药物治疗联合饮食控制治疗溃疡性结肠炎的临床疗效

目的：探讨分析溃疡性结肠炎患者采用药物治疗联合饮食控制治疗的临床疗效及其安全性。方法选取该院2013年9月—2014年6月收治的68例溃疡性结肠炎患者按照就诊顺序随机分为实验组（采用美莎拉嗪联合饮食控制治疗）和对照组（单纯给予美莎拉嗪治疗),对比观察两组患者临床疗效。结果实验组治疗总有效率（91.1%）明显高于对照组（73.5%）,差异有统计学意义（P＜0.05）;两组患者治疗后CRP及IL-8指标水平较治疗前均有明显降低,差异有统计学意义（P＜0.05）,而IL-10指标水平较治疗前明显升高（P＜0.05）,但是两组间对比,实验组改善程度更为显著,差异有统计学意义（P＜0.05）。且实验组患者不良反应发生率（11.8%）明显低于对照组（29.4%）,差异有统计学意义（P＜0.05）。结论溃疡性结肠炎患者采用美莎拉嗪联合饮食控制治疗的临床效果显著,值得在临床上进一步推广。     

黛力新和美沙拉嗪合并使用治疗溃疡性结肠炎的临床效果评价

目的：探讨黛力新联合美沙拉嗪对溃疡性结肠炎的临床效果。方法：选取我院2014年3月～2015年3月溃疡性结肠炎患者78例,采用统计软件SAS9.2产生一组随机数据,将78例患者随机分为观察组和对照组,每组39例,对照组患者采用美沙拉嗪治疗,0.2～0.3mg·kg-1·d-1保留灌肠,15min/次,2次/d,观察组在美沙拉嗪基础上加用黛力新口服,1片/次,2次/d。两组给予连续干预1个月,对比两组干预1个月后肠道菌群变化情况以及临床疗效。结果：两组治疗后组内比较均明显改善了肠道杆菌（P<0.05）,说明两组治疗后均有临床效果,两组组间治疗后比较,观察组改善肠道杆菌临床效果优于对照组（P<0.05）,观察组治愈率46.15%,好转率43.59%,总有效率为89.74%。对照组治愈率30.77%,好转率41.03%,总有效率71.80%,经统计学分析X2=4.10,P<0.05。结论：黛力新口服联合美沙拉嗪灌肠治疗溃疡性结肠炎具有更好的临床效果。     

粪菌移植干预治疗溃疡性结肠炎的免疫学机制研究

背景溃疡性结肠炎被世界卫生组织列为现代难治疾病之一。目前西医对其治疗尚存在诸多不足之处,研究显示粪菌移植（FMT）对其有一定的疗效,但机制尚不明确。目的采用FMT治疗小鼠溃疡性结肠炎模型,验证FMT的疗效和可能的作用机制。方法2019年12月至2020年4月,采用随机数字表法将60只小鼠分为正常对照组（Control组）、溃疡性结肠炎模型组（Model组）、溃疡性结肠炎模型+粪菌移植治疗组（Model+FMT组）和溃疡性结肠炎模型+5-氨基水杨酸（5-ASA）治疗组（Model+5-ASA组）,各15只。Control组不作任何干预处理;Model组制备小鼠溃疡性结肠炎模型;Model+FMT组于造模成功后,给予制备的粪菌液0.2 ml/次灌肠;Model+5-ASA组于造模成功后,给予0.019 5 g/ml 5-ASA灌肠。通过透射电镜观察肠组织超微结构变化,流式细胞检测血液辅助性T细胞（Th）-17、Th-1、Th-2、Treg细胞含量变化,酶联免疫吸附试验（ELISA）检测血清干扰素γ（IFN-γ）、白介素（IL）-2、IL-17、IL-4、IL-10、转化生长因子β（TGF-β）水平变化。结果肠组织透射电镜超微结构显示Model组造模成功;Model+FMT组与Model+5-ASA组微绒毛较为致密,形态正常,杯状细胞数目较多,线粒体轻微肿胀,粗面内质网病变不明显。Model+FMT组Th17细胞含量高于Control组、低于Model组,Model+5-ASA组Th17细胞含量低于Control组、Model组、Model+FMT组;Model+FMT组、Model+5-ASA组Th1细胞含量均分别低于Control组、Model组;Model+FMT组Th2细胞含量低于Control组、高于Model组,Model+5-ASA组Th2细胞含量低于Control组、高于Model组和Model+FMT组;Model+FMT组、Model+5-ASA组Treg细胞含量均分别低于Control组、高于Model组（P<0.05）。Model+5-ASA组IFN-γ细胞含量低于Model组;Model+FMT组、Model+5-ASA组IL-2细胞含量低于Model组;Model+FMT组、Model+5-ASA组IL-17细胞含量均分别低于Control组和Model组,Model+5-ASA组IL-17细胞含量低于Model+FMT组;Model+FMT组IL-4细胞含量低于Control组、高于Model组,Model+5-ASA组IL-4细胞含量高于Model组;Model+FMT组IL-10细胞含量高于Control组和Model组,Model+5-ASA组IL-10细胞含量高于Model组;Model+FMT组、Model+5-ASA组TGF-β细胞含量均分别低于Control组、高于Model组（P<0.05）。结论FMT可改善小鼠溃疡性结肠炎症状,推测其可能是通过调节Th1/Th2细胞平衡、Th17/Treg细胞比例达到治疗的目的。     

