吴坚炯医生的科普号

溃疡性结肠炎患者的饮食要注意以下几点：（1）供给足够的热量、蛋白质、无机盐和维生素，尽可能避免出现营养不良性低蛋白血症，以增加体质，利于病情缓解。（2）应避免食用刺激性和纤维多的食物，如辣椒、芥末等辛辣食物，以及白薯、心里美萝卜、芹菜等多渣食物。疾病发作时，应忌食生蔬菜、水果及带刺激性的葱、姜、蒜等调味品。刀工要细，不要用大块肉烹调，要经常用碎肉、肉丁、肉丝、肉末和蒸蛋羹、煮鸡蛋等形式。尽量限制食物纤维，如韭菜、萝卜、芹菜等。（3）腹泻时不宜吃多油食品及油炸食品，烹调各种菜肴应尽量少油，并经常采用蒸、煮、焖、氽、炖，水滑等主方法。可用红茶、焦米粥汤等收敛饮料，加餐宜少量多餐，增加营养。

因为五一劳动节放假3天，我在2012年4月28日（周六）北部下午加开一次专家门诊！请新老病友相互转告，可在当日下午来就诊！祝大家身体健康！

2012年4月起：我专家门诊时间为: 周一下午（北部,上海市虹口区海宁路100号 专家门诊部五楼20号诊室）周二下午（北部,上海市虹口区海宁路100号 专家门诊部五楼15号诊室)请新老患者相互转告！另外会有不定期周六上午的南部专家门诊，具体时间会提前在我个人网站上发布。

因为清明放假3天，我在2012年3月31日（周六）北部下午加开一次专家门诊！请新老病友相互转告，可在当日下午来就诊！祝大家身体健康！

因为春节放假七天，我在2012年小年夜（周六）南部上午加开一次专家门诊！请新老病友相互转告，可在当日上午来就诊！祝大家新春愉快！身体健康！

临床经验表明，防治慢性功能性便秘(包括其他便秘)，除了应保持精神愉快、纠正不良饮食和生活习惯外 ，采用如下综合性的防治办法可取得较好的效果。 1、每日充足的水分摄入：每天清晨可饮一杯温开水(250ml左右)或淡盐开水 ，既能软化粪便 ，又可预防便秘。每日要保证充足水分摄入 ，日本一项专门研究表明；每日饮水700～1000ml，排便效果较好。有报道 ，早晨饮用冷开水可刺激胃-结肠反射而达到促进排便的目的(可根据季节适当调节水温度)。 2、摄入足量的纤维素：纤维素有亲水性，能吸收水分，使食物残渣膨胀并形成润滑凝胶 ，能助肠蠕动而推动粪便，其过程有利于产生便意和排便反射，研究表明 ，维持正常人排便的纤维摄取量为每日20克 ，能达到此数量纤维的摄入，排便次数、一次排便量及总排便量均增加。所以，多食水果、蔬菜或笋类、麦片、麸皮等多纤维食物等均能促进排便。 3、培养定时的排便习惯：可制定按时排便表，尽可能调整在每日早餐后排便，因早餐后易引起胃-结肠反射，此时训练排便，易建立条件反射。有时即使无便意，也应坚持每日定时去厕所蹲10～15分钟，日久便可建立定时排便的习惯。一旦有便意时就应入厕排便 ，任何情况下都不要克制和忍耐。 4、每日坚持一定运动量：运动可促进肠供血及肠蠕动，有利于排便。运动量、次数可根据自身体力等情况而定。可每日做健身操、太极拳、步行等，运动量不需太大，但贵在坚持。如能有意识做增强腹部肌肉和骨盆肌肉张力的锻炼更好，尤其是腹肌锻炼，做时还可用排便动作锻炼提肛的收缩。长期卧床的病人容易发生便秘，可自己做床上运动，如仰卧起坐、平卧抬腿及抬高臀部等。 5、物理按摩法有助排便：为促进肠蠕动 ，可进行腹部及背部热敷、热水浸浴、腹部按摩、直肠粘膜按摩、穴位按压等。腹部按摩其方法是以脐部为中心顺时针方向缓慢按摩；直肠粘膜按摩是用手指或专用器具刺激肛门括约肌 ，轻轻按摩直肠粘膜，以刺激并诱发排便反应。有报道 ，有便秘者经直肠粘膜按摩后 ，如厕30分钟后能自行解出大便；穴位按压是通过刺激穴位使与脏腑相关的便秘症得到消除，如可常按压迎香穴(鼻翼两旁 )、足三里穴(外膝眼下3寸处)及耳穴贴压等。据报道，相关穴位按压对经常性便秘和术后排气、排便有较好疗效。 6、还可酌情适量服用缓泻剂、软化大便制剂以及食疗方法等来协助通便。 7、掏便及灌肠剂应用：如粪便硬结停滞在直肠肛门处，一般仅需用手指将大便掏出，立即可解除痛苦 ，但动作一定要轻缓，因物理刺激易引起出血，还可能诱发痔疮。灌肠药要熟悉药物的作用 ，灌肠溶液可用2%肥皂水、甘油等，顽固性便秘可选双氧水20ml、甘油或橄榄油40ml、2%肥皂水60ml(即1: 2: 3比例)混合作灌肠液。灌肠后双氧水反应放出气泡，有利于进行粘液与粪块间 ，甘油可起良好的滑润作用 ，促进顺利排便。此类方法一般在医院内使用。

