95%CI=0.767-1.374;60.8%比53.4%,P=0.133,OR=0.736,95%CI=0.494-1.098);-1722T/C基因多态性与UC临床表型无显著相关性。结论:CTLA4基因启动子区-1722T/C基因多态性与中国汉族UC无显著相关性。     

中药在溃疡性结肠炎治疗中的疗效优势

从提高疗效、缩短症状改善时间、降低复发率及治疗伴随症状四方面阐述中药对溃疡性结肠炎的影响,说明中药在溃疡性结肠炎治疗中具有重要作用.     

中西药结合直肠滴注治疗溃疡性结肠炎80例临床疗效观察

目的:初步探讨中西药结合治疗溃疡性结肠炎的疗效。方法:80例研究对象分为治疗组和对照组2组,治疗组用中西药结合疗法,对照组用传统的柳氮磺吡啶片口服。结果:治疗组疗效优于对照组(P<0.01),有统计学意义。结论:中西医结合治疗UC较传统口服柳氮磺吡啶片效果明显,值得推广。     

高频超声结合彩色多普勒对溃疡性结肠炎活动性的判定价值

使用高频超声结合彩色多普勒对60例溃疡性结肠炎(UC)进行检查,以Sourtherland评分指数(DAI)作为UC患者活动期判断标准,总结活动期患者声像图及血流信号特点.结果显示,UC患者活动期超声表现为肠壁增厚、层次改变或消失、肠壁血流信号增多.超声评价疾病活动期的准确性为85.0％,敏感性为90.0％,与临床评分一致性较好(P＜0.01).提示,UC患者活动期的超声表现具有一定特点,结合彩色多普勒对疾病活动性的判定准确性、敏感性较高,可作为病情随访及药物疗效的观察指标的参考依据.     

Kalopanaxsaponin B Ameliorates TNBS-Induced Colitis in Mice

The stem-bark of Kalopanax pictus (KP, family Araliaceae), of which main constituent is kalopanaxsaponin B, has been used for asthma, rhinitis, and arthritis in Chinese traditional medicine. To clarify anticolitic effect of KP, we examined anti-inflammatory effect of KP extract and kalopanaxsaponin B in lipopolysaccharide (LPS)-stimulated peritoneal macrophage and 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitic mice. Of KP extracts, KP BuOH-soluble fraction most potently inhibited LPS-induced IL-1β, IL-6 and TNF-α expression, as well as NF-κB activation. However, KP BuOH fraction increased IL-10, an anti-inflammatory cytokine. KP BuOH fraction also inhibited colon shortening and myeloperoxidase activity in TNBS-induced colitic mice. KP BuOH fraction also potently inhibited the expression of the pro-inflammatory cytokines, IL-1β, IL-6 and TNF-α as well as the activation of NF-κB. Kalopanaxsaponin B, a main constituent of KP, inhibited TNBS-induced colonic inflammation, including colon shortening, and TNBS-increased myeloperoxidase activity pro-inflammatory cytokine expression and NF-κB activation in mice. Based on these findings, KP, particularly its main constituent, kalopanaxsaponin B, may ameliorate colitis by inhibiting NF-κB pathway.     

Benign retroperitoneal schwannoma presenting as colitis： A case report

We report a case of a patient presenting with clinical, radiological and endoscopic features of colitis due to a compressive left para-aortic mass. Total open surgical excision was performed, which resulted in complete resolution of colitis. Histopathology and immunohistochemistry revealed benign retroperitoneal schwannoma. These neural sheath tumors rarely occur in the retroperitoneum. They are usually asymptomatic but as they enlarge they may compress adjacent structures, which leads to a wide spectrum of non-specific symptoms, including lumbar pain, headache, secondary hypertension, abdominal pain and renal colicky pain. CT and MR findings show characteristic features, but none are specific. Schwannoma can be isolated sporadic lesions, or associated with schwannomatosis or neurofibromatosis type Ⅱ （NF2）. Although they vary in biological and clinical behavior, their presence is, in nearly every case, due to alterations or absence of the NF2 gene, which is involved in the growth regulation of Schwann cells. Both conditions were excluded by thorough mutation analysis. Diagnosis is based on histopathological examination and immunohistochemistry. Total excision is therapeutic and has a good prognosis. Schwannomatosis and NF2 should be excluded through clinical diagnostic criteria. Genetic testing of NF2 is probably not justified in the presence of a solitary retroperitoneal schwannoma.     

阴阳平衡散灌肠对溃疡性结肠炎患者CD4+CD25+的影响

目的 探讨蚂蚁制剂阴阳平衡散灌肠治疗UC的作用机制.方法 溃疡性结肠炎患者82例,其中阴阳平衡散灌肠组(A组)40例和柳氮磺氨吡啶(SASP)栓剂塞肛治疗组(B组)42例,健康对照组35例,用流式细胞仪检测各组外周血及肠黏膜组织中CD+4 CD+25 Tregs细胞的变化.结果 治疗前UC患者外周血及肠黏膜组织中的CD+4 CD+25 Tregs细胞数量均显著低于健康对照组(P<0.01),而经SASP和阴阳平衡散灌肠治疗后该细胞亚群明显高于治疗前及对照组(P<0.01或P<0.05).结论 CD+4、CD+25 Tregs细胞亚群在UC的发病及病情转归中可能具有重要免疫调节作用,阴阳平衡散通过调节Tregs细胞的数量对UC发挥治疗作用.