口服和局部美沙拉嗪联用对中型远端结肠炎缓解期患者疗效的影响

[目的]观察口服和局部美沙拉嗪联用对中型远端结肠炎缓解期患者临床疗效的影响效果。[方法]按照随机数余数分组法将2017-03-2019-03收治的80例中型远端结肠炎缓解期患者分为口服美沙拉嗪治疗的口服给药组(30例)、局部美沙拉嗪治疗的局部给药组(30例)、口服和局部美沙拉嗪联用治疗的联合给药组(20例),对3组临床疗效进行对比。[结果]治疗前3组血清炎症因子、氧化应激指标、直肠肛门动力学、黏膜损伤指数、病理组织学评分差异无统计学意义(P>0.05),治疗后均较治疗前显著改善,联合给药组优于口服给药组和局部给药组(P<0.05),口服给药组与局部给药组差异无统计学意义(P>0.05);3组总有效率分别为95.00%、83.33%、86.67%,联合给药组高于口服给药组和局部给药组(P<0.05),口服给药组与局部给药组差异无统计学意义(P>0.05);3组不良反应发生率分别为15.00%、13.33%、10.00%,差异无统计学意义(P>0.05)。[结论]口服和局部美沙拉嗪联用治疗中型远端结肠炎缓解期疗效更佳,可作为优选用药方案推广使用。     

美沙拉嗪肠溶片联合中药灌肠方治疗湿热内蕴型溃疡性结肠炎疗效评价

目的:探讨美沙拉嗪肠溶片联合中药灌肠方治疗湿热内蕴型溃疡性结肠炎(UC)的临床疗效.方法:选取80例湿热内蕴型UC病人,随机分为对照组40例(单纯给予美沙拉嗪肠溶片口服)和观察组40例(美沙拉嗪肠溶片口服+中药灌肠方),疗程结束后进行中医证候疗效评价及改良UC Mayo评分.结果:治疗后,观察组中医证候积分、中医证候疗效、改良UC Mayo评分及白细胞介素-6水平均明显优于对照组(P<0.01).结论:美沙拉嗪肠溶片联合中药灌肠方在湿热内蕴型UC病人中的疗效肯定,值得临床推广.     

Mesalazine for the treatment of inflammatory bowel disease

Clopidogrel has become a mainstay in the management of acute coronary syndrome patients over the past decade, as well as an essential component of percutaneous coronary intervention (PCI) pharmacotherapy. Until recently, no prospective study has evaluated the effectiveness of clopidogrel in the setting of an ST-segment elevation myocardial infarction (STEMI). The majority of patients presenting with STEMI receive thrombolytic therapy (aspirin, heparin and a fibrinolytic agent) although many do not achieve or maintain adequate reperfusion of the infarct-related artery. The CLARITY (Clopidogrel as Adjunctive Reperfusion Therapy) study and the PCI–CLARITY substudy were designed to address whether a beneficial effect of clopidogrel, including a loading dose, would be attained among STEMI patients who were being treated with thrombolytic therapy and undergoing coronary angiography during the index hospitalisation. A total of 3491 patients who presented within 12 h after the onset of STEMI were randomly assigned to receive clopidogrel (300-mg loading dose followed by 75 mg daily) or placebo. Patients were scheduled to undergo coronary angiography after 48 h, and those who underwent PCI during the index hospitalisation formed the basis of PCI–CLARITY. This PCI cohort was followed for the combined end point of cardiovascular death, recurrent myocardial infarction and stroke for 30 days.     

Recent advances in the management of distal ulcerative colitis

The most frequent localization of ulcerative colitis (UC) is the distal colon. In treating patients with active distal UC, efficacy and targeting of the drug to the distal colon are key priorities. Oral and rectal 5-aminosalicylic acid (5-ASA) preparations represent the first line therapy of mild-to-moderate distal UC for both induction and maintenance treatment. It has been reported that many UC patients are not adherent to therapy and that non-compliant patients had a 5-fold risk of experiencing a relapse. These findings led to the introduction of once-daily oral regimens of 5-ASA as better therapeutic options in clinical practice due to improved adherence. New formulations of mesalazine, including the multi-matrix delivery system, and mesalazine granules, which allow once-daily administration, have been developed. They have been demonstrated to be efficacious in inducing and maintaining remission in mild-to-moderate distal UC in large clinical trials. However, existing data for distal UC are rather insufficient to make a comparison between new and classical 5-ASA formulations. It seems that the new formulations are at least as effective as classical oral 5-ASA formulations. Other treatment options, in the case that 5-ASA therapy is not effective, include systemic corticosteroids, thiopurines (azathioprine or 6-mercaptopurine), cyclosporine, infliximab and surgery. The combination of a prompt diagnostic work-up, a correct therapeutic approach and an appropriate follow-up schedule is important in the management of patients with distal UC. This approach can shorten the duration of symptoms, induce a prolonged remission, improve patient's quality of life, and optimize the use of health resources.     

