查看更多>>摘要：克罗恩病（CD）病情复杂，涉及多个学科，规范化诊疗对提高CD的疗效及改善预后非常重要。近年来我国在CD领域的基础及临床研究取得丰硕成果，加上新的诊疗理念、新的治疗药物不断应用于临床，使更新CD诊疗共识意见、为广大临床工作者提供基于最新循证依据的诊治指南成为必要。本指南是由中华医学会消化病学分会炎症性肠病学组结合国外最新共识、国内研究成果和实际情况，在2018年版炎症性肠病诊断和治疗共识意见基础上进行修订。本指南的制定旨在反映当前CD临床诊治的最新理念及研究成果，为CD的临床诊治提供规范化指导意见。 Crohn′s disease (CD) is a complex condition spanning multiple disciplines. Standardized diagnostics and treatment are paramount for enhancing the medical efficacy and improving the prognosis of CD. In recent years, substantial progress has been achieved in both basic and clinical research on CD. The integration of novel diagnostic and therapeutic paradigms, new treatment modalities, have necessitated the update of consensus on CD management, offering imperative, evidence-based guidelines for health providers. This guideline, collaboratively developed by the Inflammatory Bowel Disease Group, Chinese Society of Gastroenterology, incorporates the latest international consensus, domestic research findings, and practical considerations, as an update based on the 2018 Chinese consensus on diagnosis and treatment in inflammatory bowel disease. The formulation of this guideline aims to reflect the latest concepts and research findings in the clinical diagnosis and treatment of CD, providing standardized guidance for the clinical management of CD.
查看更多>>摘要：溃疡性结肠炎（UC）病情反复持久，涉及多个学科，规范化诊疗对提高UC的疗效及改善预后非常重要。近年来我国在UC的基础及临床研究取得诸多进展，加上新的诊疗理念、新的治疗药物不断应用于临床，有必要更新UC诊疗共识意见，为广大临床工作者提供基于最新循证依据的诊治指南。本指南是由中华医学会消化病学分会炎症性肠病学组结合国外最新共识、国内研究成果和实际情况，在2018年版炎症性肠病诊断和治疗共识意见基础上进行修订。本指南的制定旨在反映当前UC临床诊治的最新理念及研究成果，为UC的临床诊治提供规范化指导意见。 Ulcerative colitis (UC) is a chronic and prolonged condition spanning multiple disciplines. Standardized diagnostics and treatment are paramount for enhancing the medical efficacy and improving the prognosis of UC. In the last a couple of years, substantial progress has been achieved in both basic and clinical research on UC in our country. The integration of novel diagnostic and therapeutic paradigms, new treatment modalities, have necessitated the update of consensus on UC management, offering imperative, evidence-based guidelines for health providers. This guideline, collaboratively developed by the Inflammatory Bowel Disease Group of Chinese Society of Gastroenterology of Chinese Medical Association, incorporates the latest international consensus, domestic research findings, and practical considerations, as an update based on the 2018 Chinese Consensus on diagnosis and treatment in inflammatory bowel disease. The formulation of this guideline aims to reflect the latest concepts and research findings in the clinical diagnosis and treatment of UC, providing standardized guidance for the clinical management of UC.
查看更多>>摘要：炎症性肠病（IBD）是一类慢性反复发作的肠道炎性疾病，病因不明，治疗难度大。目前IBD治疗研究进展主要集中在两个方面，一是生物制剂和小分子药物，包括新药新疗法研发和现有药物疗效提升；二是精准医学在IBD治疗中的应用，借助人工智能等技术实现IBD精准治疗。本文就上述内容进行探讨，以期为临床和研究提供借鉴。 Inflammatory bowel disease (IBD) is a chronic and recurrent inflammatory disease of the gastrointestinal tract with unknown etiology and the treatment is difficult. Currently, research progress in IBD treatment mainly focuses on two aspects. The first is the development of biologics and small molecule drugs, including the new drugs and therapies and the improvement of the effectiveness of existing drugs. The second is the application of precision medicine in IBD treatment, utilizing technologies such as artificial intelligence to achieve precise treatment of IBD. This article explores the above topics in order to provide clinical and research insights.
