摘要： In a recent issue of the journal, Rahmani et al summarized findings from earlier cohort studies on the association between body mass index (BMI) and risk of inflammatory bowel disease (IBD).[1] They found a significant positive association between BMI and odds of Crohn's Disease (CD) but no association was seen with ulcerative colitis (UC). Body mass index and the risk for Crohn's disease and ulcerative colitis: data from a European Prospective Cohort Study (The IBD in EPIC Study). [Extracted from the article]

关键词： Advanced endoscopy   Endoscopic submucosal dissection   Inflammatory bowel disease   Colorectal dysplasia  

关键词： China   gastroenterologists   inflammatory bowel diseases   vaccination  

摘要： Objective The prevalence of inflammatory bowel disease (IBD) has been increasing worldwide, and the risk of infection has increased due to the use of immunosuppressive and biologic medications. Some of these infections can be prevented with vaccinations. The aim of this study was to evaluate the vaccination practices of Chinese gastroenterologists for patients with IBD. Methods Questionnaires based on quick response codes were sent using email and the WeChat platform to gastroenterologists at 20 hospitals in China. The vaccination practices of the gastroenterologists, including vaccinating for hepatitis B, hepatitis A, and varicella, were assessed. Results Of the 468 gastroenterologists who received the questionnaire, 307 (65.6%) completed it. Of the gastroenterologists who were most concerned about hepatitis B;83.4% always or frequently asked about an infection history, 53.7% took an immunization history, and 73.6% tested patients for hepatitis B infection. However, few gastroenterologists did so for hepatitis A or varicella. The proportion of patients who were asked about an infection and immunization history and tested for varicella infection was 16.0%, 15.0%, and 9.4%, respectively. Only a few gastroenterologists recommended vaccination for patients without an infection before IBD medical treatment (26.7% for hepatitis A, 45.6% for hepatitis B, and 28% for varicella vaccination). Conclusion Vaccination practices for patients with IBD used by Chinese gastroenterologists vary greatly, suggesting that education about immunization is needed.

关键词： Inflammatory bowel disease   ulcerative colitis   Crohn disease   microbiome   microbiota   inflammation   genetics   environmental factors   antibiotics   probiotics   prebiotics   fecal microbiota transplantation  

摘要： Inflammatory bowel disease (IBD) is a chronic immune-mediated disease affecting the gastrointestinal tract. IBD consists of 2 subtypes: ulcerative colitis and Crohn disease. IBD is thought to develop as a result of interactions between environmental, microbial, and immune-mediated factors in a genetically susceptible host. Of late, the potential role of the microbiome in the development, progression, and treatment of IBD has been a subject of considerable interest and enquiry. Indeed, studies in human subjects have shown that the gut microbiome is different in patients with IBD compared with that in healthy control subjects. Other evidence in support of a fundamental role for the microbiome in patients with IBD includes identification of mutations in genes involved in microbiome-immune interactions among patients with IBD and epidemiologic observations implicating such microbiota-modulating risk factors as antibiotic use, cigarette smoking, levels of sanitation, and diet in the pathogenesis of IBD. Consequently, there has been much interest in the possible benefits of microbiome-modulating interventions, such as probiotics, prebiotics, antibiotics, fecal microbiota transplantation, and gene manipulation in the treatment of IBD. In this review we will discuss the role of the gut microbiome in patients with IBD;our focus will be on human studies.

关键词： Inflammatory bowel disease   ulcerative colitis   Crohn's disease   vedolizumab   older onset IBD  

摘要： Background The GEMINI trials established the efficacy of vedolizumab in moderate-to-severe inflammatory bowel disease (IBD) and demonstrated a favorable safety profile, suggesting it may be advantageous in older patients at greater risk of treatment-related complications. However, there is a paucity of data exploring the outcomes of vedolizumab in this group. Our objective was to determine the clinical effectiveness and safety of vedolizumab in older IBD patients within a real-world multicenter UK cohort. Methods A retrospective review of electronic records across 6 UK hospitals was undertaken to evaluate the clinical effectiveness and safety outcomes of vedolizumab in IBD patients aged >= 60 at start of therapy. Rates of clinical response, remission and corticosteroid-free remission were assessed at weeks 14 and 52, using validated clinical indices, and were compared to historical controls from real-world vedolizumab-treated cohorts unstratified by age. Results Of 74 patients aged 60 years or above (median 66 years), 48 were included in our effectiveness analysis (29 ulcerative colitis, 19 Crohn's disease). Rates of clinical response, remission and corticosteroid-free remission at week 14 were 64%, 48% and 30%, respectively. By week 52, the rates of clinical response, remission, and corticosteroid-free remission were 52%, 38%, and 32%, respectively. Six (8%) patients experienced adverse effects. Effectiveness and safety outcomes were comparable to those of age-unstratified vedolizumab-treated cohorts. Conclusion Our 1-year outcome data suggests that vedolizumab is safe and effective in older IBD patients and broadly comparable to cohorts unselected by age.

