国医大师邓铁涛治消化道疾病验方精选

国医大师邓铁涛,治学既重视理论又着力于临床,他从脾胃论治,善治各种消化道疾病。本文整理了邓老对于几大消化道疾病的临床经验方。1.治胃、+二指肠溃疡方组成:党参18克,白术12克,云茯苓15克,柴胡9克,佛手片5克,乌贼骨[或瓦愣子(煅)]15克,甘草5克。     

大肠溃疡性疾病的内镜分析

大肠溃疡可由多种疾病引起，我们将武汉大学人民医院近年来诊治的大肠溃疡性病变的内镜资料进行回顾性分析，旨在提高对大肠溃疡性病变的认识。     

肠白塞病外周血参数在临床诊疗中的价值

目的 分析肠白塞病(Behcet's disease，BD)外周血参数特点及其与肠溃疡活动度的相关性，为全面评估肠BD提供简易方法。 方法 选择2015年1月-2017年1月复旦大学附属华东医院收治的肠BD患者50例，以单纯皮肤黏膜BD患者50例和复发性阿弗他溃疡(recurrent aphthous ulcer,RAU)患者40例作对照，比较肠BD组外周血参数与单纯皮肤黏膜BD组和RAU组之间的差异。应用简化的内镜下克罗恩病活动度标准(SES-CD)将肠BD分为活动期25例和稳定期25例，评价外周血参数与肠溃疡活动度的相关性。 结果 与对照组比较，肠BD组红细胞(RBC)、血红蛋白(HGB)明显下降(均P<0.05)；纤维蛋白原(FIB)、血沉(ESR)和C-反应蛋白(CRP)明显升高(均P<0.05)；HGB和CRP预测肠BD的受试者工作特征曲线(ROC)下面积分别为0.826和0.871；与肠BD稳定期比较肠BD活动期ESR、CRP和FIB显著升高(均P<0.05)，HGB显著降低(P=0.001)；HGB、ESR、CRP和FIB判断肠溃疡活动度的ROC曲线下面积分别为0.758、0.787、0.888和0.792。 结论 BD患者HGB下降和CRP升高时需警惕肠溃疡；HGB、ESR、CRP和FIB是判断肠BD溃疡活动度的简易指标。      

Replication of interleukin 23 receptor and autophagy-related 16-like 1 association in adult- and pediatric-onset inflammatory bowel disease in Italy

AIM： To investigate gene variants in a large Italian inflammatory bowel disease （IBD） cohort, and to analyze the correlation of sub-phenotypes （including age at diagnosis） and epistatic interaction with other IBD genes. METHODS： Total of 763 patients with Crohn＇s disease （CD, 189 diagnosed at age 〈 19 years）, 843 with ulcerative colitis （UC, 179 diagnosed 〈19 years）, 749 healthy controls, and 546 healthy parents （273 trios） were included in the study. The rs2241880 [autophagy-related 16-like 1 （ATG16L1）], rs11209026 and rs7517847 [interleukin 23 receptor （IL23R）], rs2066844, rs2066845, rs2066847 （CARD15）, rs1050152 （OCTN1）, and rs2631367 （OCTN2） gene variants were genotyped. RESULTS： The frequency of G allele of ATG16L1 SNP （Ala197Thr） was increased in patients with CD compared with controls （59% vs 54% respectively） （OR = 1.25, CI = 1.08-1.45, P = 0.003）, but not in UC （55%）. The frequency of A and G （minor） alleles of Arg381Gln, rs11209026 and rs7517847 variants of IL23R were reduced significantly in CD （4%, OR = 0.62, CI = 0.45-0.87, P = 0.005; 28%, OR = 0.64, CI = 0.55-0.75, P 〈 0.01）, compared with controls （6% and 38%, respectively）. The A allele （but not G） was also reduced signifi cantly in UC （4%, OR = 0.69, CI = 0.5-0.94, P = 0.019）. No association was demonstrated with sub-phenotypes and interaction with CARD15 , and OCTN1/2 genes, although both gene variants were associated with pediatric-onset disease. CONCLUSION： The present study confirms the association of IL23R polymorphisms with IBD, and ATG16L1 with CD, in both adult- and pediatric-onset subsets in our study population.     

白塞病合并8号染色体三体22例分析及文献复习

目的 探讨分析8号染色体三体异常白塞病(Behcet's disease,BD)患者的临床特点.方法 分析2012年10月至2020年7月复旦大学附属华东医院收治的22例8号染色体三体BD的住院患者,并检索中英文文献库中BD合并8号染色体三体的患者共46例,对临床特点进行比较分析.结果 22例8号染色体三体的BD患者中...     

