Effects of oral tacrolimus as a rapid induction therapy in ulcerative colitis

AIM:To determine the efficacy and safety of rapid induction therapy with oral tacrolimus without a meal in steroid-refractory ulcerative colitis(UC)patients.METHODS:This was a prospective,multicenter,observational study.Between May 2010 and August 2012,49 steroid-refractory UC patients(55 flare-ups)were consecutively enrolled.All patients were treated with oral tacrolimus without a meal at an initial dose of 0.1mg/kg per day.The dose was adjusted to maintain trough whole-blood levels of 10-15 ng/m L for the first 2 wk.Induction of remission at 2 and 4 wk after tacrolimus treatment initiation was evaluated using Lichtiger’s clinical activity index(CAI).RESULTS:The mean CAI was 12.6±3.6 at onset.Within the first 7 d,93.5%of patients maintained high trough levels(10-15 ng/m L).The CAI significantly decreased beginning 2 d after treatment initiation.At 2wk,73.1%of patients experienced clinical responses.After tacrolimus initiation,31.4%and 75.6%of patients achieved clinical remission at 2 and 4 wk,respectively.Treatment was well tolerated.CONCLUSION:Rapid induction therapy with oral tacrolimus shortened the time to achievement of appropriate trough levels and demonstrated a high remission rate 28 d after treatment initiation.Rapid induction therapy with oral tacrolimus appears to be a useful therapy for the treatment of refractory UC.

Frequency and prognostic role of mucosal healing in patients with Crohn's disease and ulcerative colitis after one-year of biological therapy

AIM: To assess the endoscopic activity before and after a one-year period of biological therapy and to evaluate the frequency of relapses and need for retreatment after stopping the biologicals in patients with Crohn’s disease (CD) and ulcerative colitis (UC).

Effect of Wumeiwan on Cytokines TNF-α,IL-6,IL-8,IL-10 and Expression of NF-κBp65 in Rats with Ulcerative Colitis

The effects of Wumeiwan （WMW） on TNF-α, IL-6, IL-8, IL-10 and NF-κBp65 in rats with ulcerative colitis （UC） were investigated, the curative effectiveness of WMW vs salicylazosulfapyridine （SASP） was compared, and the action mechanism was analyzed. Fifty-Six Sprague-Dawley （SD） rats were randomly divided into four groups （n=14 in each group, with equal ratio of male and female）： normal control group, model group, SASP group, and WMW group. Except normal control group, the rat UC models in the remaining three groups were established using the method of 2.4-dinitrochlorobenzene （DNCB） immunization and acetic acid local enema. The rats in model group, SASP group, and WMW group were treated with distilled water, SASP, and WMW respectively. The changes in the symptoms and signs were observed, and levels of IL-6, IL-8, TNF-α, IL-10 and the expression of NF-κBp65 in the colonic tissues were statistically analyzed. The results showed that the levels of IL-6, IL-8, and TNF-α were significantly increased （P〈0.01）, while those of IL-10 significantly reduced （P〈0.01） after establishment of rat UC models as compared with normal control group. The levels of IL-6, IL-8, and TNF-α were obviously lower, but the level of IL-10 was obviously higher in WMW and SASP groups than those in model group （P〈0.05）. The levels of IL-6, IL-8, and TNF-α were lower, while the level oflL-10 was higher in WMW group than in SASP group. NF-κBp65 was expressed negatively or weakly in normal colonic tissues. The positive expression rate of NF-κBp65 in WMW group and SASP group was obviously lower than in model group （P〈0.01）, and there was significant difference between WMW group and SASP group （P〈0.05）. It was concluded that rat UC model was established successfully. WMW could up-regulate the expression of IL-10, down-regulate the expression of TNF-α, IL-6, IL-8, and inhibit the NF-κBp65 activity to adjust immune function, indicating WMW had better curative effects on UC in rats.

Effects of four regulating-intestine prescriptions on pathology and ultrastructure of colon tissue in rats with ulcerative colitis

