中西医治疗克罗恩病概况

克罗恩病在我国发病率明显增高,病因病机尚不明确,临床表现复杂多样,且容易误诊。从一般治疗、西药治疗、外科手术、干细胞移植、中医药治疗等多方面综述了治疗克罗恩病概况。辨病与辨证相结合,中西并举,取长补短,充分发挥中医与西医的各自优势,方能取得满意的治疗效果,提高克罗恩病治疗的整体水平。     

The possible mechanisms of Picrasma quassiodes (D. Don) Benn. in the treatment of colitis induced by 2,4,6-trinitrobenzene sulfonic acid in mice

Ethnopharmacological relevance

Picrasma quassiodes (D. Don) Benn.(PQB) is used in folk medicines for the treatment of colds, upper respiratory infection, acute tonsillitis, acute gastroenteritis, bacillary dysentery and a variety of acute infectious diseases in Asia. Although recent reports indicate that PQB has antibacterial, and anti-inflammatory effects, its effects on colitis and its inhibitory mechanisms have not been previously reported.

Aim of the study

To assess the effects and the mode of action of the extract of Picrasma quassiodes (D. Don) Benn.(PQB) on a model of colitis in mice induced by trinitrobenzene sulfonic acid (TNBS).

Materials and methods

We induced mice colitis using TNBS/ethanol, then different doses of Picrasma quassiodes (D. Don) Benn.(PQB) extract (100, 200 and 400 mg/kg/day) and sulfasalazine (500 mg/kg/day) were administered by gavage for 7 days after the induction of colitis. The mice body weight, colonic wet weight, colonic lengths, myeloperoxidase (MPO) activity, macroscopic and histological colon injury were observed. Pro-inflammatory cytokines such as: tumor necrosis factor-alpha (TNF-α) and interleukin-8 (IL-8) were assayed by enzyme-linked immunoassay. The protein expression of cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) in the colons were determined by immunohistochemical analysis.

Results

PQB administration effectively prevented mice diarrhea, decreasing of the body weights, shortening of colon length and increasing of colon wet weight. Macroscopic and histological examinations also indicated that it was protected against colonic edema, ulceration and MPO activity elevation. Furthermore, PQB inhibited the abnormal secretions of pro-inflammatory cytokines, such as TNF-α and IL-8. Additionally, administration of PQB effectively inhibited COX-2 and iNOS protein expression.

Conclusions

These results suggest that PQB has an anti-inflammatory effect on TNBS-induced colitis due to the down-regulations of the productions and expressions of inflammatory mediators, and that it may be a potential inflammatory bowel disease (IBD) drug candidate.     

Cellular senescence and senescence‐associated secretory phenotype via the cGAS‐STING signaling pathway in cancer

Cellular senescence is historically regarded as a tumor suppression mechanism to prevent damaged cells from aberrant proliferation in benign and premalignant tumors. However, recent findings have suggested that senescent cells contribute to tumorigenesis and age‐associated pathologies through the senescence‐associated secretory phenotype (SASP). Therefore, to control age‐associated cancer, it is important to understand the molecular mechanisms of the SASP in the cancer microenvironment. New findings have suggested that the cyclic GMP‐AMP synthase (cGAS)‐stimulator of interferon genes (STING) signaling pathway, a critical indicator of innate immune response, triggers the SASP in response to accumulation of cytoplasmic DNA (cytoplasmic chromatin fragments, mtDNA and cDNA) in senescent cells. Notably, the cGAS‐STING signaling pathway promotes or inhibits tumorigenesis depending on the biological context in vivo, indicating that it may be a potential therapeutic target for cancer. Herein, we review the regulatory machinery and biological function of the SASP via the cGAS‐STING signaling pathway in cancer.     

Oncogenic RAS-induced senescence in human primary thyrocytes: molecular effectors and inflammatory secretome involved

Oncogene-induced senescence (OIS) is a robust and sustained antiproliferative response to oncogenic stress and constitutes an efficient barrier to tumour progression. We have recently proposed that OIS may be involved in the pathogenesis of thyroid carcinoma by restraining tumour progression as well as the transition of well differentiated to more aggressive variants. Here, an OIS inducible model was established and used for dissecting the molecular mechanisms and players regulating senescence in human primary thyrocytes. We show that oncogenic RAS induces senescence in thyrocytes as judged by changes in cell morphology, activation of p16^INK4a and p53/p21^CIP1 tumour suppressor pathways, senescence-associated β-galactosidase (SA-β-Gal) activity, and induction of proinflammatory components including IL-8 and its receptor CXCR2. Using RNA interference (RNAi) we demonstrate that p16^INK4a is necessary for the onset of senescence in primary thyrocytes as its depletion rescues RAS-induced senescence. Furthermore, we found that IL-8/CXCR2 network reinforces the growth arrest triggered by oncogenic RAS, as its abrogation is enough to resume proliferation. Importantly, we observed that CXCR2 expression coexists with OIS markers in thyroid tumour samples, suggesting that CXCR2 contributes to senescence, thus limiting thyroid tumour progression.     

