目的 探讨黄葵敛疡汤灌肠对轻中度活动期溃疡性结肠炎(ulcerative colitis,UC)的临床疗效及安全性.方法 选取该院2016年1月-2020年6月UC患者101例,以黄葵敛疡汤灌肠为主治疗.比较治疗前后部分Mayo评分、中医证候积分、肠镜及炎症指标变化情况,判定临床疗效.结果 黄葵敛疡汤治疗UC的总有效率为74.20％(77/101),UC患者的部分Mayo评分、中医证候积分较治疗前显著降低(P＜0.01),腹泻、脓血便、腹痛、里急后重等单项证候积分也较前显著下降(P＜0.05).其中近期复查肠镜或炎症指标的UC患者,肠镜及粪便钙卫蛋白有显著改善(P＜0.05).结论 黄葵敛疡汤治疗轻中度活动期UC疗效确切,值得临床推广应用.

目的 以炎症小体NLRP3为切入点,探讨黄葵敛疡汤对溃疡性结肠炎(ulcerative colitis,UC)的治疗作用.方法 将50只C57BL/6小鼠随机分为正常组,模型组,美沙拉嗪组(0.82 g·kg-1),黄葵敛疡汤低、高剂量组(10.98、21.96 g·kg-1),每组10只.以2.5％葡聚糖硫酸钠(dextran sulfate sodium,DSS)溶液建立UC模型.观察并记录小鼠每日进食和饮水情况、统计疾病活动指数(disease activityindex,DAI)评分、测量结肠长度;采用苏木素-伊红(hematoxylin-eo-sin stain,HE)染色法观察小鼠结肠组织病理学变化;以实时荧光定量PCR法检测各组小鼠结肠组织中白细胞介素(IL)-1β、IL-18、IL-6、TNF-α、NLRP3、ASC和Caspase-1的mRNA表达;分别采用免疫组织化学染色法和蛋白免疫印迹法考察小鼠结肠组织中NLRP3蛋白表达.结果 与正常组相比,模型组小鼠DAI评分显著升高,肠壁组织明显破坏,NLRP3、ASC和Caspase-1 mRNA表达和蛋白表达明显升高(P＜0.05,P＜0.01);与模型组相比,各给药组小鼠结肠组织破坏明显得到改善,其中,黄葵敛疡汤高剂量组小鼠结肠组织中NLRP3、ASC和Caspase-1 mRNA表达和蛋白表达显著降低(P＜0.05,P＜0.01).结论 黄葵敛疡汤可通过抑制炎症小体NLRP3活化缓解DSS所致小鼠溃疡性结肠炎.

白介素-1受体相关激酶家族(IRAKs)是一类丝氨酸-苏氨酸激酶,介导来自TLRs和白介素-1受体(IL-1R)的信号激活.IRAKs由4名成员组成:IRAK1、IRAK2、IRAKM、IRAK4,与先天免疫、适应性免疫和炎症的正向或负向调节密切相关.越来越多证据表明,IRAKs在炎症性肠病(IBD)发生发展中起重要免疫调节作用.本文就IRAKs的结构、功能、转录和调控及其在IBD中的作用进行综述,以期寻找新的IBD诊治靶点.

ABSTRACT Patients with ulcerative colitis (UC) have a high prevalence of mental disorders, such as depression and anxiety. Gut microbiota imbalance and disturbed metabolism have been suggested to play an important role in either UC or mental disorders. However, little is known about their detailed multi-omics characteristics in patients with UC and depression/anxiety. In this prospective observational study, 240 Chinese patients were enrolled, including 129 patients with active UC (69 in Phase 1 and 60 in Phase 2; divided into depression/non-depression or anxiety/non-anxiety groups), 49 patients with depression and anxiety (non-UC), and 62 healthy people. The gut microbiota of all subjects was analyzed using 16S rRNA sequencing. The serum metabolome and proteome of patients with UC in Phase 2 were analyzed using liquid chromatography/mass spectrometry. Associations between multi-omics were evaluated by correlation analysis. The prophylactic effect of candidate metabolites on the depressive-like behavior of mice with colitis was investigated. In total, 58% of patients with active UC had depression, while 50% had anxiety. Compared to patients with UC without depression/anxiety, patients with UC and depression/anxiety had lower fecal microbial community richness and diversity, with more Lactobacillales, Sellimonas, Streptococcus, and Enterococcus but less Prevotella_9 and Lachnospira. Most metabolites (e.g., glycochenodeoxycholate) were increased in the serum, while few metabolites, including 2ʹ-deoxy-D-ribose and L-pipecolic acid, were decreased, accompanied by a general reduction in immunoglobulin proteins. These related bacteria, metabolites, and proteins were highly connected. A prophylactic administration of 2ʹ-deoxy-D-ribose and L-pipecolic acid significantly reduced the depressive-like behaviors in mice with colitis and alleviated the inflammatory cytokine levels in their colon, blood and brain. This study has identified a comprehensive multi-omics network related to depression and anxiety in active UC. It is composed of a certain set of gut microbiota, metabolites, and proteins, which are potential targets for clinical intervention for patients with UC and depression/anxiety.