查看更多>>摘要：目的 探讨2018-2023年炎症性肠病（IBD）领域的研究热点，通过对比中国和全球文献发表情况，分析中国近年来该领域的发展情况以及不足。 方法 检索Web of Science数据库中的核心合集，检索日期设置为2018年1月1日至2023年12月31日，利用VOSviewer软件进行关键词共现分析并实现可视化。 结果 共纳入24 543篇文献，其中中国发文量稳步增长，自2018年全球占比11.0%增至2023年的26.4%，发文量跃居全球第二。发文期刊平均影响因子相对偏低。IBD发文量前十的机构均来自欧美国家，我国发文量较多的机构为中山大学。全球文献的关键词主要聚焦于4大领域，包括机制研究、疾病管理与流行病学、药物治疗和生活质量，而我国文献的关键词则主要聚焦于3大领域，包括机制研究、疾病管理与流行病学、肠道菌群及相关治疗，反映出IBD研究领域的热点方向。近6年，我国IBD学者在热点领域发表了多篇高质量研究论文。 结论 中国IBD研究发展迅速，文章数量居世界前列，高质量研究不断增多。然而，总体IBD研究质量还需要进一步加强。 Objective To explore the research hotspots in the field of inflammatory bowel disease (IBD), and analyze the development and shortcomings of this research field in China from 2018 to 2023 by comparing the quantity, quality, and research hotspot of published literature in China and all around the world. Methods The Web of Science core collection database was searched from January 1, 2018 to December 31, 2023. VOSviewer software was used for visual and quantitative analysis of keywords co-occurrence. Results A total of 24 543 articles were included, of which the number of publications in China increased steadily, from 11.0% in 2018 to 26.4% in 2023, ranking the second in the world. However, the average impact factor of published journals in China is relatively low. The top ten institutions with the largest number of publications are all from Europe and the United States, and the most prolific institution in China is Sun Yat-sen University. The key words in the global literature mainly focused on four areas, including mechanism and epidemidogy research, disease management, drug therapy and quality of life, while the key words in the Chinese literature focused on 3 areas including mechanism research, disease management and epidemilogy, and intestinal microbiota with related treatment, reflecting the research hotspots of IBD research. In the past six years, Chinese scholars had published a number of high-quality research papers in these hot areas. Conclusions IBD research in China has developed rapidly, with the number of articles ranking in the forefront of the world and the number of high-quality studies increasing. However, the overall research quality needs to be further improved.
查看更多>>摘要：目的 利用深度卷积神经网络算法，构建溃疡性结肠炎（UC）Mayo内镜评分模型，并评估模型效能。 方法 收集苏州大学附属第一医院消化内镜中心及HyperKvasir数据库的内镜图片共2400张作为训练集和验证集；收集江苏大学附属金坛医院消化内镜中心内镜图片200张作为测试集。内镜图片根据Mayo内镜评分系统进行评分（0~3分）。选取在ImageNet数据集预训练的4种深度卷积神经网络（MobileNetV2、ResNetV2、Xception及EfficientNetV2S），利用迁移学习建立UC四分类模型，并在测试集中基于混淆矩阵，使用准确率、马修相关系数（MCC）、卡帕系数评价模型的分类能力，与高、低年资医师的表现比较。采用梯度加权分类激活映射算法可视化呈现模型分类过程。 结果 针对UC内镜图片，成功构建4个基于深度学习的Mayo评分模型。MobileNetV2、ResNetV2、Xception及EfficientNetV2S在测试集中的分类准确性分别达0.785、0.800、0.815、0.830，平均分类准确性为0.808。其中，EfficientNetV2S模型表现最好，优于低年资医师（0.785），略低于高年资医师（0.870）。 结论 基于深度学习算法构建的UC内镜图片评分模型分类能力较高，可扩大样本量、优化模型框架进一步提升模型分类效能。 Objective To develop deep learning models for ulcerative colitis (UC) classification based on Mayo endoscopic score. Methods A total of 2400 endoscopic images from the Gastrointestinal Endoscopy Centre of the First Affiliated Hospital of Soochow University and the HyperKvasir database were extracted for training classification models, and 200 endoscopic images from Affiliated Jintan Hospital of Jiangsu University were extracted for evaluating the models, both scored by endoscopists according to Mayo endoscopic score (score 0-3). Four