2011年3月7日起专家门诊时间调整为:周一下午（北部), 周四上午（南部),请各位病友相互转告！

Inflammatory disease of the X-ray diagnosis of gastrointestinal X ray examination Yao on the mild, moderate, not high and the UC diagnosis and imaging techniques and conditions related to Crohn's disease but do have a higher value. Are summarized as follows:First, the UC X-rayUC mainly involving the rectum, sigmoid colon, part of the descending colon can be affected, transverse colon, and even the entire colon. Therefore, X-ray double contrast barium examination method, clearly shows that as the colon mucosa outline form, ulcers and inflammatory polyps, and to understand the scope of disease, and complications such as degree of involvement. However, cases of severe or fulminant UC, in order to avoid complications, should wait until after the condition improved. Fasting before the test meal, taking mannitol, Nursing and slowly drink laxative, do not drink cause acute vomiting or abdominal distension induced by intestinal perforation expansion.More gastroenteritis knowledge: incentives and rehydration of acute gastritis knowledgeUC X-ray findings are:1, the intestinal mucosal folds contour and acute changes in bowel mucosa of the lesion is diffuse edema, intestinal blurry edges, loss of normal mucosal folds form thick mucous membrane disorder. Most of the small shallow ulcers and secretions can thin or thick contour lines appear jagged burrs or changed. If the formation of inflammatory polyps, can be seen by the numerous round or oval filling defect. Mucosal lesions may be due to chronic fibrosis and showed granular changes in bowel rough or rugged. Mucosa after row of barium mucosal disturbance as shown, the more easily see the sizes of inflammatory polyps of the image.2, changes in colonic bag Run acute diffuse inflammation caused by bowel wall edema and ulceration, can cause colon bags disappear. When the lesions improved, intestinal bags can be re-appears. Development of chronic or recurrent fibrosis has occurred due to the intestinal wall, colonic continuity disappears bags. 3, intestinal morphological changes (1) intestinal stenosis, acute intestinal inflammation due to infiltration, allows the expansion of intestinal spasm of the limitations caused by restricted or narrow the intestine, but after the narrow if remission can disappear. Development of advanced or recurrent intestinal fibrosis by multiple inflammatory polyps of varying sizes, can cause permanent intestinal stenosis. (2) intestinalShortening, rigidity, diastolic and systolic function disappeared, the so-called 'lead pipe "-like or" sausage ", inflation will not make the lumen expansion. Bowel disease after barium filling may be due to dysfunction of the row of barium weakened, intestine caused by left large amounts of barium. such as acute exacerbation of patients was extremely lumen expansion is acute in the characteristics of toxic megacolon (diameter 8cm). must be noted that UC X-ray findings and clinical performance is not necessarily proportional. In particular, cases of early or light, X-ray abnormalities may be no, X-ray section of diseases of the rectum a few worthless.4, "paving stone"-like changes can also occur with severe UC, "paving stone"-like change, "paving stone" kind of change is the collapse of the remnants of the mucosal ulcers and the formation of the convex surface of the island, while barium attached to the uneven generated images.X-ray findings of Crohn's disease Crohn's disease occurred in the ileum better and adjacent colon, a few can occur in the stomach, duodenum, jejunum and other parts. X-ray examination is an important means of diagnosis of Crohn's disease. There are reports that experienced radiologists can reach the correct diagnosis rate of 90%. Especially the use of double contrast barium, supplemented by improved techniques can increase the positive rate. Suspected ileocecal, colonic lesions, it is desirable for the barium enema examination when necessary, and barium enema have used two methods.Recommended reading: to help you understand the acute gastritisX-ray findings of Crohn's disease are:1, Crohn's disease lesions were typical of the segmental distribution, inflatable segment stenosis limits of expansion and a clear, normal bowel disease intestine are separated between the lesion can be single or multiple, but the more common multiple.2, early lesions due to inflammatory edema of submucosa, mucosal fold thickening and disorders. Bowel disease compared with a fixed shape, but no significant stenosis performance, close to the normal bowel disease can have a normal section, relaxation and creep functions.3, the lesion extended to the submucosa, a lot of granulation tissue, in addition to disturbance of mucosal folds, thickening, but may be a "paving stones (pebbles)"-like filling defect in the bags disappear colon, bowel irregularity.4, erosion of the intestinal wall lesions can be seen when full-thickness round or longitudinal fissure Kanying ulcers, when the barium filling the intestine, its jagged contours or spikes-like prominence, which is the Kanying.5, advanced cases, the ulcer healing process of scar contraction of granulation tissue and submucosa, leading to reduced intestinal luminal irregular stenosis, usually manifested in the expansion of the proximal stenosis. Small bowel Crohn's disease may be due to the emergence of segmental distribution of lesions were more narrow, that is, lesions were "jumping" phenomenon, a narrow section of each of varying lengths, often above the range of 2cm. Irregular bowel showed a narrow thin strip shadow, called the line-like symptoms. Bowel disease of the bowel wall stiffness, creep completely disappear.6, gall tube formation, the Yin Kelong disease often full-thickness erosion of the colon wall, easy to produce mass and intra-abdominal abscess, adhesions of intestinal loops, showing the vicinity of the barium bowel disease with another directly connected to the communication occurred between the intestinal curve, called fistula. Many have intestinal adhesions between music phenomena, such as barium filling of the road leading to atrophy of abdominal wall, you are prompted for the fistula. Barium and endoscopy with the application if, it will undoubtedly be able to catch the high rate of correct diagnosis of inflammatory bowel disease