AIM: To observe different histomorphologic changes of ulcerative colitis (UC) rats that were treated with four regulating-intestine prescriptions (FRIP), to investigate the curative effects of FRIP and to analyze their treatment mechanism.METHODS: The UC rat model was made by the method of 2,4-dinitro chloro benzene (DNCB) immunity and acetic acid local enema. Ninety-eight SD rats were randomly divided into seven groups, namely, the normal control group, model group, salicylazosulfapyridine (SASP) group,Wumeiwan (WMW) group, Baitouwengtang (BTWT) group,Senglingbaishusan (SLBSS) group, and Tongxieyaofang (TXYF) group. Each group had 14 rats (with equal ratio of male and female). The six animal model groups of UC-SASP, TXYF, WMW, BTWT, SLBSS, TXYF-were treated by distilled water except the normal control group. Changes of the rat's general conditions after treatment were respectively observed, the colon tissue damage scores were given out, the pathology of colonic mucosa and changes of ultrastructure were analyzed.RESULTS: Different pathological changes on histology were shown after treatment by FRIP. The colon tissue damage score in model group was higher than that of FRIP groups and SASP group (q = 4.59, 4.77, P＜0.05 or q = 5.48,6.25, 5.97, P＜0.01). The scores of WMW group, BTWT group and SLBSS group were lower than that of SASP (q = 4.13, P＜0.05 or q = 5.31, 5.12, P＜0.01). There was no remarkable difference between the damage score of TXYF group and SASP group (q = 3.75, P＞0.05). In addition, some apoptosis cells were found in the pathologic control group.CONCLUSION: The model made with DNCB and acetic acid was successful, and FRIP had better curative effect and WMW was the best curative effect, BTW, SLBSS and TXYF were similar to SASP, and we discovered that apoptosis was possibly related to UC.

Mechanism and Research Progress of Fuyang Huoxue Jiedu Formula against Recurrence of Ulcerative Colitis

By introducing the composition and modern pharmacology of Fuyang Huoxue Jiedu Formula,the paper further explored the mechanism and research progress of Fuyang Huoxue Jiedu Formula against recurrence of ulcerative colitis(UC).The formula can effectively improve the TCM syndromes of UC patients,reduce the recurrence rate,and improve clinical efficacy and patients’quality of life.

中医药调控PI3K/AKT信号通路干预溃疡性结肠炎研究进展

通过干预磷脂酰肌醇3-激酶(phosphatidylinositol 3-kinase,PI3K)/蛋白激酶B(protein kinase B,AKT)信号通路中的相关因子而发挥治疗作用的中医药疗法可分为清热解毒燥湿、活血化瘀止血、健脾温肾祛湿和攻补兼施等,能有效遏制UC的发生发展,其作用机制为:(1)通过抑制上游信号因子表皮生长因子受体,进而抑制PI3K/AKT通路,减少肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)和白细胞介素-6(interleukin-6,IL-6)在内的促炎细胞因子的表达,降低结肠炎症反应,减轻炎症所引起的结肠组织损伤;(2)直接作用于PI3K-AKT通路,进而抑制核转录因子-κB(nuclear transcription factor-κB,NF-κB)的表达,减少细胞凋亡和促炎因子的表达,缓解肠黏膜组织损伤,修复肠黏膜屏障功能的完整性;(3)通过PI3K/AKT途径下调辅助性T细胞17(T helper cell 17,Th17)和辅助性T细胞3(T helper cell 3,Th3)的分化,调节免疫反应及细胞凋亡,改善肠黏膜屏障,缓解UC结肠炎症反应。中医药具有成分复杂,有效成分作用靶点多,治疗途径多样等特点,但其具体分子生物学作用机制尚未完全明确,今后,需对分子生物学作用机制进行深入研究,为临床治疗溃疡性结肠炎等易反复发作的消化性疾病和新药的开发提供新策略。

芒针联合中医辨证干预肝郁脾虚型溃疡性结肠炎临床疗效观察

目的评价芒针疗法联合中医辨证干预肝郁脾虚型溃疡性结肠炎的有效性和安全性。方法选择肝郁脾虚型溃疡性结肠炎患者64例,按照随机数字表法将其分为两组,分别为治疗组和对照组,治疗组根据中医辨证,给予芒针治疗,配合培土疏郁汤口服;对照组口服美沙拉嗪缓释颗粒。比较两组治疗前后的中医证候积分及治疗后临床有效率。结果治疗后,治疗组中医证候积分低于对照组,差异有统计学意义(P<0.01);治疗组的临床总有效率高于对照组,差异有统计学意义(P<0.05)。结论芒针疗法联合中医辨证干预肝郁脾虚型溃疡性结肠炎较单纯西药口服更具有优势,值得临床推广。

