首页 > 文献资料
-
-
溃结液保留灌肠治疗溃疡性结肠炎44例临床观察
溃疡性结肠炎是以结肠粘膜呈慢性非特异性炎症改变为主要特征的疾病,其病因和发病机理尚未完全阐明,目前认为该病与自身免疫性反应有着密切的关系.多侵犯直肠和远端结肠,病变主要在结肠粘膜和粘膜下层,病灶呈糜烂、溃疡等炎性改变.临床主要表现为慢性腹泻,稀便、粘液便或脓血便,便次多,腹痛,里急后重,病程长,轻重不一,重者可伴发热,消瘦等全身性表现.常有反复发作的特点,是一种难治性慢性疾病.
-
溃疡性结肠炎的细胞免疫学机制及中医学研究进展
溃疡性结肠炎(ulcerative colitis, UC)是一种以黏膜和黏膜下层浸润为主,特发于大肠的非特异性炎症性肠病, 临床主要表现为腹痛、腹泻、黏液样脓血便、里急后重.近年来东欧、南美、亚洲等低发地区的发病率有大幅增加的趋势[1].UC病因复杂,目前多认为与环境、微生物感染、遗传、免疫等多种因素有关.越来越多的学者认为UC是一种自身免疫性疾病,其免疫因素尤其是细胞免疫在UC发病机制中的地位越来越受重视,同时中医学对其研究也取得较大的进展,现综述如下.
-
溃疡性结肠炎的中西医结合研究新进展
溃疡性结肠炎(ulcerative colitis,UC)又称慢性非特异性溃疡性结肠炎,系原因不明的大肠黏膜的慢性炎症和溃疡性病变,临床以腹痛、腹泻、黏膜脓血便为特征.
-
溃疡性结肠炎中西医治疗优势与对策
溃疡性结肠炎(ulcerative colitis,UC)是一种多因素、多变量、多层次复杂疾病.临床以腹泻、黏液脓血便、腹痛及里急后重为主要症状.本病病因未明,治愈难度大,复发率高,具有较高的癌变率,被世界卫生组织列为现代难治病之一.
-
溃疡性结肠炎药物治疗评价及中医药治疗经验
慢性非特异性溃疡性结肠炎(ulcerative colitis,UC)是以腹泻、黏液脓血便、腹痛、里急后重等为主要症状,以结肠黏膜慢性炎症和溃疡形成为病理特点的一种消化道疾病.
-
中西医结合诊疗溃疡性结肠炎
溃疡性结肠炎又称慢性非特异性溃疡性结肠炎,系原因不明的大肠黏膜的慢性炎症和溃疡性病变,临床以腹泻、黏液脓血便、腹痛为特征.其病程漫长,病情轻重不一,常反复发作,是消化系统的疑难病之一.
-
溃疡性结肠炎中西医结合诊治方案(草案)
溃疡性结肠炎中西医结合诊断、辨证和疗效标准试行方案已执行10年,近年来本病的诊断和治疗有了很大的进展,经过本专业委员会数十位专家的反复讨论,现修改重订如下.
-
溃疡性结肠炎中医诊疗共识(2009)
溃疡性结肠炎(ulcerative colitis,UC)是消化内科的常见疑难病.近年来国内外关于炎症性肠病(IBD,包括UC)的诊疗指南与共识意见相继更新发表,如2004年美国胃肠病学会(AGA)修订的临床指南中有关UC的诊断与评估推荐意见、英国胃肠病学会(BSG)的成人炎症性肠病处理指南和亚太消化系疾病周(APDW)制定的亚太地区炎症性肠病处理共识意见,中华医学会消化病分会也在2007年修订了我国炎症性肠病诊断治疗规范的共识意见.
-
中西医结合治疗溃疡性结肠炎94例疗效观察
溃疡性结肠炎(ulcerative colitis,UC)是一种病因不明的直肠和结肠粘膜的非特异性炎症.以腹泻、粘液浓血便、腹痛为主.为探讨采用中西医结合治疗UC新途径,我院对UC住院患者进行研究,现报告如下.
-
In recent years, our department has adopted a catgut point-embedding therapy in the treatment of 76 cases of chronic ulcerative colitis, with quite good therapeutic effects. The following is a report of it.Clinical DataOf 76 cases we treated, 32 were male, and 44 female, with the ages ranging from 23 to 65 years and the duration of illness from 6 months to 20 years.All the cases complained of chronic diarrhea, most of them had mucous and blood stool, and some had tenesmus. Sigmoscopic findings showed that all the cases had varying degrees of colic mucosal congestion and edema, fragile mucosa easy to bleed upon touching, or rough mucosa with multiple ulcers varying in size, shape, and depth.
