溃疡性结肠炎的研究进展2013.ppt

Introduction  IBD是一种病因尚不十分清楚的慢性非特异性肠道炎症，包括UC和CD 。 其发病率呈逐年上升趋势，且多为青壮年发病，临床表现复杂，并发症严重，肠外表现多样，严重影响个人生活质量和社会生产力。 此外，因其有癌变的风险，备受广大医生的重视。 近年来在国内外IBD基础与临床研究高潮迭起，基础研究的成果直接指向临床治疗，取得了划时代的进展。 探讨和摸索适合国人的治疗方案以降低重症UC的并发症和死亡率显得十分重要。 Epidemiolgy The incidence of UC ranged from 1.0 to 2.0 per 100 000 person years. The prevalence of UC has ranged from 4.0 to 44.3 per 100 000. In a recent study, the speculated prevalence was 11.6/100 000 in China. Compared to time trends in the West, there appears to be a time lag phenomenon involving incidence and and prevalence of IBD with regard to the Asian experience. Ouyang Q, Tandon R, Goh KL et al. Management consensus of inflammatory bowel disease for the Asia-Pacific region. J Gastroenterol. Hepatol. 2006; 21: 1772–82. Lennrd-Jones JE. Incidence of infammatory bowel disease across Europe:is there a difference between north and south?. Gut 1996; 39: 690-697. Etiology and Pathogenesis 目前对IBD病因和发病机制的认识可概括为： 环境因素作用于遗传易感者，在肠道菌群丛的参与下，启动了肠道免疫系统及非免疫系统，最终导致免疫反应和炎症过程。 可能是由于抗原的持续刺激或（及）免疫调节紊乱，这种免疫炎症反应表现为过度亢进或难于自限。 Baumgart DC, Carding SR. Inflammatory bowel disease: cause and immunobiology. Lancet 2007;369:1627–1640. Brown SJ，Mayer I．The immune response in inflammatory bowel disease．Am J Gastroenterol，2007，102：2058—2069． Bernstein CN，Shanahan F．Disorders of a modern lifestylel reconciling the epidemiology of inflammatory bowel diseases．Gut，2008，57：1185-1191． Family history Kitahora et al. found a strong familial occurrence in UC among Japanese patients. In a Korean study, a similar familial aggregation was also reported. Kitahora T, Utsunomiya T, Yokota A. Epidemiological study of ulcerative colitis in Japan: incidence and familial occurrence. The Epidemiology Group of the Research Committee of Inflammatory Bowel Disease in Japan. J. Gastroenterol. 1995; 30 (Suppl. 8): 5–8. Park ER, Yang SK, Myung SJ et al. Familial occurrence of ulcerative colitis in Korea. Korean J. Gastroenterol. 2000; 36: 770–4. Risk factors Objective To screen the risk factors