基于PI3K/AKT信号通路中医药改善溃疡性结肠炎机制研究进展

溃疡性结肠炎是消化系统常见疾病,磷脂酰肌醇-3-激酶(PI3K)/丝氨酸/苏氨酸蛋白激酶(AKT)与细胞存活、细胞凋亡、炎症等生物学过程密切相关,溃疡性结肠炎的病程中PI3K与AKT表达水平显著升高,细胞凋亡进程加快,炎症水平提高,肠黏膜屏障功能被破坏。近年来,中医药领域开展大量PI3K/AKT信号通路相关基础研究和临床试验,结果表明PI3K/AKT信号通路有望成为溃疡性结肠炎治疗的重要潜在靶点。本文从中药单体、提取物及复方,以及针灸方面综合分析中医药调控PI3K/AKT信号通路干预溃疡性结肠炎的作用机制,认为调控此信号通路对溃疡性结肠炎防治具有重大意义,可为药物研发提供参考。

四神丸治疗溃疡性结肠炎研究进展

四神丸是治疗脾肾泻的经典方剂,具有温肾暖脾、涩肠止泻功效。临床治疗溃疡性结肠炎脾肾阳虚证常以四神丸为基础方加减联合中医其他治法或中西医结合治疗,疗效显著。药理学研究显示,四神丸可能通过调控相关信号通路蛋白表达,调节炎症因子、抑制炎症反应,调节自噬,调节肠道菌群、改善肠黏膜通透性、修复肠黏膜屏障,调节细胞能量代谢,抗氧化应激,调节细胞免疫功能等治疗溃疡性结肠炎。本文对四神丸治疗溃疡性结肠炎研究现状进行整理、归纳,为进一步研究其作用机制及临床应用提供参考。

铁死亡与溃疡性结肠炎及中医药治疗研究进展

溃疡性结肠炎是一种慢性非特异性炎症性疾病,其肠道上皮细胞的持续性损伤是疾病发生发展的关键。近年来,研究人员发现了一种新形式的细胞死亡方式——铁死亡,这被认为是导致肠道上皮细胞死亡的重要因素。铁死亡的发生往往与细胞内铁代谢异常、胱氨酸/谷氨酸反向转运体活性降低、脂质代谢异常、电压依赖性阴离子通道激活以及Nrf2基因过度表达等因素相关。铁死亡能够导致线粒体变小、膜密度增加和嵴数量减少,与传统的细胞死亡方式不同,其并不表现出特定的现象。相关研究发现,中医药能够通过降低细胞内铁含量、抑制脂质活性氧产生、调节Nrf2基因表达等途径来缓解肠上皮细胞的铁死亡,从而起到治疗溃疡性结肠炎的作用。因此,中医药可能成为治疗溃疡性结肠炎的一种重要手段。本文就细胞铁死亡与溃疡性结肠炎的关系以及中医药通过铁死亡通路治疗溃疡性结肠炎的研究进展进行综述。

溃疡性结肠炎的中医药治疗研究进展

溃疡性结肠炎(ulcerative colitis,UC)是一种病因尚不十分明确、以结直肠黏膜连续性、弥漫性炎症改变为特点的慢性非特异性肠道炎性疾病,其病变主要限于大肠黏膜和黏膜下层。西医尚无可治愈该病的特效药物,氨基水杨酸类、糖皮质激素或免疫抑制剂虽对本病均有一定疗效,但服药时间长,不良反应大;中医药治疗慢性溃疡性结肠炎具有自身特点和独特优势,疗效稳定,不易复发,避免了西药治疗带来的不良反应,且治疗费用低廉,符合国情,深受患者欢迎,具有广阔的应用前景。该文就中医治疗溃疡性结肠炎的研究进展进行分析探讨,综述如下。

基于肠道屏障探讨“脾主为卫”在溃疡性结肠炎发病与治疗中的作用机制

溃疡性结肠炎(UC)是一种以肠道屏障受损为特点,表现为直肠黏膜的持续性炎症反应、溃烂以及反复发作的炎症性肠病。脾与肠道屏障有密切联系,“脾主为卫”的功能失调是UC的重要病机,然而对UC中“脾主为卫”功能失调的微观机制尚不清楚。肠道屏障与“脾主为卫”的功能异曲同工,肠道屏障的破坏与UC互为因果,从肠道屏障的角度可以为中医“脾主为卫”理论做出新的科学阐释。现代医学尚缺乏对UC的有效治愈方法,药物治疗仍存在不良反应大、停药后加重、易复发等缺点。而中医基于“脾主为卫”理论的益气健脾治法可有效恢复肠道屏障功能,促进黏膜愈合,且无上述不良反应,对于促进UC的愈合以及防止其复发具有重要的临床价值。

