重症溃疡性结肠炎药物治疗的进展与困惑

目前临床上对重症溃疡性结肠炎患者的治疗多采用糖皮质激素、免疫抑制剂、生物制剂和抗生素等,使病情得到缓解。然而,这些药物的长期疗效、副作用等需要进一步临床观察,根据病情合理选择有效药物治疗。     

重症溃疡性结肠炎药物治疗的进展与困惑

目前临床上对重症溃疡性结肠炎患者的治疗多采用糖皮质激素、免疫抑制剂、生物制剂和抗生素等,使病情得到缓解。然而,这些药物的长期疗效、副作用等需要进一步临床观察,根据病情合理选择有效药物治疗。     

炎症性肠病的临床治疗新进展

炎症性肠病是一种累及胃肠道的慢性疾病,目前主要治疗药物如氨基水杨酸制剂和免疫抑制剂均有一定的局限性.英夫利昔等多种生物制剂的使用,临床已取得可靠疗效,为患者带来更多治疗机会.随着对炎症性肠病发病机制认识的不断深入,针对免疫功能异常的新的治疗手段也越来越被人们所接受和使用,本文就目前IBD的生物免疫治疗进展做一综述.     

化学性免疫调节剂在溃疡性结肠炎中的应用

近年来,免疫调节剂（如硫唑嘌呤、6-巯基嘌呤、甲氨喋呤、环孢素等）已广泛应用于临床中,主要用于治疗激素依赖型或激素无效的溃疡性结肠炎患者,显示有良好的疗效。然而,这些药物的剂量、副作用和长期维持治疗,应根据个人的具体情况适当选择适应证,以达到最佳疗效。     

溃疡性结肠炎患者TPMT基因多态性的研究

为探讨溃疡性结肠炎患者硫嘌呤甲基转移酶(TPMT)基因多态性分布,预测服用硫唑嘌呤(AZA)的溃疡性结肠炎(UC)患者疗效和副作用,实验测定2010年7月～2011年8月昆明医科大学第一附属医院确诊的40例溃疡性结肠炎患者和30例健康对照者TPMT基因型,调查其中9例服用AZA患者的疗效和安全性.结果在2例发生骨髓抑制的患者中发现TPMT* 3C杂合子;其余病例未发现TPMT突变等位基因.结果提示UC患者服用AZA安全有效;TPMT基因多态性检测能在一定程度上预测UC患者使用AZA的副反应并指导临床药物用量.     

全面分析溃疡性结肠炎发病的危险因素

溃疡性结肠炎是一种慢性非特异性结肠炎症,是多因素共同作用的综合结果。在研究其发病因素的过程中,应用系统论的方法综合考虑各危险因素的作用,尤其是在新的医学模式下社会心理因素对其的影响,能更加全面的把握溃疡性结肠炎发生的作用机制,从而更好地指导临床治疗的开展。     

全面分析溃疡性结肠炎发病的危险因素

溃疡性结肠炎是一种慢性非特异性结肠炎症,是多因素共同作用的综合结果.在研究其发病因素的过程中,应用系统论的方法综合考虑各危险因素的作用,尤其是在新的医学模式下社会心理因素对其的影响,能更加全面的把握溃疡性结肠炎发生的作用机制,从而更好地指导临床治疗的开展.     

溃疡性结肠炎患者的心理治疗策略

溃疡性结肠炎是一种病因未明、反复发作的肠道慢性炎症.其发生除与遗传、环境和免疫因素有关外,也与精神心理因素有关.精神心理因素可能是通过改变下丘脑-垂体-肾上腺轴、细菌黏膜间相互作用和肥大细胞的活性增加等途径导致该病的发生或复发.药物治疗的同时进行心理干预治疗可能有利于该病的康复.     

溃疡性结肠炎患者的心理治疗策略

溃疡性结肠炎是一种病因未明、反复发作的肠道慢性炎症。其发生除与遗传、环境和免疫因素有关外,也与精神心理因素有关。精神心理因素可能是通过改变下丘脑-垂体-肾上腺轴、细菌黏膜间相互作用和肥大细胞的活性增加等途径导致该病的发生或复发。药物治疗的同时进行心理干预治疗可能有利于该病的康复。     

结肠镜检查对溃疡性结肠炎的诊断价值

结肠镜能直观地评价结肠有无炎症或炎症的性质、程度以及部位,并能辅以活体病理检查,在溃疡性结肠炎的诊断与鉴别诊断中起十分重要的作用。又因溃疡性结肠炎病变多累及黏膜浅层,故结肠镜检和活检意义均较高．因此,近年来已经有倾向将结肠镜检列为诊断溃疡性结肠炎的常规和必需检查。本文详细介绍了内镜下溃疡性结肠炎表现、病变分布范围与方式、活动性评价、鉴别诊断及活组织学检查的重要性。     