Anti-inflammatory effect of Diammonium Glycyrrhizinate in a rat model of ulcerative colitis

AIM: To explore the anti-inflammatory mechanism of Diammonium Glycyrrhizinate in a rat model of ulcerative colitis induced by acetic acid. METHODS: Spragur-Dawley female rats were divided into four groups: Diammonium Glycyrrhizinate group, dexamethasone group, acetic acid control and normal control group. Colonic inflammation was evaluated by disease activity index, gross morphologic damage, histological injury and colonic myeloperoxidase activity. Immunohistochemistry was used to detect the expression of NF-κB, TNF-αand ICAM-1 in colonic mucosa. RESULTS: Compared to the acetic acid control, both Diammonium Glycyrrhizinate and dexamethasone showed a significant anti-inflammatory effect (P < 0.01). The expression of NF-κB, TNF-a and ICAM-1 in colonic mucosa was significantly lower in the Diammonium Glycyrrhizinate group and dexamethasone group than in the acetic acid group. CONCLUSION: Diammonium Glycyrrhizinate could reduce inflammatory injury in a rat model of ulcerative colitis. This may occur via suppression of NF-κB, TNF-a and ICAM-1 in colonic mucosa.     

泮托拉唑、奥美拉唑与埃索美拉唑治疗消化性肠溃疡的疗效比较研究

目的探讨泮托拉唑、奥美拉唑与埃索美拉唑治疗消化性肠溃疡的疗效,为合理选择药物提供参考。方法将消化性肠溃疡活动期患者90例随机分为3组——泮托拉唑组、奥美拉唑组和埃索美拉唑组各30例,3组都采用传统三联疗法治疗,但是3组分别使用泮托拉唑、奥美拉唑与埃索美拉唑质子泵抑制剂。结果埃索美拉唑组溃疡愈合率与HP根除率明显高于其他两组,差异有统计学意义（P〈0．05）。3组主要不良反应都比较少且轻,3组之间发生率差异无统计学意义（P〉0．05）。结论以质子泵抑制剂为基础的三联疗法治疗消化性肠溃疡能取得比较好的效果,推荐使用埃索美拉唑,能提高溃疡愈合率与HP根除率,值得临床推广应用。     

Single nucleotide polymorphism in the tumor necrosis factor-alpha gene affects inflammatory bowel diseases risk

AIM： To investigate the role that single nucleotide polymorphisms （SNPs） in the promoter of the tumour necrosis factor-alpha （TNF-α） gene play in the risk of inflammatory bowel diseases （IBDs） in a New Zealand population, in the context of international studies. METHODS： DNA samples from 388 patients with Crohn＇s disease （CD）, 405 ulcerative colitis （UC）, 27 indeterminate colitis （IC） and 201 randomly selected controls, from Canterbury, New Zealand were screened for 3 common polymorphisms in the TNF-α receptor： -238 G→A, -308 G→A and -857C→T, using a TaqmanR assay. A meta-analysis was performed on the data obtained on these polymorphisms combined with that from other published studies. RESULTS： Individuals carrying the -308 G/A allele had a significantly （OR = 1.91, χ2 = 17.36, P 〈 0.0001） increased risk of pancolitis, and a 1.57-fold increased risk （OR = 1.57, χ2 = 4.34, P = 0.037） of requiring a bowel resection in UC. Carrying the -857 C/T variant decreased the risk of ileocolonic CD （OR = 0.56, χ2 =4.32, P = 0.037）, and the need for a bowel resection （OR = 0.59, χ2 = 4.85, P = 0.028）. The risk of UC was reduced in individuals who were smokers at diagnosis, （OR = 0.48, χ2 = 4.86, P = 0.028）. CONCLUSION： TNF-α is a key cytokine known to play a role in inflammatory response, and the locus for the gene is found in the IBD3 region on chromosome 6p21, known to be associated with an increased risk for IBD. The -308 G/A SNP in the TNF-α promoter is functional, and may account in part for the increased UC risk associated with the IBD3 genomic region. The -857 C/T SNP may decrease IBD risk in certain groups. Pharmaco- or nutrigenomic approaches may be desir- able for individuals with such affected genotypes.     

Possible role of human cytomegalovirus in pouchitis after proctocolectomy with ileal pouch-anal anastomosis in patients with ulcerative colitis

AIMTo detect the presence of human cytomegalovirus(HCMV)proteins and genes on the ileal pouch of patients with ulcerative colitis who have undergone proctocolectomy with ileal pouch-anal anastomosis(IPAA).METHODSImmunohistochemistry,polymerase chain reaction(PCR)and PCR sequencing methods were utilized to test the presence of HCMV in pouch specimens taken from 34 patients in 86 endoscopies.RESULTSHCMV genes and proteins were detected in samples from 12(35.2%)patients.The rate of detection was significant in the endoscopies from patients diagnosed with pouchitis(5 of 12,41.6%),according to the Japanese classification of pouchitis,in comparison to patients with normal pouch(7 of 62,11.2%;P = 0.021).In all patients with pouchitis in which the HCMV was detected,it was the first episode of pouchitis.The virus was not detected in previous biopsies taken in normal endoscopies of these patients.During the followup,HCMV was detected in one patient with recurrent pouchitis and in 3 patients whose pouchitis episodes improved but whose positive endoscopic findings persisted.CONCLUSIONHCMV can take part in the inflammatory process of the pouch in some patients with ulcerative colitis who have undergone proctocolectomy with IPAA.