中药灌肠对活动期溃疡性结肠炎肠黏膜及炎性因子影响的Meta分析

目的系统评价中药灌肠对活动期溃疡性结肠炎(UC)肠黏膜及炎性因子的影响。方法选择中国期刊全文数据库(CNKI)、万方数据库(Wanfang)、中国科技期刊数据库(VIP)及PubMed数据库,全面检索关于中药灌肠治疗活动期UC的临床随机对照试验(RCT)。筛选出符合纳入标准的文献,并进行数据提取和质量评价,运用RevMan5.4软件进行数据统计分析。结果最终纳入22篇文献,共计2087例患者。Meta分析结果显示中药灌肠组患者Baron内镜评分、Mayo疾病活动指数评分、黏膜组织Geboes指数评分显著低于对照组(P<0.05);肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、白细胞介素-1β(IL-1β)、白细胞介素-4(IL-4)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)显著低于对照组(P<0.05);转化生长因子-β1(TGF-β1)、白细胞介素-10(IL-10)及临床有效率显著高于对照组(P<0.05)。结论中药灌肠治疗UC可提高临床总有效率,激活IL-10及TGF-β1的表达水平,沉默TNF-α、hs-CRP、IL-1β、IL-4、IL-6、IL-8等促炎因子,减少炎症浸润,修复受损的肠道黏膜。

中药灌肠修复肠黏膜屏障治疗溃疡性结肠炎研究进展

溃疡性结肠炎(UC)是一种慢性非特异性炎症性肠病,肠黏膜屏障受损是其基本病理改变。多项研究表明,中药灌肠能够多靶点、多层面修复肠黏膜屏障,从而遏制UC进展。本文基于UC研究现状、肠黏膜屏障及中药灌肠疗法,对中药灌肠调节肠道菌群防治UC相关研究进行综述,以期为中药灌肠治疗UC提供科学依据。

消痈愈溃汤治疗复发型溃疡性结肠炎经验

复发型溃疡性结肠炎是临床治疗难点,其中医病性乃本虚标实。脾阳亏虚,久则及肾;太少两感,久则累及厥阴,三阴合病,阳气大伤;湿热、浊毒、寒凝、食滞等邪气外侵内袭,伏于肠络,瘀阻化热,熏蒸脂膜而成内疡。正虚无力托疮是发病之本,肠络瘀滞是发病之标,“瘀”作为主要病理因素贯穿疾病始终。采用托疮祛瘀的思路论治,自拟消痈愈溃汤托疮生新,祛瘀消滞,燮理寒热,以扶正托毒,祛瘀通络,使邪去正安,内疡愈合,临证治疗复发型溃疡性结肠炎取得良好疗效。

中医药治疗溃疡性结肠炎知识图谱可视化分析

目的:对近十年中医药治疗溃疡性结肠炎的相关文献进行可视化分析,建立中医药治疗溃疡性结肠炎相关文献CiteSpace的知识图谱,对该领域的研究热点和趋势进行相对客观的研究及总结。方法:检索中国知网、万方、维普、Web of Science 2011年1月1日-2021年12月31日收录的有关中医药治疗溃疡性结肠炎的相关文献,对纳入文献的发文量、作者、研究机构、关键词等方面,利用CiteSpace V5.6.R2软件进行可视化分析。结果:中文数据库纳入2779篇符合要求的文献,Web of Science中纳入259篇符合要求的文献。中文数据库中2012年发文量达到315篇,发文量最多的作者是沈洪教授,发文量最多的机构是南京中医药大学,关键词排名居前3位的是溃疡性结肠炎、中药保留灌肠、中医药疗法。Web of Science中2021年发文量达到70篇,发文量最多的作者是HUANGAN WU教授,发文量最多的机构是上海中医药大学,关键词排名居前3位的是Ulcerative Colitis、Inflammatory Bowel Disease、Traditional Chinese Medicine。结论:本研究基于中国知网近十年的文献,应用CiteSpace V5.6.R2软件对中医药治疗溃疡性结肠炎的相关文献进行可视化分析,对文献的作者、关键词、研究机构做分析性探讨,以了解目前国内中医药治疗溃疡性结肠炎的研究动态及探讨可能的趋势,为后续的进一步研究提供可供参考的依据。总体来讲中医药治疗溃疡性结肠炎研究领域的研究内容及方向趋于稳定,但在研究领域、研究机构合作等方面有重大进展。

复方黄芩汤治疗湿热型溃疡性结肠炎临床观察

目的观察复方黄芩汤对湿热型溃疡性结肠炎(UC)患者炎症因子及免疫功能的影响。方法80例UC患者随机分为对照组和观察组,对照组予美沙拉嗪肠溶片,观察组予复方黄芩汤;比较2组临床疗效、中医证候积分、炎症因子、免疫功能。结果观察组总有效率高于对照组(P<0.05)。观察组中医证候积分改善情况优于对照组(P<0.05)。治疗后,观察组IL-10、CD3^(+)、CD4^(+)/CD8^(+)升高,CD8^(+)、IL-1β、TNF-α降低,改善程度优于对照组(P<0.05)。结论复方黄芩汤可以改善湿热型UC患者的中医证候积分、炎症状态和免疫功能,提高临床疗效。