deep convolutional neural networks (MobileNetV2, ResNetV2, Xception, EfficientNetV2S), which were pre-trained in the ImageNet database, were used to develop the UC classification models by transfer learning. Models were evaluated in the test set based on the confusion matrix using accuracy, Matthews correlation coefficient (MCC) and Cohen′s kappa, and compared with the performance of senior and junior physicians. Meanwhile, the model was visualized by gradient-weighted class activation mapping. Results Four deep learning Mayo score models based on UC endoscopic image classification models were successfully developed. In the test set, the accuracy of MobileNetV2, ResNetV2, Xception and EfficientNetV2S was 0.785, 0.800, 0.815, 0.830, respectively (average accuracy 0.808). Amoug them, EfficientNetV2S model was the best, higher than junior physician′s accuracy (accuracy 0.785), and slightly lower than senior physician′s (accuracy 0.870) . Conclusions The UC endoscopic severity classification models developed by deep learning show good performance, which can be further improved by larger sample size and optimizing the framework.
查看更多>>摘要：目的 总结分析克罗恩病（CD）合并小肠癌患者的临床特征。 方法 回顾性收集并分析2018年5月至2022年9月于浙江大学医学院附属邵逸夫医院诊治的CD合并小肠癌患者的临床资料，包括一般资料、临床特点（包括病变部位、疾病行为和并发症等）、CD相关病史、肿瘤特征、诊断、治疗和预后。通过检索PubMed数据库截止至2022年3月发表的CD合并小肠癌的病例，并进行文献复习及总结。 结果 纳入7例CD合并小肠癌患者，其中男性5例，女性2例。7例患者中6例病理类型为小肠腺癌，1例为高级别上皮内瘤变。病变均累及回肠并发生狭窄。仅有2例影像学检查发现肿瘤。小肠癌确诊前7例患者CD相关治疗用药及时长不一，小肠癌治疗以手术为主，化疗及CD相关治疗为辅。5例患者经治疗后未发现肿瘤复发，1例患者术后7个月肿瘤复发，第2次术后3年疑似肿瘤再发；1例患者失访。共检索到文献7篇。 结论 CD合并小肠癌多为男性患者、回肠受累多见，肿瘤类型以小肠腺癌和淋巴瘤最为常见，影像学检查发现CD合并小肠癌的能力有限。 Objective To summarize and analyze the clinical characteristics of patients with Crohn′s disease (CD) complicated with small intestinal cancer (SBC) . Methods Clinical data of patients with CD complicated with SBC treated in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from May 2018 to September 2022 were collected and analyzed retrospectively, including general data, clinical features (lesion location, disease behavior and complications, etc.), CD-related history, tumor features, diagnosis, treatment and prognosis. The cases of CD complicated with SBC published in PubMed database up to March 2022 were searched, and the literatures were reviewed and summarized. Results There were 7 patients with CD complicated with SBC in our hospital, including 5 males and 2 females. Of the 7 patients, 6 patients were small intestinal adenocarcinoma and 1 patient was high-grade intraepithelial neoplasia. All the lesions involved ileum with stenosis. Tumors in only 2 cases of tumors were found by imaging examination. Before the diagnosis of SBC, the drugs and duration of CD-related treatment were different in 7 patients. SBC was mainly treated by surgery, supplemented by chemotherapy and CD-related treatment. No tumor recurrence was found in 5 patients after treatment, 1 patient had tumor recurrence 7 months after operation, and suspected tumor recurrence 3 years after the second operation. One patient ws lost during follow-up. Seven literatures were retrieved. Conclusion Most of the patients with CD complicated with PBC are male, and ileal involvement is more common. Small intestinal adenocarcinoma and lymphoma are the most common tumor types. The ability of imaging examination to detect CD-SBC is limited.