Oral administration of mesalazine protects against mucosal injury and permeation in dextran sulfate sodium-induced colitis in rats

Abstract

Objective. Mesalazine, from which 5-aminosalicylic acid is released, is a therapeutic drug for inflammatory bowel disease. There has been no study concerning the effect of orally administered mesalazine on dextran sodium sulfate (DSS)-induced colitis in the rat model of ulcerative colitis. Material and methods. Colitis was evaluated by means of the length of the colon, white blood cell count (WBC), tissue myeloperoxidase (MPO) activity, and histological inflammation scores. Colonic mucosal permeation was evaluated using Evans blue. The localization of a tight junction protein, occludin, was evaluated immunohistochemically and examined using confocal laser scanning microscopy. Results. Mesalazine significantly improved changes in the length of the colon, tissue MPO activity, WBC, and the histological inflammation score as compared with DSS-induced colitis. Furthermore, the drug completely inhibited the increased permeation in DSS-induced colitis in rats. The immunofluorescence signals of occludin were disrupted and irregularly distributed in DSS-induced colitis, while the signals appeared as a typical reticular pattern but with reduced intensity by the administration of mesalazine, without any reduction in the protein content. In addition, the oral administration of mesalazine significantly improved mucosal permeation, thereby protecting the intestinal mucosa against injury in DSS-induced colitis in rats. Conclusions. These findings suggest that the recovery of mucosal impairment due to treatment with mesalazine may be associated with the protection of the tight junction protein occludin in DSS-induced colitis.     

美沙拉嗪治疗溃疡性结肠炎的临床疗效观察

目的探讨美沙拉嗪治疗溃疡性结肠炎的临床疗效。方法选择我科2009年3月-2012年3月收治的溃疡性结肠炎患者60例,随机分为对照组30例（柳氮磺胺吡啶）及实验组30例（美沙拉嗪）,实验组30例（美沙拉嗪）每次1.0 g,每日3次口服;对照组30例（柳氮磺胺吡啶）1.0 g,每日4次口服,观察治疗前后血清IL-2、INF-γ、IL-13水平。结果在对炎性因子血清浓度变化分析发现,两组经过治疗后与对照组比较,实验组IL-2（58.8±14.16、50.3±11.70、45.7±10.26）pg/mL、INF-γ（640±103、433±88、291±63）p g/m L两指标在治疗后4、8、12周后,血清浓度水平幅度有着显著的改变（p＜0.05）,实验组I L-13在治疗后4、8、12周（55±10.11、65±11.2、73±13.55）pg/mL与对照组比较有显著的统计学差异（p＜0.05）。在组内比较中,可见治疗4周后实验组的IL-2与INF-γ浓度较治疗前比较有着显著的提高,治疗4周后实验组的IL-13浓度较治疗前比较有着显著的下降（p＜0.05）。结论美沙拉嗪也许是通过纠正Th1/Th2失衡,改善机体炎症状态,从而令溃疡性结肠炎得到一定的缓解。     

微生态制剂联合美沙拉嗪对溃疡性结肠炎疗效及血清炎症因子影响的Meta分析

目的Meta分析微生态制剂联合美沙拉嗪治疗溃疡性结肠炎(UC)的疗效及其对血清炎症因子的影响。 方法计算机检索2018年以来中英文期刊数据库,包括知网、万方医学、维普、Pubmed、Cochrane、EMbase等,纳入微生态制剂联合美沙拉嗪治疗UC的随机对照试验报道并筛选、评价文献质量,对疗效及其对血清炎症因子的影响采用RevMan5.3软件进行Meta分析。 结果本研究共纳入10篇文献资料,质量均合格；微生态制剂联合美沙拉嗪对UC的总有效率、血清白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)的影响报道经异质性检验差异均无统计学意义(P＞0.05),均借助固定效应模型进行分析,结果发现微生态制剂联合美沙拉嗪较单纯美沙拉嗪能提高UC治疗的总有效率和血清IL-10水平(RR=1.42,95%CI为1.06~1.58,P＝0.012；WMD=11.36,95%CI为7.83~14.29,P＜0.001),降低血清TNF-α水平(WMD=－4.35,95%CI为－6.12~－1.28,P＜0.001),且上述文献均未见明显偏倚风险,敏感性分析均证实Meta分析结果稳定性良好。 结论微生态制剂联合美沙拉嗪治疗溃疡性结肠炎有效,且可减轻炎症反应。     

Investigational treatment options in microscopic colitis

Collagenous and lymphocytic colitis are the two recognized major presentations of microscopic colitis. Both diseases present with chronic watery diarrhea and a chronic inflammatory infiltrate in the colonic mucosa without specific endoscopic abnormalities, and hence diagnosis is established by histology. Recent epidemiological studies suggest that microscopic colitis may affect as many patients as Crohn's disease or ulcerative colitis. The cause of these diseases is unknown; however, several lines of evidence support the hypothesis of mucosal injury from an unknown agent in the fecal stream. Due to the lack of disease causality, therapeutic management of microscopic colitis is now directed primarily at symptoms' resolution or improvement. Based on current evidence, oral budesonide represents an effective treatment option for patients with microscopic colitis to achieve and maintain remission. Other anti-inflammatory drugs such as mesalazine or bismuth subsalicylate are now under evaluation. The optimal long-term management strategy of microscopic colitis, however, remains an unsolved issue.