炎症性肠病面临的问题与挑战ppt课件.ppt

1、炎症性肠病：面临的问题与挑战,Increasing cumulative number of ulcerative colitis and Crohns 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,Yao T, Matsui T, et al. Dis Colon Rectum 2000;,Age- and

2、 sex-adjusted annual incidence ofCD and UC in the Songpa-Kangdongdistrict, Seoul, 19862005.,Yang SK, et al. Inflamm Bowel Dis 2008,New Cases （香港）,Leong Inflamm Bowel Dis 2004,0,5,10,15,20,25,30,35,85,86-89,90-92,93-95,96-98,99-01,Year,New Cases,Ulcerative colitis n= 121,Crohns disease n = 80,Annual

3、Incidence of IBD in Hong Kong,0,0.2,0.4,0.6,0.8,1,1.2,1.4,85,86-89,90-92,93-95,96-98,99-01,Year,Annual Incidence per 105,Ulcerative colitis: 1.2 per 100,000,Crohns disease: 1 per 100,000,UC (3100 cases),Time trend (data from 7 hospitals),Endoscopy,Hospitalized,Yr,Cases,Patients in 2003 : patients in

4、 1990: Patients diagnosed by endoscopy 4.09 : 1.00 Hospitalized patients 3.36:1.00,中华消化杂志 2006; 26(6):368,10,8,6,4,2,1930,1940,1950,1960,1970,1980,Year of Diagnosis,Comparing East 26(6):368,Treatment of UC,胡伏莲: 中国新药杂志 2001; 10(3):201,Efficacy and safety of mesalazine (Etiasa) Etiasa SASP p value N=5

5、2 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,蔡建庭: 中华消化杂志 2001; 21(10):593,Efficacy and safety of Osalazine Osalazine SASP p value n=100 n=30 Marked effect(%) 39.0 13.3 0.05 Effect(%) 47.0 63.3 No effect(%) 14.0 23.4 A

6、dverse event(%) 20.0 33.3 0.05 * at week 4,Treatment of UC,刘占举: 中华消化杂志 2007; 27(5):295,Efficacy and safety of Balsalazide Balsalazide SASP p value n=57 n=43 Marked effect(%) 49.1 44.1 0.05 Effect(%) 35.1 32.6 No effect(%) 15.8 23.3 Adverse event(%) 8.8 30.2 0.05 * at week 8,Treatment of CD,Analysis

7、of 515 CD patients - Aminsalicylates: 57.67% - Corticosteroids: 28.74% - Immunopressants: 4.66% - Antibiotics: 45.63% - Chinese medicine: 14.25% - Surgical treatment: 33.2%,J Gastroenterol Hepatol 2006; 21:1009,治疗 UC：5-ASA、皮质激素、免疫调节剂 疗程、适应症、疗效、副反应 CD： 生物制剂的应用 黏膜愈合作为新的疗效标准？ 上阶梯疗法与下阶梯疗法 维持治疗的方法？长期维持或过

8、度到免疫抑制剂？ 长期治疗的担心：肿瘤发生率是否升高？,IBD 面临的问题与挑战,中外有关IBD的共识意见,中国炎症性肠病协作组. 对我国炎症性肠病诊断治疗规范的共识意见(2007) Carter M J，et al. Guidelines for the management of inflammatory bowel disease in adults. Gut,2004,53(9):V1-16(英国) Travis S P L, et al. European evidence based consensus on the diagnosis and management of Croh

9、ns disease: current managementJ. Gut,2006,55(suppe 1):i16-i35(欧洲) Lichtenstein G R, et al. American Gastroenterological Association Institute Medical Position Statement on Corticosteroids, Immunomodulators,and Infliximab in Inflammatory Bowel Disease. Gastroenterol, 2006, 130(3):935-939；940-987(美国),最新的共