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关键词： Wnt/β-catenin信号通路   ERS   UPR   结肠炎   黄连素  

摘要： 研究背景:经典的Wnt/β-catenin信号通路在胚胎发育、肿瘤形成和干细胞的维持与分化等生物学过程中起着关键作用。研究表明,Wnt/β-catenin信号通路除了可以调控肝脏的发育及癌变外,还对肝细胞的代谢功能有一定的调节作用,但具体的分子机制仍不明确。肝脏是人和哺乳动物体内极其重要的消化和代谢器官,在发生Ⅱ型糖尿病等代谢紊乱性疾病时,肝脏会出现“选择性胰岛素抵抗”。调控胰岛素信号通路的因素较多,Wnt/β-catenin信号通路对肝细胞内胰岛素信号的作用仍不清楚。同时,基于“肝肠轴”学说,肠屏障和肠道菌群与许多肝脏疾病密切相关。目前仍不清楚肠上皮细胞内的Wnt/β-catenin信号通路是否可以通过影响肠道屏障来调节肠道菌群对肝脏功能的影响。现有的临床前和临床证据表明,肝细胞内持续的内质网应激(Endoplasmic reticulum stress,ERS)会提高包括糖尿病、肥胖和血脂异常在内的代谢性疾病的发病风险。然而,目前并不清楚Wnt/β-catenin信号通路与内质网应激在调控肝细胞代谢方面是否存在相互作用关系。由于肝脏内持续的内质网应激会造成肝损伤及肝代谢异常,可导致肝硬化、肝癌甚至死亡,因此寻找内质网应激型肝损伤的药物是十分必要的。近年来多项研究发现中药组分黄连素具有降血糖、降血脂的药理作用,但其具体的分子生物学机制并不完全清楚。本文将利用HepG2肝癌细胞模型和C57BL/6小鼠模型,探讨Wnt/β-catenin信号在肝细胞代谢、肠屏障中的作用与机制,同时研究黄连素通过抑制肝细胞内质网应激改善肝细胞损伤及代谢紊乱的作用与分子机制。研究目的:1、探究Wnt/β-catenin信号通路对肝细胞代谢的调节作用;2、探明Wnt/β-catenin信号通路通过内质网应激影响肝细胞代谢的分子机制;3、探究Wnt/β-catenin信号通路对肠道炎症发生的调节作用及其分子机制;4、探究黄连素对肝损伤的保护作用及其分子机制。研究方法:1、以HepG2细胞为模型探讨Wnt/β-catenin信号通路的过度激活对肝细胞代谢的作用机制;2、以腹腔注射氯化锂小鼠为模型探讨Wnt/β-catenin信号通路在肝脏代谢紊乱、结肠炎症发生中的作用机制;3、以腹腔注射衣霉素诱导内质网应激型肝损伤小鼠为模型探讨黄连素防治肝损伤的作用及机制;研究结果:1、Wnt信号通路的过度激活会导致肝细胞代谢异常,且抑制内质网应激可改善Wnt信号通路的过度激活所导致的肝细胞代谢异常;2、腹腔注射氯化锂激活Wnt信号通路并导致肝损伤、结肠炎症及肠道菌群紊乱;3、腹腔注射氯化锂引发结肠炎的可能机制:(1)氯化锂能激活巨噬细胞F4/80分泌促炎细胞因子TNFα、IL-1β;(2)氯化锂抑制浆细胞IgA编码基因的转录;(3)氯化锂抑制结肠上皮细胞pigr和claudin-15的表达。4、黄连素通过改善未折叠蛋白反应通路(Unfold Protein response,UPR)和调节肠道菌群来防治内质网应激型肝损伤;研究结论:过度激活Wnt信号通路导致内质网应激进而造成肝细胞代谢异常;同时,过度激活Wnt信号通路导致结肠炎症及肠道菌群紊乱;黄连素可以有效防治内质网应激型肝损伤及代谢异常。