中医整体护理干预联合自拟中药方灌肠对溃疡性结肠炎患者的应用效果分析

目的:探讨中医整体护理干预联合自拟中药方灌肠对溃疡性结肠炎患者的应用效果,为临床护理提供依据。方法:选取2022年7月—2023年4月济南市第三人民医院脾胃病科收治的84例溃疡性结肠炎患者作为研究对象,按照随机数表法将其分成对照组和观察组,每组各42例。对照组采用常规护理,观察组在常规护理基础上实施中医整体护理联合自拟中药方灌肠干预。比较两组患者干预前后的疗效(改良Mayo评分)、遵医依从性(遵医依从性量表评分)和生活质量[炎症性肠病患者生活质量问卷(IBDQ)评分]情况。结果:干预后,两组患者改良Mayo评分均低于干预前,且观察组低于对照组,差异有统计学意义(t=5.026,P<0.05);干预后,观察组患者遵医依从性量表中饮食、运动、服药维度评分均高于对照组,差异均有统计学意义(t=4.095、5.332、6.388,P<0.05);干预后,观察组患者IBDQ各维度评分及总体评分均高于对照组,差异均有统计学意义(t=6.814、6.865、1.012、7.544、5.628,P<0.05)。结论:对溃疡性结肠炎患者实施中医整体护理干预联合自拟中药方灌肠进行针对性的护理,有利于提高患者的治疗效果和遵医依从性,进而改善其生活质量。

溃疡性结肠炎中医辨证分型与血清pANCA、IL-23水平及疾病严重程度的相关性研究

目的:探究溃疡性结肠炎中医辨证分型与血清核周型抗中性粒细胞质抗体(pANCA)、白介素-23(IL-23)水平及疾病严重程度的相关性。方法:回顾性选取我院2021年1月~2023年6月收治的278例溃疡性结肠炎患者为研究对象,分析患者的临床资料并将纳入的患者进行中医辨证分型。收集所有患者的血清pANCA、IL-23水平;采用Mayo活动性分级评估患者的疾病严重程度分级。通过单因素分析、Pearson相关性分析等方法进行统计分析。结果:278例溃疡性结肠炎患者中,大肠湿热证131例(47.12%),脾肾阳虚证99例(35.61%),血瘀肠络证48例(17.27%)。三种中医辨证分型患者的Mayo活动性评分、血清pANCA、IL-23水平进行比较,差异有统计学意义(P<0.05)。根据Mayo活动性评分将患者分为轻度活动期、中度活动期和重度活动期三种疾病严重程度,共分得轻度活动期116例、中度活动期96例和重度活动期66例,其中轻度活动期主要以脾肾阳虚证为主,中度活动期以大肠湿热证为主(P<0.05),重度活动期例数则无明显差异(P>0.05)。三种疾病严重程度患者的pANCA、IL-23水平呈重度活动期>中度活动期>轻度活动期趋势,差异有统计学意义(P<0.05)。Pearson相关性分析结果显示,血清pANCA、IL-23水平与Mayo活动性评分呈正相关性(P<0.05)。结论:溃疡性结肠炎中医辨证分型与血清pANCA、IL-23水平及疾病严重程度具有一定的关系,临床可根据血清pANCA、IL-23水平及疾病严重程度来判断溃疡性结肠炎患者的中医辨证分型。

温针灸治疗脾虚型溃疡性结肠炎的效果观察

目的:观察温针灸治疗脾虚型溃疡性结肠炎的效果。方法:选取2020年2月—2022年5月滕州市荆河社区卫生服务中心收治的脾虚型溃疡性结肠炎患者66例为研究对象,以随机数字表法分为参照组和研究组,各33例。参照组采用普通针刺法治疗,研究组采用温针灸治疗。比较两组治疗总有效率、中医症状积分。结果:研究组治疗总有效率高于参照组,差异有统计学意义(P=0.004);治疗后,两组黏液脓血便、腹胀痛、充血水肿、里急后重、溃疡、糜烂评分均低于治疗前,研究组低于参照组,差异有统计学意义(P<0.05)。结论:温针灸治疗脾虚型溃疡性结肠炎的效果显著,可降低患者中医症状积分,促进患者临床症状改善。