-
慢性结肠炎发生及癌变的分子机制研究进展
结肠癌是常见的恶性肿瘤之一,其发病率和病死率在中国乃至世界范围内均很高[1-2],其中一部分结肠癌是由慢性结肠炎引起的,称之为结肠炎相关的结肠癌( colitis-associated colon cancer )。大量的流行病学、实验病理学和临床研究表明炎症性肠病( inflammatory bowel disease ),特别是慢性溃疡性结肠炎( chronic ulcerative colitis)和克罗恩病( Crohn disease)的长期存在可以恶性转化为结肠癌,甚至促进结肠癌的进展和早期转移[3-4]。本文主要论述慢性结肠炎的发生及其恶变的分子机制研究进展。
-
达纳康对大鼠溃疡性结肠炎细胞因子的影响
目的:观察大鼠实验性溃疡性结肠炎脾淋巴细胞,肠组织和血清中,细胞因子的表达及达纳康对其的影响,探讨达纳康对溃疡性结肠炎的保护作用及其机制.方法:用三硝基苯磺酸(TNBS)建立大鼠溃疡性结肠炎模型.将动物随机分为空白对照组、三硝基苯磺酸、三硝基苯磺酸+生理盐水组、三硝基苯磺酸+达纳康组四组观察肠道大体形态和组织学改变.采用ELISA法测定脾细胞、大肠黏膜及血清中的白介素-12(IL-12)、干扰素γ(IFN-γ)和白介素4(IL-4).结果:与三硝基苯磺酸组比较三硝基苯磺酸+达纳康损伤指数明显下降(2.83±0.94 vs 5.33±1.50,P<0.01,1.92±0.67 vs 4.33±0.98,P<0.01).IFN-γ浓度明显下降.脾细胞:60±21.5 vs 125.6±14.6,P<0.01大肠黏膜:202.8±49.6 vs 431.8±57.6,P<0.01血清:8.6±1.4 vs 13.5±1.7,P<0.01.与模型组比较TNBS组+EGb组IL-4浓度明显升高(脾细胞:11.2±1.3 vs 6.05±1.5,P<0.01大肠黏膜:10.2±1.9 vs 6.9±1.4,P<0.01血清:7.9±1.8 vs4.2±1.1,P<0.01).血清IL-12浓度明显下降(8.2±2.2 vs25.8±4.8,P<0.01)血清IL-12/IL-4比值下降(1.13±0.49 vs64±1.8,P<0.01).IFN-γIL-4比值明显下降(脾细胞:5.2±2.0 vs 21.9±4.9,P<0.01,大肠黏膜:20.9±7.97 vs65.9±18,P<.01;血清:1.1±0.3 vs 3.4±0.8,P<0.01).结论:TNBS诱导的大鼠UC模型是Th1(IL-12)亚型为主的免疫应答反应,EGb通过抑制IL-12,IFN-γ生成,恢复Th1/Th2细胞因子的平衡,发挥对溃疡性结肠炎的保护作用.
-
大蒜素对大鼠溃疡性结肠炎淋巴细胞凋亡及其调控蛋白的影响
目的:通过观察大鼠溃疡性结肠炎淋巴细胞凋亡及其调控蛋白Bcl-2和Bax的表达及大蒜素对其的影响,探讨大蒜素(Allitridi,Alt)对溃疡性结肠炎肠黏膜的保护作用及其机制.方法:用三硝基苯磺酸(TNBS)建立大鼠溃疡性结肠炎模型.将动物随机分为空白对照组(Normal group)、三硝基苯磺酸组(TNB S group)、三硝基苯磺酸+生理盐水组(TNBS+NS group)、三硝基苯磺酸+大蒜素组(TNBS+Altgroup)四组.利用DNA缺口末端标记技术(TUNEL法)和Bcl-2、Bax蛋白免疫组化染色,分别检测溃疡性结肠炎大鼠肠组织中的淋巴细胞凋亡和淋巴细胞Bcl-2和Bax的表达,生化检测一氧化氮(N0)含量,并观察肠道大体形态和组织学改变.结果:和三硝基苯磺酸组相比,三硝基苯磺酸+大蒜素组中淋巴细胞凋亡增加(2.1±1.0 vs 5.9±2.0,P<0.01),Bcl-2表达阳性淋巴细胞减少及一氧化氮(NO)含量下降(10.0±2.5 vs 31.0±6.0,197±11 vs 523±40,P<0.01).损伤指数明显下降(1.6±0.5 vs 5.8±0.7,2.1±0.6 vs6.1±0.6,P<0.01).结论:大蒜素可以通过促进淋巴细胞凋亡和清除NO自由基而对TNBS诱导的溃疡性结肠炎肠黏膜有保护作用.
