炎症性肠病的药物治疗现状及进展

炎症性肠病（IBD）病程迁延反复,影响患者生活质量,耗费卫生资源。虽然传统药物如5-氨基水杨酸、糖皮质激素、免疫抑制剂等仍是目前治疗主流,但是大量有关发病机制的研究以及循证医学的发展对IBD的治疗产生了积极的推进作用。IBD的治疗正步入免疫调节的生物学时代,多种新型生物制剂的出现为IBD的治疗提供了新的策略和选择。现就目前IBD药物治疗现状以及最新进展进行综述,以期对临床IBD治疗提供参考。     

艰难梭菌疫苗研究的现状与展望

艰难梭菌是引起伪膜性肠炎的致病菌。目前国内外均出现了同时耐两种主要治疗药物——甲硝唑、万古霉素的菌株,疫苗研究是防治艰难梭菌的重要手段。国外研制艰难梭菌疫苗近20年,取得了一定进展,本文将对现有的艰难梭菌疫苗的研究现状进行总结,并对疫苗的发展进行展望。     

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。     

Effects of guided imagery with relaxation training on anxiety and quality of life among patients with inflammatory bowel disease

Background: Inflammatory Bowel Disease (IBD) impacts quality of life (QoL). Psychological factors influence the course of the disease and should be targeted for intervention.

Methods: Our study was a prospective, randomised control trial. Fifty-six outpatients were randomly chosen and allocated to a treatment group or a waiting-list control group. Treatment group patients attended three relaxation-training sessions and received an audio disc for home practice. Evaluations performed pre and post-treatment: state anxiety was assessed with the State-Trait Anxiety Inventory, QoL with the IBD Questionnaire. The Visual Analogue Scale assessed pain, depression, stress and mood. Patients completed a symptom monitoring diary. The control group's symptoms were monitored without study-related treatment.

Results: Thirty-nine subjects completed the study and were included in the data analysis. Following the relaxation-training intervention, the treatment group's (n?=?18) measured results showed a statistically significant improvement as compared to the control group (n?=?21) (time by treatment interaction): anxiety levels decreased (p?<?0.01), QoL and mood improved (p?<?0.05), while levels of pain and stress decreased (p?<?0.01).

Conclusions: Findings indicate IBD patients may benefit from relaxation training in their holistic care. New studies as well as further investigation of the subject are warranted.     

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.     

Behavioral interventions may prolong remission in patients with inflammatory bowel disease

Inflammatory Bowel Diseases (IBDs) are chronic, relapsing and remitting gastrointestinal conditions with no known cure. Previous studies have linked behavioral factors, including stress and medication adherence, to relapse.

Purpose

We sought to determine the effect of participation in a behavioral self-management program on incidence of flare within 12 months following behavioral intervention when compared to the natural history of flare incidence prior to program participation.

Results

Results from a 2-level regression model indicated that those participants in the treatment group were 57% less likely to flare in the following 12 months (compared to 18% in the control group). The decline in “flare odds” was about 2 times greater in treatment versus controls (OR = 0.52, t(34) = 2.07, p < 0.05). Office visits, ER visits, and disease severity (all p < 0.05) were identified as moderators of flare risk.

Conclusions

We have demonstrated 1) a statistical model estimating the likelihood of flare rates in the 12 months following a behavioral intervention for IBD (compared to a control condition), and 2) that the introduction of a behavioral intervention can alter the natural course of a chronic, relapsing and remitting gastrointestinal condition such as IBD.     

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。     

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。     

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。     

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。