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 compare Crohn disease(CD) with intestinal tuberculosis(ITB) in clinical and multislice CT(MSCT) features that may be helpful for the differential diagnosis. MethodsThirty-eight patients with CD and 13 with ITB proved surgically and pathologically were recruited for this study. The clinical symptoms, laboratory, and MSCT findings in these patients were retrospectively analyzed. ResultsThe MSCT changes helpful in distinguishing CD from ITB included:①CD presented symmetrical intestinal wall thickening in most cases, while ITB were asymmetric (P < 0.05).②The irregular stricture was more common usually shown in CD groups, while coaxial in ITB(P < 0.05).③The lymphadenopathy with obvious enhancement and tortuously mesenteric vessels were frequently found in ITB group (P < 0.05). The clinical features of CD including abdominal pain, diarrhea, fever, anemia, hematochezia, weight loss, and intestinal complications were similar with ITB, and similar results were detected in the laboratory examination including the acceleration of erythrocyte sedimentation rate, postive C-reactive protein, and the reduction of albumin. The feature of hematochezia was more common in CD than in ITB, while concomitant pulmonary tuberculosis was more revealed in ITB(P < 0.05). ConclusionsThe MSCT findings of CD and ITB are characteristic. Combined with the similar clinical and laboratory features, the features of MSCT maybe helpful for definitive diagnosis.
ObjectiveTo investigate long-term efficacy of infliximab (IFX) combined with seton placement in treatment of perianal fistulizing Crohn disease (CD) and to analyze factors affecting its clinical healing and recurrence.MethodsThe patients with perianal fistulizing CD underwent the IFX combined with seton placement therapy from July 2010 to January 2017 were collected from the HIS database of the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine. The healing and recurrence of perianal fistulizing CD were counted and their influencing factors were analyzed.ResultsA total of 103 patients with perianal fistulizing CD were included in the study. After a median follow-up of 36 months, 64 patients (62.1%) had a complete fistula healing, 34 patients (33.0%) relapsed. The cumulative recurrence rates of fistula in the 1, 3, and 5 years was 21.8%, 32.6%, and 37.4%, respectively. The multivariate analysis showed that the Montreal classification B1 ［HR=3.987, 95% CI (1.640, 9.694), P=0.023］ and without abscess ［HR=2.724, 95% CI (1.101, 6.740), P=0.030］ were positively associated with the long-term healing of fistula, and the IFX maintenance treatment >3 times ［HR=5.497, 95% CI (1.197, 25.251), P=0.028］ was a risk factor for the recurrence of the fistula.ConclusionsLong-term healing rate of fistula by IFX combined with seton placement therapy is higher. Montreal classification B1, without abscess, and IFX maintenance treatment less than 3 times are expected to have a better long-term efficacy.
Objective To explore key genes and mechanisms of depression aggravating Crohn disease. Methods In March 2023, the Public Health Genomics and Precision Health Knowledge Base and Gene Expression Omnibus database were used to identify the overlapping differentially expressed genes between Crohn disease and depression and the key genes were screened by Metascape, STRING, Cytoscape, and protein interaction network analysis. The Gene Expression Omnibus database was used to analyze the correlations between key genes and clinical pathologies such as Crohn Disease Endoscopic Index of Severity and intestinal microvilli length. Results There were 137 overlapping differentially expressed genes between Crohn disease and depression, and 25 key genes were further screened out. Among them, CREB1, FKBP5, MAPT, NTSR1, OXTR, PROK2, POMC, HTR2B, and PPARGC1A genes were significantly correlated with multiple clinical parameters. The functions of PROK2 and PROK2-related genes were mainly enriched in neutrophil and granulocyte migration, neutrophil and granulocyte chemotaxis, etc. Conclusions There are 25 key genes, especially CREB1, FKBP5, MAPT, NTSR1, OXTR, PROK2, POMC, HTR2B, and PPARGC1A, that possibly contribute to the establishment and deterioration of Crohn disease caused by depressive disorder. Among these genes, PROK2 showes the possibility of regulating immune cell (neutrophils and CD8+ T cells) infiltration.
ObjectiveTo summarize the occurrence of anal fistula in Crohn disease (CDAF) accompanying with preoperative rectal stenosis and analyze its influencing factors. Meanwhile to explore the effect of improved anal sphincter retention virtual-hanging (hereafter this text will be abbreviated as virtual-hanging) for treatment of CDAF. MethodsThe CDAF patients admitted to the Third People’s Hospital of Bengbu from January 2019 to June 2021 were retrospectively collected, who were treated with virtual-hanging. Meanwhile the multivariable logistic regression analysis was used to identify the risk factors for accompanying with preoperative rectal stenosis and which were used to establish a decision tree model by Chi squared automatic interaction detection method. ResultsA total of 234 patients with CDAF were collected, and the incidence of accompanying with preoperative rectal stenosis was 22.2% (52/234). The multivariate logistic regression analysis found that the patients with preoperative proctitis, Montreal subtype B2, fistula located above the musculi levator ani (MLA), single fistula accompanied by branches or multiple fistulas, lymphocyte count (Lym) ≥6.03×109/L, platelet count (PLT) ≥0.61×109/L, erythrocyte sedimentation rate (ESR) ≥39.11 mm/h, C-reactive protein (CRP) ≥5.13 mg/L, and brain natriuretic peptide (BNP) ≥313.26 ng/L had higher probability of accompanying with preoperative rectal stenosis (P<0.05). For the patients with or without preoperative rectal stenosis, the CD activity index score and perianal CD activity index score, and anal resting pressure all showed decreasing trends after treatment with the virtual-hanging, and the anal maximal contraction pressure showed a increasing trend as compared to before treatment. The decision tree consisted 18 nodes and 9 terminal nodes. The gain map of the decision tree model gradually increased from 0% to 100%; The index chart maintained a high level starting from 198% and then rapidly decreased to 100%. The area under the receiver operating characteristic curve of the decision tree model was 0.852 [95%CI (0.821, 0.908)], with a sensitivity of 84.35% and a specificity of 82.33%. ConclusionsThe incidence of accompanying with preoperative rectal stenosis in patients with CDAF is relatively higher. The effect of virtual-hanging for treatment of CDAF is better. For patients with preoperative proctitis, Montreal subtype B2, fistula above the MLA, single fistula accompanied by branches or multiple fistulas, and higher Lym, PLT, ESR, CRP, and BNP, attention should be paid to their accompanying with preoperative rectal stenosis. The decision tree model based on these factors to distinguish whether accompanying with preoperative rectal stenosis is better.