溃疡性结肠炎患者的临床治疗分析

目的观察柳氮磺胺吡啶口服与巴柳氮片剂灌肠治疗溃疡性结肠炎的效果。方法将56例患者分为两组,对照组（28例）与治疗组（28例）,对照组采用柳氮磺胺吡啶口服治疗,治疗组采用巴柳氮片剂灌肠治疗。两组治疗时间与评价标准相同。结果对照组近期治愈9例,总有效率为53.6%;治疗组近期治愈13例,总有效率为82.1%,治疗组与对照组相比,差异有统计学意义（P≤0.05）。结论巴柳氮片剂灌肠治疗比柳氮磺胺吡啶口服治疗效果好。     

柳氮磺胺吡啶、云南白药灌肠治疗溃疡性结肠炎疗效观察

目的：比较柳氮磺胺吡啶（SASP）、云南白药联合保留灌肠和SASP、云南白药口服治疗轻、中型溃疡性结肠炎的临床疗效与不良反应.方法：于6年内连续收集经电子肠镜确诊的溃疡性结肠炎患者97例.A组48例予SASP 2g、云南白药2g加入100ml生理盐水中,保留灌肠,每晚1次;B组49例口服SASP 4g/d、云南白药2.25g/d.30d后均改为口服SASP 2g/d,总疗程均为90d.结果：A组总有效率85.4%（41/48）,临床治愈率37.5%（18/48）;B组总有效率67.3%（33/49）,临床治愈率14.3%（7/49）,P＜0.01,差异有非常显著性.A组中1例因不良反应停药,不良反应发生率6.3%（3/48）;B组中5例因不良反应未完成疗程,不良反应发生率22.4%（11/49）,两组比较P＜0.01,差异有非常显著性.结论：SASP、云南白药联合保留灌肠治疗轻、中型溃疡性结肠炎疗效好,尤以左半结肠甚,不良反应少.     

自免清合SASP结肠溶胶囊治疗溃疡性结肠炎的临床研究

目的探讨中药自免清合柳氮磺吡啶(SASP)结肠溶胶囊治疗溃疡性结肠炎(UC)的临床疗效及免疫调节机制。方法将UC患者随机分成治疗组和对照组(各30例),治疗组口服自免清合剂及SASP结肠溶胶囊治疗,对照组口服SASP普通片剂治疗,疗程均为1个月,检测治疗前血清ESR、IgA、IgG、Ig M、补体C3和肠镜活检标病理学变化等指标,并总结其临床疗效。结果治疗组临床显效率为(23·3%)、总有效率为(93·3%),均显著高于对照组(分别为10·7%、71·4%)。治疗组治疗后补体C3各组显著升高、IgG、ESR显著下降,与对照组比较差异均有显著性(均P<0·05)。结论中药自免清结合SASP结肠溶胶囊治疗UC,能通过调节肠道免疫内环境,从而有效缓解溃疡性结肠炎的临床症状,降低复发率。     

益生菌联合柳氮磺胺吡啶治疗炎症性肠病

目的评价益生菌联合柳氮磺胺吡啶对炎症性肠病的疗效。方法以本院92例住院和门诊的轻中度炎症性肠病患者为研究对象,随机分成2组,一组为益生菌联合柳氮磺胺吡啶治疗组,另一组为单用柳氮磺胺吡啶对照组。治疗8周后观察2组患者的主观评价、总体评价以及内镜复查的情况。结果治疗组患者的主观评价明显高于对照组(P<0.05),临床缓解率也高于对照组(P<0.05)。而内镜复查结果2组无显著性差异(P>0.05)。结论益生菌对炎症性肠病的治疗是有效的和安全的。     

白头翁加味汤治疗溃疡性结肠炎的的疗效及安全性研究

目的：评价白头翁加味汤治疗溃疡性结肠炎（UC）的临床有效性及安全性。方法：采用该汤剂与阳性药物对照的试验设计。符合入选标准的患者,随机分为试验组和对照组。试验组予白头翁加味汤150 mL,每日一剂,睡前保留灌肠。对照组予柳氮磺胺吡啶片（SASP）,每次1.0 g,每日4次,口服。两组均一个月为一疗程,连续观察两个疗程。观察治疗前后两组的临床症状缓解、肠镜评分及病理改变,监测肝肾功能及血常规等变化。结果：共入组病例76例,可进行疗效评价分析的共68例,对照组、试验组各34例,试验组总有效率97.1%,对照组总有效率76.5%,两组间比较有统计学意义（P<0.05）。试验组未观察到不良反应,对照组不良反应发生率14.7%,两组间比较无统计学意义（P>0.05）。结论：白头翁加味汤治疗UC效果优于SASP,具有减轻炎症、促进溃疡愈合的作用,且安全性高,不良反应少。