1炎症性肠病：面临的问题与挑战.ppt

炎症性肠病：面临的问题与挑战 Increasing cumulative number of ulcerative colitis and Crohn’s disease patients in Japan during a 17-year period according to the national registry maintained by the Ministry of Health, Labor and Welfare of the Japanese government Age- and sex-adjusted annual incidence ofCD and UC in the Songpa-Kangdongdistrict, Seoul, 1986–2005. Annual Incidence of IBD in Hong Kong UC (3100 cases) Time trend (data from 7 hospitals) IBD — 我国面临的问题与挑战 流行病学：近年病例数增长很快，但缺乏基于社区人口的流行病学研究，缺乏确切的患病率、发病率 中国处于一个流行病学研究的黄金时期 生活模式发生巨大变化：冰箱（冷链学说） 食物解构：西方化 IBD — 我国面临的问题与挑战 遗传易感性 中国（亚洲）与西方明显不同：NOD2 易感基因的筛选：高通量基因筛选或全基因组扫描 Disease LocationChow et al. Inflamm Bowel Dis, in press Louis et al. Gut 2001 Phenotype Evolution of disease behavior as determined by the Montreal Classification over 10 years in Chinese patients with Crohn’s Disease.Chow et al. Inflamm Bowel Dis 2008  Extra-intestinal manifestationsis uncommon CD与肠结核的鉴别 —尚未解决的问题 IBD — 我国面临的问题与挑战 CD与TB的鉴别 TB依然常见 CD与TB临床表现与内镜下表现相似 CD病人有时抗TB治疗有效 千万不要忘记TB 仔细鉴别：PCR 应用 有疑问时先抗结核 密切随访 Treatment Chinese consensus on the diagnosis and management of inflammatory bowel disease 中华消化病学会 2007 Treatment of UC Analysis of 3015 UC patients - Aminsalicylates: 66.8% - Corticosteroids: 26.2% - Immunopressants: 2.1% - Chinese medicine: 3.7% - Adding/only topical treatment: 32.5% - Turn to operation: 3.1% Treatment of UC Efficacy and safety of mesalazine (Etiasa) Etiasa SASP p value N=52 n=34 Symptom free(%) 57.7 50.0 0.05 Endoscopic healing 26.9 2.9 0.05 Side effect(%) 1.9 10.8 0.05 * at week 6 Treatment of UC Efficacy and safety of Osalazine Osalazine SASP p value n=100 n=30 Marked effect(%) 39.0 13.3 0.05 Effect(%) 47