关键词： 肠疾病   饮食   热量限制   肠道菌群   代谢通路  

摘要： 肠道菌群是动物消化道的关键组成部分，可以分解复杂的碳水化合物、蛋白质，并且在一定程度上分解到达下胃肠道的脂肪。肠道菌群在发酵的过程中会产生大量的潜在有益或有害的代谢产物，因此饮食结构（特别是脂肪、蛋白质、碳水化合物的比例）是调节肠道菌群并影响宿主健康的重要驱动因素。长期来看，饮食也是改善代谢最有效和最健康的干预方式。另一方面，在满足机体生长的基础上，减少总热量的摄入(CalorieRestriction，CR)，可以显著延长寿命，改善许多与衰老相关的疾病，近期的研究也指出，肠道菌群在CR改善宿主代谢的过程中发挥着重要的免疫作用。　　为了探究饮食-肠道菌群-代谢之间的关联，为将来科学的饮食干预提供-些参考数据，本研究分析了28种饮食模式下小鼠肠道菌群及其代谢功能的变化。我们首先设置了24种不同脂肪、蛋白质、碳水化合物比例的饮食，并用上述24种食物喂食C57BL/6小鼠12周后，提取盲肠内容物样本进行宏基因组学分析。结果显示对菌群结构差异贡献率最大的5种细菌，分别是Bifidobacteriumpseudolongum、Bacteroidesintestinalis、Bacteroidesthetaiotaomicron、Bacteroidesuniformis、Bacteroidesvulgatus。在低脂肪组(LowFat，LF)，Bacteroidesthetaiotaomicron与蛋白质含量显著负相关(r=-0.37，p＜0.05)，38条代谢通路与蛋白质含量显著正相关，1条代谢通路与蛋白质含量显著负相关。高脂肪组(HighFat,HF),Eubacteriumplexicaudatum(r=0.47,p＜0.05)、Akkermansiamuciniphila(r=-0.35,p＜0.05)、Bacteroidesthetaiotaomicron(r=-0.32,p＜0.05)与蛋白质含量显著相关，IsoprenebiosynthesisⅠ、MethylerythritolphosphatepathwayⅡ与蛋白质含量显著正相关。低蛋白组(LowProtein，LP)，Mucispirillumschaedleri(r=0.31,p＜0.05)、Bacteroidesintestinalis(r=-0.66,p＜0.05)、Eubacteriumplexicaudatum(r=-0.65,p＜0.05)、AnaerotruncusspG3_2012(r=-0.46，p＜0.05)与脂肪含量显著相关，46条代谢通路与脂肪含量正相关，7条代谢通路与脂肪含量负相关。高蛋白组（HighProtein，HP），Mucispirillumschaedleri(r=0.48,p＜0.05)、Bacteroidesintestinalis(r=-0.67,p＜0.05)、Lactococcuslactis(r=-0.32，p＜0.05)与脂肪含量显著相关，22条代谢通路与脂肪含量正相关，7条代谢通路与脂肪含量负相关。　　同时将4种不同CR水平的食物喂养C57BL/6小鼠12周后，取粪便样本进行宏基因组学分析，发现CR处理组的小鼠肠道菌群结构与对照组具有显著差异(adonis，p＜0.05)，CR处理显著升高了Bifidobacteriumpseudolongum的含量，降低了Enterorhabduscaecimuris、Alistipes、Mucispirillumschaedleri、Lactococcuslactis、Peptostreptococcaceae的含量，并显著增强了菌群的糖酵解和支链氨基酸的合成能力，降低了精氨酸的合成功能。　　因此本研究通过分析不同饮食模式下小鼠肠道菌群及其代谢功能的响应特征，表明饮食可以通过调节肠道菌群的结构及代谢功能影响宿主健康，同时CR改善代谢的机制之一可能是促进益生菌的生长并利用菌群提高食物利用率。因此低热量、低脂的饮食干预可以是未来改善与肠道菌群相关的代谢疾病的重要方法之一。

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关键词： ESR   fecal calprotectin   inflammatory bowel disease   TNF-alpha   Urtica Dioica  

摘要： BACKGROUND: Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis in which inflammatory factors are thought to play an important role. OBJECTIVE: This study examined the effects of Urtica dioica leaf extract on tumor necrosis factor alpha (TNF-alpha) and fecal calprotectin as inflammation markers and erythrocyte sedimentation rate (ESR) in patients with inflammatory bowel disease. METHODS: This study was a double-blind, placebo-controlled, randomized, clinical trial, conducted on 64 patients with IBD. The participants were divided into a Urtica Dioica group (n = 32) and a placebo group (n = 32) by permuted block randomization. Subjects received three tablets daily for 12 weeks of either hydroalcoholic nettle extract (400 mg) or a placebo. Levels of TNF-alpha in serum, fecal calprotectin and ESR were assessed at baseline and at the end of study. RESULTS: 59 participants completed the trial. After 12 weeks, levels of TNF-alpha and fecal calprotectin showed a significant reduction in the Urtica Dioica group compared to the placebo group (p < 0.05). No significant difference was found in the level of ESR between the groups at the end of the study. CONCLUSION: Our results indicate that supplementation with hydroalcoholic nettle extract can improve levels of TNF-alpha and fecal calprotectin as inflammatory factors in patients with IBD.