很多克隆病患者经常会问医生到底该不该吃补品？我们的回答是：不能进补！原因很简单，补品都有增强免疫的作用，而克隆病患者本身就是一个免疫过强的体质，所以进补后往往会造成疾病复发和加重！所以克隆病患者饮食要清淡，切忌进补！

一、 定义 糖皮质激素抵抗型是指任何部位的溃疡性结肠炎,曾采用过最大剂量的氨基水杨酸类药物口服和/或局部治疗无效, 尽管采用糖皮质激素治疗, 症状仍未缓解者。糖皮质激素依赖型指糖皮质激素治疗有效，但减量即复发的患者。 二、 发病情况 炎症性肠病（包括溃疡性结肠炎和克罗恩病）的药物治疗失败常见，欧美等国家大约20%的溃疡性结肠炎及50%的克罗恩病患者需要进一步手术。克罗恩病患者中约1/3为糖皮质激素依赖，1/5表现为耐药，其中约60%的耐药患者、30%药物依赖患者在糖皮质激素治疗的6个月内需要手术。根据我们的统计，国内10 218例溃疡性结肠炎患者中, 有6859例患者的治疗被描述, 只有87例患者手术治疗(1.3%) , 国内手术治疗少的原因有两个：一是国内重症患者较欧美等国家少见，二是国内同行对手术治疗态度非常保守，不认为溃疡性结肠炎是一种可治愈性疾病，结肠切除术加回肠-肛门贮袋吻合术（colectomy with ileo-anal pouch anastomosis）是治疗慢性活动性或难治性结肠病变的一种重要的替代内科治疗的方法。对国内中、重度患者来说, 糖皮质激素经常应用, 而免疫调节剂及抑制剂(如6-MP)等很少应用。 三、糖皮质激素抵抗的机制 尽管有新的治疗方法不断涌现，但溃疡性结肠炎患者的药物控制状况仍不容乐观，而糖皮质激素治疗无效的原因尚不清楚。近年来，多药抗性表达（MDR）与糖皮质激素抵抗或耐药的关系开始引起关注。 MDR是描述肿瘤细胞生物学行为的一个术语，即肿瘤细胞一旦出现对一种细胞毒性制剂耐药，便可对多种细胞毒性制剂交叉耐药。MDR基因编码的Pgp-170是一个胞膜转运泵，可将细胞内的MDR底物转运出胞，从而降低它们的胞内浓度。Pgp-170在外周血淋巴细胞及肠黏膜上皮细胞最表面均有表达，而二者均为已知的药物作用靶细胞，几种主要的药物是MDR底物。体外实验证实，MDR高表达细胞中糖皮质激素、环磷酰胺、甲氨蝶呤胞外转运活跃，从而使得其胞内浓度明显降低。罗丹明（rhodamine）123及柔红霉素（daunorubicin）荧光染色提示MDR高表达与Pgp-170转运活性相关，体内及体外实验证实， MDR抑制剂可逆转Pgp-170的药物泵出作用。