早期结直肠癌可通过内镜黏膜切除术(EMR)或内镜黏膜剥离术(ESD)治疗,但如果术后病理显示存在预后不良的危险因素,则需追加根治性手术.在结直肠癌根治手术中,提高转移淋巴结的检出率及清除率对判断肿瘤分期、改善预后等意义重大.纳米碳淋巴示踪技术能够对淋巴结进行染色定位,提高根治术中淋巴结的检出率.现报道1例内镜黏膜剥离术后追加纳米碳淋巴染色辅助下腹腔镜结肠癌切除术,治疗乙状结肠癌患者的诊疗经过,通过对此病例的分析,以期对临床工作有所帮助.

溃疡性结肠炎(UC)当前治疗策略能够大大改善患者临床结局,但是总体治疗效果仍远未达到最佳状态.中医药发挥整体调控,多靶点作用的优势,在UC治疗中具有显著的疗效.“证候”是中医领域研究的核心问题,但中医证候缺乏客观、量化指标制约中医学的发展和中医现代化的进程.系统生物学是一种整合性研究方法,通过研究生物系统中不同部分(基因、蛋白质、代谢物等)之间的相互关系和相互作用,从整体性、动态性、多维度的角度去解析生命活动过程及机制,其研究特点与中医药“整体观”、“辨证论治”十分契合,在中医药研究中发挥了重要作用.本文通过阐释系统生物学的UC中医证候研究现状,从系统生物学角度提出UC疾病研究的未来展望.

溃疡性结肠炎( ulcerative colitis,UC)是一种反复发作的慢性炎症性疾病,以腹痛、腹泻、黏液脓血便等为主要临床表现.UC确切的发病机制目前尚未明确,基因改变以及肠道免疫系统失调引起的肠黏膜持续性炎症,肠屏障功能改变可能是导致其发病的重要原因.炎症小体作为固有免疫的重要组成部分,在肠道微生物感染、黏膜免疫反应以及代谢过程的调节中发挥了关键作用[1].炎症小体包括NL-RP1、NLRP3、NLRC4、AIM2、NLRP6 等亚型,其中NLRP3是研究最为全面的亚型之一,正迅速成为肠道内稳态和肠道炎症反应的重要调节因子.本文聚焦NLRP3炎症小体与UC的关系,综述近年来中医药干预NLRP3炎症小体治疗UC的相关研究进展,更好地发挥中医药治疗优势.

溃疡性结肠炎是一种病因未明的慢性非特异性炎症性肠病.临证可衷中参西,临证运用现代医学诊断技术指导诊疗.根据本病所处不同阶段,宏微观辨证结合,分期论治:急性期多寒热错杂证,以祛实为要,兼以扶正;缓解期多虚实夹杂证,以补虚为主,兼以祛邪.从疡论治,拟经验方黄葵敛肠汤局部灌肠,使药物直达病所,可快速修复肠道黏膜.针对溃疡性结肠炎常合并抑郁状态,遵循脑肠同治原则,制订全方位治疗方案.附验案1则以佐证.

溃疡性结肠炎(UC)的发病机制与炎症通路的激活密切相关,其中Toll样受体4(TLR4)/髓样分化因子88(MyD88)/核因子-κB(NF-κB)信号通路在UC发病中起关键作用.综述了姜黄素、小檗碱、鸦胆子苦醇、黄芩苷、雷公藤多苷等中药活性成分及泄浊解毒方、乌梅丸、芍药汤、葛根芩连汤等中药复方制剂,通过干预TLR4/MyD88/NF-KB信号通路中不同细胞因子的结合及影响其表达水平,抑制NF-κB的活化,从而降低信号通路下游炎症因子的水平,缓解UC病情.参考文献50篇.