Objective To assess the efficacy and safety of mesalazine versus sulfasalazine in the treatment of ulcerative colitis.Methods The literatures were searched from PubMed (1966 to January 2010), the Cochrane Library (1966 to January 2010), EMbase (1974 to January 2010), CNKI (1994 to January 2010), VIP (1989 to January 2010), and CBM (1978 to January 2010). The data were extracted, the quality of studies was evaluated according to The Cochrane Handbook, and meta-analyses were performed using RevMan 5.0 software. Results Sixteen RCTs involving 1 333 patients were included in this study. The results of meta-analyses showed that the total effective rate of the mesalazine group was significantly higher than that of the sulfasalazine group (RR=1.10, 95%CI 1.04 to 1.17, Plt;0.05), and significant differences were noted in the total remission rate (RR=1.82, 95%CI 1.14 to 2.91, Plt;0.05), while there was no significant difference in the relapse rate between the two groups (RR=0.86, 95%CI 0.57 to 1.29, Pgt;0.05). Twelve RCTs reported adverse effects and meta-analyses showed that the incidence of adverse effects was significantly lower in the mesalazine group than in the sulfasalazine group (RR=0.56, 95%CI 0.42 to 0.73, Plt;0.05). Conclusion Analyses show that mesalazine is much more effective and safe in the management of ulcerative colitis than sulfasalazine. However, there is a moderate risk of bias due to methodological quality problems in all 16 included RCTs, so more strictly-designed multi-centered randomized controlled trials with high quality in large-scale are needed to confirm this result.
Objective To evaluate the effectiveness and safety of probiotic agents for ulcerative colitis. Methods We searched electronically the Cochrane Central Register of Controlled Trials (Issue 1, 2007), MEDLINE (1978 to 2007), EMBASE (1978 to 2007), OVID Database (1978 to 2007), Chinese Biological Medicine Database (CBM Disc) (1978 to 2007), CNKI (1979 to 2007), Chinese VIP Database (1989 to 2007) and Wanfang Database (1978 to 2007). We also checked the reference lists of retrieved articles and hand-searched 4 kinds of important journals to identify randomized controlled trials of probiotic agents for ulcerative colitis. Meta-analyses were conducted with The Cochrane Collaboration’s RevMan 4.2 software. Results Thirteen trials involving 1146 patients were included. Meta-analyses showed that probiotic agents were not superior to aminosalicylates for the clinical remission rate (OR 0.93, 95% CI 0.53 to 1.66; P=0.82); but the combination of probiotic agents and aminosalicylates were superior to aminosalicylates alone (OR 2.69, 95% CI 1.57 to 4.61; P=0.0003). In terms of the clinical relapse, the rate for probiotic agents was superior to that for placebo (OR 0.03, 95% CI 0.00 to 0.15; Plt;0.0001); but not superior to aminosalicylates (OR 0.95, 95% CI 0.65 to 1.38; P=0.79). The combination of probiotic agents and aminosalicylates was not superior to aminosalicylates alone (OR 0.57, 95% CI 0.24 to 1.32; P=0.19). As for the incidence of adverse effects, probiotic agents were not superior to aminosalicylates (OR 0.85, 95% CI 0.43 to 1.70; P=0.65); and the combination of probiotic agents and aminosalicylates was not superior to aminosalicylates alone (OR 0.30, 95% CI 0.06 to 1.54; P=0.15). Conclusion Probiotic agents are not superior to aminosalicylates based on the evidence in this review, but the combination of probiotic agents and aminosalicylates is superior to aminosalicylates alone in maintaining remission. Probiotic agents are superior to placebo but not superior to aminosalicylates, and the combination of probiotic agents and aminosalicylates is not superior to aminosalicylates alone in preventing relapse. Probiotic agents have good tolerability. However, all these findings should be interpreted with caution and more clinical trials are needed.
目的 针对近期收治的1例常规治疗疗效不理想的溃疡性结肠炎患者,我们进行了证据检索和评价,以期找到更有效的治疗方法.方法 计算机检索MEDLINE(1978～2004)、CBMdisc(1978～2004)及Cochrane图书馆(2004年第3期),查找 5-氨基水杨酸(5-ASA)灌肠液治疗溃疡性结肠炎及与病情缓解有关的系统评价、临床随机对照试验等,并对所获证据进行评价.结果 高质量的临床证据表明,5-ASA灌肠液治疗溃疡性结肠炎及帮助病情缓解均优于口服5-ASA及柳氮磺胺嘧啶局部灌肠治疗.据此临床证据,结合医生经验及病人意愿,对该例患者实施5-ASA 1g+生理盐水100 ml qd,睡前保留灌肠治疗.1周后,患者临床症状明显缓解,腹泻基本停止,每天解黄色黏液便1～2次.肠镜复查,炎症较前明显减轻.出院后继续用上述方案维持治疗,每周2次.门诊随访1年,患者未再复发,也无明显副作用发生.结论 5-ASA灌肠液是控制溃疡性结肠炎活动期间病情及帮助缓解、减少复发的有效药物.