A Study of the Effects of Restraint Stress on Colitis Induced by Dextran Sulphate Sodium in Singly Housed Rats

The inflammatory bowel diseases (Crohn's disease and ulcerative colitis) are multifactorial diseases. Clinical reports indicate that emotional stress may contribute to the onset, progression and remission of these diseases. Using an experimental animal model of ulcerative colitis, the effect of stress on the development of and recovery from symptoms was studied prospectively. Singly housed rats received 4 percent dextran sulphate sodium orally until fecal blood was detected, indicating the presence of colonic erosions. Tap water was then administered until there were no signs of fecal blood. Two hours of restraint stress were administered daily over four successive days, either prior to or after the induction of colitis. Latencies in days to symptom development and recovery were compared to an unstressed group. Daily measures of fluid-intake, body-weight, and hemoglobulin in feces were made. RESULTS: Rats exposed to restraint stress procedures prior to induction of colitis had shorter latencies to development of symptoms. There was no significant difference in latency to recovery. The amount of fluid-intake did not significantly differ between groups, nor did the groups differ in body-weight. CONCLUSION: There is an effect of stress on the latency to develop colitis induced by dextran sulphate sodium. This preliminary study suggests that the impact of stress may be one factor underlying the emergence of ulcerative colitis.     

A study of the effets of restraint stress on colitis induced by dextran sulphate sodium in singly housed rats

The inflammatory bowel diseases (Crohn’s disease and ulcerative colitis) are multifactorial diseases. Clinical reports indicate that emotional stress may contribute to the onset, progression and remission of these diseases. Using an experimental animal model of ulcerative colitis, the effect of stress on the development of and recovery from symptoms, was studied prospectively. Singly housed rats received 4 percent dextran sulphate sodium orally until, fecal blood was detected, indicating the presence of colonic erosions. Tap water was then administered until there were no signs of fecal blood. Two hours of restraint stress were administered daily over four successive days, either prior to or after the induction of colitis. Latencies in days to symptom development and recovery were compared to an unstressed, group. Daily measures of fluid-intake, body-weight, and hemoglobulin in feces were made. Results  Rats exposed to restraint stress procedures prior to induction of colitis had shorter latencies to development of symptoms. There was no significant difference in latency to recovery. The amount of fluid-intake did not significantly differ between groups, nor did the groups differ in body-weight. Conclusion  There is an effect of stress on the latency to develop colitis induced by dextran sulphate sodium. This preliminary study suggests that the impact of stress may be one factor underlying the emergence of ulcerative colitis.     

Questions at the general hospital. Ulcerative colitis and Crohn disease in the light of a discussion on the body and soul

The author is an internist in a non-university hospital. He discusses the possibilities and limits of dealing with patients suffering from ulcerative colitis and Crohn's disease. He demonstrates the clinical importance of a psychoanalytic perspective with three case illustrations.     

溃疡性结肠炎的血清学诊断

对溃疡性结肠炎（UC）的诊断应结合临床表现、内镜、实验室、放射学及病理学检查等。血清学标志物在鉴别UC和克罗恩病中有一定价值,包括核周型抗中性粒细胞抗体、抗酿酒酵母抗体、抗胰腺腺泡抗体、抗细胞外膜蛋白复合物抗体和抗12抗体等。这些抗体的检测对UC的诊断和鉴别诊断、活动度判定、亚型分层以及对治疗的反应方面有重要价值。     

炎症性肠病的基因学诊断

炎症性肠病（IBD）是一种涉及多基因的复杂疾病,传统的IBD的诊断方法是依靠病史和临床表现、结肠镜检、钡剂灌肠、病理检查及实验室检查等综合性诊断,但难以满足病因学及亚型分类,随着IBD易感基因的发现,采用血清免疫学和基因标志物来诊断和鉴别IBD与其他疾病以及评估临床病程及预后等成为可能。现将IBD易感基因以及临床应用作一综述。     

The Double Bind Hypothesis and the Parents of Schizophrenics

This paper is a report of an investigation in which the interaction of parents of schizophrenics, in response to a double bind situation, was compared with that of parents of delinquents, ulcerative colitis patients, and controls. Differences in the parental transactions that are related to the offsprings' pathology are reported. The parents of schizophrenics were also exposed to a non-double-binding situation and significant differences in their interaction are described. The results support the double bind hypothesis as a theory of the current family situation of the schizophrenic.