-
溃疡性结肠炎患者肠黏膜Th1/Th2类细胞因子m-RNA的表达
目的:探讨溃疡性结肠炎肠黏膜内Th1型细胞分泌的细胞因子TNF-α、IL-2,Th2型细胞分泌的细胞因子IL-4、IL-10的作用.方法:住院重症溃疡性结肠炎患者30例,男24例,女6例,年龄18-59(平均45±13)岁.全部患者均经电子结肠镜检查及组织学检查确诊,并连续粪培养2次排除细菌感染,同时排除阿米巴肠病,血吸虫病,肠道肿瘤和内分泌疾病.病变部位包括全结肠型15例,乙状结肠9例,直肠型6例;临床类型包括复发型20例,持续型7例和初发型3例.急性期患者均服用强的松30 mg,柳氮磺胺嘧啶500 mg 2次/d.治疗8 wk后复查纤维结肠镜.另选健康对照20名,男14名,女6名,年龄22-61(平均43±12)岁,排除胃肠道和内分泌疾病.应用RT-PCR检测溃疡性结肠炎患者黏膜内细胞因子的表达.结果:溃疡性结肠炎患者急性期应用柳氮磺胺吡啶和糖皮质激素可降低TNF-α(急性期1.22±0.02,慢性期0.78±0.08,P<0.01)、IL-2(急性期0.82±0.06,慢性期0.47±0.04,P<0.01)的表达;提高IL-10(急性期0.68±0.03,慢性期0.91±0.02,P<0.01)的表达.结论:溃疡性结肠炎患者以分泌Th1细胞因子为主,存在Th1和Th2细胞因子的平衡漂移.提示他们在溃疡性结肠炎的发生发展中起了重要作用.
-
溃疡性结肠炎组织中NF-κB,OX-2和iNOS表达的意义
目的:转录因子NF-кB的诱导,调控着免疫和炎症反应中众多基因的表达.溃疡性结肠炎(ulcerative colitis,C)存在上皮细胞、淋巴细胞、巨噬细胞的异常激活及细胞因子的表达失调.我们检测了UC组织中NF-кBp65,及两种启动子含NF-кB结合位点的蛋白COX-2和iNOS的表达和分布,探讨他们在UC发病机制中的作用,及三者之间的关系.方法:用免疫组化SP法检测39例活动期溃疡性结肠炎内镜活检标本及30例正常对照石蜡包埋组织中NF-κBp65,OX-2和iNOS的表达情况.结果:UC组p65,OX-2和iNOS均为阳性表达,主要分布于上皮细胞.固有层炎性细胞及血管内皮细胞也有程度不同的表达对照组均为阴性或弱阳性表达.三者在UC组的表达与对照组相比,差异均有非常显著性(P<0.01).p65的表达与内镜及病理分级有关.内镜Ⅱ级与Ⅰ级比较(5.8±2.6 vs 3.6±1.9),差异显著(P<0.05).病理Ⅱ,Ⅲ级与Ⅰ级比较(6.1±2.4,.3±2.5 vs 4.0±2 3),差异显著(P<0.05,<0.01).iNOS的表达与病理分级有关,Ⅲ级与Ⅰ,Ⅱ级比较(7.8±2.5 vs 4.6±2.3,5.0±1.6),差异显著(P<0.01,<0.05).COX-2的表达在病情轻重,内镜及病理分级间差异无显著性(P>0.05).p65与COX-2,NOS表达显著相关(rs1分别为0.713,.706;P<0.01),COX-2与iNOS表达显著相关(rs1=0.854,<0.01).结论:NF-кB的诱导参与UC的发生、发展.COX-2,NOS也参与UC的炎症及损伤过程,可能iNOS发挥的作用更显著.COX-2,NOS表达的调控机制可能相似,且与NF-κBp65的诱导有直接关系.