Objective To explore the value of fecal calprotectin （FCP） in the activity evaluation for ulcerative colitis （UC）. Methods Sixty three patients with UC （UC group） and 30 patients with gastrointestinal symptoms but without abnormal results of colonoscopy （control group）， who were treated in The Forth Affiliated Hospital of China Medical University between Sep. 2007 to Dec. 2009 were enrolled to examine the FCP， C-creative protein （CRP）， and erythrocyte sedimentation rate （ESR）. Then comparison between UC group and control group was performed. Results Levels of FCP and CRP in active gradeⅠ，Ⅱ， and Ⅲ group were all significantly higher than those of control group and inactive UC group （P＜0.05）， with the increase of active grade of UC， the level of FCP gradually increased （P＜0.05）. The levels of CRP in active grade Ⅱ and Ⅲ group were all significantly higher than those of gradeⅠgroup （P＜0.05）， but didn’t differed between active grade Ⅱ and Ⅲ group （P＞0.05）. There were no significant difference among 5 groups on ESR （P＞0.05）. Levels of FCP （rs=0.807， P＜0.01）， CRP（rs=0.651， P＜0.01）， and ESR （rs=0.371， P＜0.05） in active grade group were significantly related to histological grade under colonoscopy. Conclusion FCP examination is simple， inexpensive， repeatable， and noninvasive， and FCP can be used as an marker of activity evaluation in UC.
ObjectiveTo summarize the recent progress in studies of intestinal immunity in inflammatory bowel disease (IBD). MethodsThe literatures on studying the intestinal immunity in IBD, including ulcerative colitis and Crohn disease were reviewed and analyzed. ResultsIBD comprised two main diseases that cause inflammation of the intestines: ulcerative colitis and Crohn disease. Although the diseases had some features in common, there were some important differences in clinical symptoms and pathological features. Accumulating evidence suggested that IBD results from an inappropriate inflammatory response to intestinal microbes in a genetically susceptible host. Immunity studies highlighted the importance of host-microbe interactions in the pathogenesis of these diseases. Prominent among these findings were genomic regions containing nucleotide oligomerization domain 2 (NOD2), autophagy genes, miRNAs, and components of the interleukin-23/type 17 helper T-cell (Th17) pathway. The disfunction of the intestinal microbiome, intestinal epithelium, intestinal immune cells, and the intestinal vasculature played a key role in the process of IBD. The treatment with monoclonal antibody had been introduced to treat IBD and had been certificated effective. ConclusionThe study of basic intestinal immunity and regulation network of molecules in pathogenic process of IBD provides theory basis on prevention of IBD, while related genes of IBD can offer more gene therapy targets.
ObjectiveTo investigate the significance of endoscopic punctiform erosion around appendiceal orifice with diffused inflammation in left semicolon in the diagnosis of ulcerative colitis. MethodsTwenty-nine patients with endoscopic punctiform erosion around appendiceal orifice with diffused inflammation in left semicolon treated in West China Hospital from January 2007 to November 2012 were included in our study.Patients with either edema,ulcer,polyps around the appendiceal orifice,inflammation in the ascending colon or transverse colon,or segmental inflammation in left semicolon were excluded.The endoscopic characteristic changes and the final diagnosis were compared by means of the pathological biopsy. ResultsOf the total 29 patients with characteristic changes under the endoscope,26 patients were eventually diagnosed to have left-sided ulcerative colitis,one was identified to be with Cronh's disease,and the remaining two patients could not be classified. ConclusionOur findings suggest that the characteristic changes under the endoscope may help the diagnosis of ulcerative colitis.
ObjectiveTo investigate the effects of Aucklandia and Coptis pills on cellular apoptosis and the expression of Bcl-2 and Bax mRNA in model rats with ulcerative colitis (UC). MethodsFifty male Wistar rats at the age of seven weeks were randomly divided into five groups: control group, model group, Chinese medicine group (Aucklandia and Coptis pills), inhibitor group, and Chinese medicine plus inhibitor group. The experiment was performed with rats of UC induced by trinitro-benzene-sulfonic acid enema. AG-490 and Aucklandia and Coptis pills were administrated to them by intraperitoneal injection and gavage. Colonic mucosal tissues in rats of all the five groups were observed and evaluated by light microscope. Cellular apoptosis in colonic mucosal tissues was detected by TUNEL. The expressions of Bcl-2 and Bax mRNA were detected by reverse transcription polymerase chain reaction. ResultsThere were many ulcers in the colon of UC rats, and pathological changes in colonic mucosa such as inflammation, congestion and edema were observed in the colon of UC model rats by naked eye and microscope. Compared with UC rats without treatment, Aucklandia and Coptis pills alleviated colonic mucosal injuries and decreased apoptosis rate of colonic epithelial cells, while the expression of Bax mRNA was decreased in the colonic mucosa in UC rats treated with Aucklandia and Coptis pills, and Bcl-2 mRNA expression was increased. ConclusionAucklandia and Coptis pills can effectively inhibit mRNA expression of apoptosisrelated molecules to down-regulate colonic epithelial cells apoptosis in colonic mucosa in rats with UC.
ObjectiveTo summarize the significance of laboratory examinations in diagnosis of ulcerative colitis (UC). MethodsLiteratures at home and abroad were searched to review the clinical significance of laboratory examinations indexes in diagnosis of UC. ResultsAnti-neutrophilcytoplasmicantibodies (ANCA) had some value in diagnosis of UC, but it was limited in evaluation of UC in active patients. The positive rate of anti-intestinal goblet cell antibody (GAB) in patients with UC was higher than that of patients with Crohn's disease (CD), so it could be used as identification indexes of the two diseases, but it could not reflect the severity of the disease. Anti-saccharomyces cerevisiae antibodies (ASCA) and anti-pancreatic antibody (PAB) were mainly used in the differential diagnosis of UC and CD, but they had no significant advantages in diagnosis of UC. Fecal calprotectin (FCP) played a positive role in evaluation of recurrence and activity in UC. Although lactoferrin, M2-pyruvate kinase (M2-PK), and S100A12 were not as effective as FCP, but if combined with related indicators, they were also important. ConclusionsOf the relevant indexes of laboratory examination in the diagnosis of UC, FCP plays an importent role in the evaluation of recurrence and activity of UC.