查看更多>>摘要：胆石症是炎症性肠病（IBD）患者常见的共患疾病之一，由于其发病率显著高于普通人群，且胆结石引起的胆囊炎、胰腺炎、胆囊癌等并发症增加疾病负担，值得临床医生关注。本文对IBD患者胆石症的发生率、发生机制及危险因素等临床特点进行综述，发现IBD患者胆石症的发生机制可能与胆汁酸肠肝循环受损、胆囊动力减低等相关，性别、年龄、病程、病变部位及肠道手术是其危险因素。 Cholelithiasis is one of the common comorbidities in patients with inflammatory bowel disease (IBD). It has a significantly higher incidence in IBD than the general population, and the complications caused by gallstones such as cholecystitis, pancreatitis, and gallbladder carcinoma increase the burden of the disease, which deserves the concern of clinicians. This article provides a comprehensive review of the clinical characteristics of cholelithiasis in IBD patients, including its incidence, mechanisms, and risk factors. It suggests that the mechanisms of cholelithiasis in IBD patients may be related to impaired enterohepatic circulation of bile acids and decreased gallbladder motility, and risk factors include gender, age, disease duration, affected site, and intestinal surgery.
查看更多>>摘要：克罗恩病的诊断目前仍缺乏金标准，而病理提示非干酪性肉芽肿是诊断克罗恩病的重要依据。国内外文献报道其在克罗恩病的诊断、鉴别、发展、治疗、预后中发挥着重要作用。本文就肉芽肿在克罗恩病诊断治疗中的作用进行探讨。 There is still a lack of gold standard for the diagnosis of Crohn′s disease, and non-caseating granuloma is an important basis for the diagnosis of Crohn′s disease. Domestic and foreign literature reports that it plays an important role in the diagnosis, differentiation, development, treatment and prognosis of Crohn′s disease. This article discusses the role of granulomas in the diagnosis and treatment of Crohn′s disease.
查看更多>>摘要：本综述旨在总结目前关于新型冠状病毒肺炎（简称"新冠肺炎"）在炎症性肠病（IBD）患者中的风险和影响的证据，并讨论在此疫情期间IBD的优化管理。IBD患者并没有更高的新冠肺炎发病率，也不伴更严重的疾病进展。多种因素与新冠肺炎感染风险增加、住院率增加和严重新冠肺炎风险增加相关。IBD的治疗与更严重的新冠肺炎无关，5-氨基水杨酸和硫唑嘌呤与新冠肺炎的风险增加的关系尚有争议。不同类别和疾病程度的IBD患者治疗方案需要调整。新冠肺炎疫苗对IBD患者是有效和安全的。 This review aims to summarize the current evidence on the risk and impact of coronavirus disease 2019 (COVID-19) in patients with inflammatory bowel disease (IBD), and to discuss optimal management of IBD during this outbreak. IBD patients did not have a higher incidence of COVID-19 or more severe disease progression. Multiple factors are associated with an increased risk of COVID-19 infection, increased hospitalization rate, and increased risk of severe COVID-19. Treatment of IBD is not associated with more severe COVID-19, and the association of 5-aminosalicylic acid and thiopurine with increased risk of COVID-19 is controversial. Treatment regiments for IBD patients with different categories and levels of disease need to be adjusted during the epidemic. COVID-19 vaccine is effective and safe for patients with IBD.
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