-
重视溃疡性结肠炎的诊断和个体化规范化治疗
溃疡性结肠炎的诊断和治疗对于临床医生仍然是-个挑战.诊断方面,因为该病缺乏特异的诊断指标,必须强调排除性和综合性的原则,要做到这些有时是非常困难的.治疗方面,由于该病病因和发病机制目前还不完全清楚,因此治疗缺乏特异性,对如何减少复发以及提高难治性患者的疗效仍然是一个难题.而在我国,没有一个适合我国国情的规范化治疗方案则是突出的问题.本文结合我们自己的工作,提出了在分型基础上进行个体化规范化治疗的建议,以期引起对这个问题的重视和探讨,形成具有中国特色的创新性治疗方案.
-
In the western world a sharp rise in the incidence of inflammatory bowel disease (IBD) has been observedsince the early 1950s. The increase in the incidence of ulcerative colitis preceded the increase in the incidenceof Crohn's disease by about 10 - 15 years. In high incidence areas, a female preponderance at a young age isobserved in Crohn's disease, whereas in ulcerative colitis male incidence is still high at older ages. IBD ismore common in the western world than in eastern areas and, in both the United States and Europe, a north-south gradient has been reported, with IBD more common in the north than in the south. There are alsoindications that in typically low-incidence areas, more cases are being seen lately. Rates for Japan suggestthat this Asian population is now affected with approximately equal frequency as western populations withregard to ulcerative colitis; Crohn's disease in contrast is still less common. The prevalence of Crohn'sdisease in the Chinese populations in Hong Kong and Singapore appears to be increasing, and more cases havealso been observed lately in central China. This could be due to a greater awareness and better availability ofhealth care and/or improved study methods. However, it may also be a real increase, reflecting changingenvironmental factors. Both genetic factors and environment are thought tO be important in developing IBD,the observed increase during the past decennia is probably due to environmental factors since genetic make-upcannot change that quickly. Smoking is the only consistent risk factor in case-control studies, but does notseem to explain the observed changes in incidence and age and gender distribution in the two diseases,nutrition and life-style factors changed to a great extent during the period in which the rising incidence ofIBD has been reported. Following the temporal trends in these areas and using case-control settings in apopulation based manner during the coming years should prove to be of great interest, as this might shedsome light on the role of environmental factors in the etiology of IBD.
-
AIM To observe the effect of herbs-partition moxibustion on IL-1β and TNF-c in UC rats.METHODS The animal models were created by immunological method. They were divided into 5 groups atrandom, after treated by different methods, IL-1β and TNF-α in colon tissue of UC rats were detected withimmunologic technique.RESULTS In control group, there was a little or no IL-1β positive cell in colon mucosa. Compared withthat in rats of control group, the number of IL-1 positive cell in model group was much larger, and IL-1βcells with brown granules were mainly expressed in cytoplasm of macrophage in lamina propria of colon.Compared with model group, IL-1β positive cells in mild moxibustion group markedly decreased (P < 0.05),and those in electro-acupuncture group and herbs-partition moxibustion group decreased even more markedly(P < 0.01). The difference between the last two groups is evident (P < 0.05). TNF-α positive cells are not or seldomly found in UC rats, but in model group, these cells increasedevidently, which were mainly the macrophages in lamina propria of colon. Compared with those in modelgroup, the positive cells decreased markedly in electro-acupuncture group (P<0.05), and decreased moremarkedly in mild moxibustion group and in herbs-partition moxibustion group (P<0.01). There werestatistically significant differences between herbs-partition moxibustion group and electro-acupuncture group(P<0.05).CONCLUSION The mechanism of acupuncture and moxibustion may be that inhibited macrophageactivation, reduced expression of IL-1β and TNF-a and thereby blocking their further activation and thencontrolled, the initiated inflammation and its immunity cascade reaction and resulted in restoring the normalimmunity function and benefited in healing of ulcer.
-
The 1990's have brought a significant promise and the hope for a better and brighter future in the new millennium for patients with inflammatory bowel disease (I3D). A better understanding of the pathophysiology of IBD symptoms has led to newer treatnent modalities and streamlining of therapy for specific subsets of patients. ULCERATIVE COUTISThe treatnent for ulcerative colitis (UC) is aimed at modulating the inflammatory response. The drugs which are found to be effective are sulfasalazine (Azulfidine, Salazopyrin) and its 5ASA derivatives, glucocorticosteroids, immunomodulators/immunosuppressants, and other new potential drugs (Table 1).