我们在研究中发现，与正常人相比,难治性溃疡性结肠炎患者血液中Pgp-170明显升高，由于糖皮质激素是Pgp-170的底物，药物治疗无效的溃疡性结肠炎患者与MDR表达有关。血液和组织中无显著性差异，提示外周血MDR表达稳定，不受疾病活动或激素治疗影响，且与结肠上皮细胞表达呈正相关。Farrell RJ对炎症性肠病肠黏膜MDR表达患者进行Pgp-170抑制治疗，氢化可的松及环磷酰胺的泵出功能明显受抑制。因此，MDR可能在溃疡性结肠炎患者对激素治疗的反应中起重要作用。外周血淋巴细胞及肠黏膜的MDR表达状况在决定炎症性肠病患者对糖皮质激素的有效性上具有重要作用。 四、糖皮质激素抵抗型的治疗 增加糖皮质激素用量对该型患者无效，进一步治疗的方法有运用免疫调节剂、其他药物辅助治疗和手术治疗。 （一）免疫调节剂 硫唑嘌呤及其代谢产物6-MP皆可诱导2/3的患者症状缓解。从50mg/d开始治疗, 每月增加25mg, 最大剂量硫唑嘌呤2.5mg/kg·d, 6-MP1.5mg/kg·d。约3~6个月生效, 故泼尼松治疗至少维持2个月才可减量或中断。约有10%的患者因不良反应如发热、皮疹、白细胞减少、胰腺炎或感染等而被迫停药或不得不维持在低剂量治疗。硫唑嘌呤或6-MP治疗6个月仍然无效者, 有报道改用甲氨蝶呤可以诱导部分患者症状缓解, 口服和肌注效果无显著性差异。开始剂量每周7.5mg, 逐渐递增至每周25mg, 8～12周可见疗效。应密切观察临床状态、血常规和肝功能等。对于应用甲氨蝶呤治疗慢性活动性溃疡性结肠炎的疗效也有许多研究持否定意见。我们的经验是，对糖皮质激素抵抗的患者，对甲氨蝶呤往往也耐药，必要时可行手术治疗。 （二）其他药物辅助治疗 对糖皮质激素依赖或抵抗的患者, 如果伴有血小板活化或者高凝状态，加用肝素或低分子肝素治疗，有时可获得意外疗效, 这可能主要与肝素类药物抗微血栓形成及抗炎作用有关。 （三） 手术治疗 结肠切除术加回肠-肛门贮袋吻合术是治疗慢性活动性或难治性结肠病变的一种重要的替代内科治疗的方法。许多患者可因此而治愈。国内同行应避免过于保守而不采用手术治疗。 五、 激素依赖型患者的治疗 （一）可选用新型糖皮质激素治疗 如布地奈德（Budesonide）等，以减少不良反应。 （二） 改用硫唑嘌呤治疗 这些患者多数在用硫唑嘌呤（2.0~2.5mg/kg）治疗后可得到改善（硫唑嘌呤治疗溃疡性结肠炎似乎不如用于治疗克罗恩病的疗效为佳）。虽然，另有一些研究报道，硫唑嘌呤对于慢性稳定性结肠炎患者并无任何益处，但对维持溃疡性结肠炎缓解却有效。 （三）必要时可考虑手术治疗 可行结肠切除术加回肠-肛门贮袋吻合术。