美沙拉嗪联合麦滋林治疗溃疡性结肠炎的临床观察

目的评价美沙拉嗪联合麦滋林治疗溃疡性结肠炎(UC)的疗效。方法将确诊的92例轻、中度UC患者分为两组,治疗组(n=46)口服美沙拉嗪+麦滋林;对照组(n=46)口服美沙拉嗪,治疗3个月后评价治疗效果。结果 3个月后治疗组有效率93.4%,明显高于对照组的80.4%(P<0.01)。结论美沙拉嗪联合麦滋林治疗UC效果显著,值得临床推广。     

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。     

Noninfectious interstitial lung disease during infliximab therapy:Case report and literature review

Pulmonary abnormalities are not frequently encountered in patients with inflammatory bowel diseases.However,lung toxicity can be induced by conventional medications used to maintain remission,and similar evidence is also emerging for biologics.We present the case of a young woman affected by colonic Crohn’s disease who was treated with oral mesalamine and became steroid-dependent and refractory to azathioprine and adalimumab.She was referred to our clinic with a severe relapse and was treated with infliximab,an antitumor necrosis factor α(TNF-α)antibody,to induce remission.After an initial benefit,with decreases in bowel movements,rectal bleeding and C-reactive protein levels,she experienced shortness of breath after the 5thinfusion.Noninfectious interstitial lung disease was diagnosed.Both mesalamine and infliximab were discontinued,and steroids were introduced with slow but progressive improvement of symptoms,radiology and functional tests.This represents a rare case of interstitial lung disease associated with infliximab therapy and the effect of drug withdrawal on these lung alterations.Given the increasing use of anti-TNF-α therapies and the increasing reports of pulmonary abnormalities in patients with inflammatory bowel diseases,this case underlines the importance of a careful evaluation of respiratory symptoms in patients undergoing infliximab therapy.     

Adrenal Incidentaloma: Review of 197 Patients and Report of a Drug-Related False-Positive Urinary Normetanephrine Result

Purpose To determine the incidence and importance of functioning tumors among incidentally discovered adrenal masses in the era of laparoscopic surgery. Methods We defined adrenal incidentaloma as a tumor detected during abdominal imaging for adrenal-unrelated reasons, and we reviewed 197 consecutive patients with adrenal incidentaloma diagnosed since we started laparoscopic adrenalectomy. Results Incidentaloma was discovered initially in 91 (46%) patients and pheochromocytoma was detected as an incidentaloma in 21 (39%) of 54 patients. One patient, a 21-year-old woman taking mesalamine for ulcerative colitis, had a remarkably elevated urinary normetanephrine level, which resulted in the initial misdiagnosis of a 10-cm right adrenal incidentaloma as a pheochromocytoma. Laparoscopic right adrenalectomy resulted in a pathological diagnosis of ganglioneuroma. A series of urinary normetanephrine measurements were taken in parallel with the mesalamine doses. We found that other patients medicated with mesalamine, without adrenal tumors, had elevated urinary normetanephrine levels, confirming that mesalamine metabolites interfere with urinary normetanephrine measurements. Conclusions It is essential to diagnose the functional potential of adrenal incidentaloma preoperatively, and not to perform laparoscopic adrenalectomy for adrenal incidentaloma without careful evaluation first.     

Management of diverticular disease is changing

Diverticular disease of the colon is primarily a disease of humans living in westernized and industrialized countries. Sixty percent of humans living in industrialized countries will develop colonic diverticula. It is rare before the age of 40, but more prone to complications when it occurs in the young. By age 80, over 65% of humans have colonic diverticula. The cause remains uncertain, but epidemiologic studies attribute it to dietary fiber deficiency. The cause of diverticulitis remains uncertain, but new observations and hypotheses suggest that it is due to chronic inflammation in the bowel wall. Standard medical therapies of bowel rest and antibiotics are still the recommended treatment. However, changing concepts and new therapies indicate that anti-inflammatory agents such as mesalamine and possibly probiotics may be helpful in shortening the course and perhaps preventing recurrences. Standard surgical treatment for perforation for severe acute disease has developed so that two-stage procedures are recommended. In addition, laparoscopic surgery has proven safe and may slowly become the technique of choice.