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中华临床医师杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 220 -226. doi: 10.3877/cma.j.issn.1674-0785.2023.02.019

综述

肠白塞病的研究进展
王红权, 詹杰(), 彭春晓, 梅振华, 邹亮   
  1. 448000 湖北荆门,湖北省荆门市人民医院风湿免疫科
    448000 湖北荆门,湖北省荆门市人民医院功能检查科
  • 收稿日期:2021-12-10 出版日期:2023-02-15
  • 通信作者: 詹杰
  • 基金资助:
    湖北省荆门市科技计划项目(2020YDKY011)

Progress in research of intestinal Behcet's disease

Hongquan Wang, Jie Zhan(), Chunxiao Peng, Zhenhua Mei, Liang Zou   

  1. Department of Rheumatology and Immunology, the People's Hospital of Jingmen, Hubei Province, 448000 Jingmen, China
    Functional Inspection Section, the People's Hospital of Jingmen, Hubei Province, 448000 Jingmen, China
  • Received:2021-12-10 Published:2023-02-15
  • Corresponding author: Jie Zhan
引用本文:

王红权, 詹杰, 彭春晓, 梅振华, 邹亮. 肠白塞病的研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(02): 220-226.

Hongquan Wang, Jie Zhan, Chunxiao Peng, Zhenhua Mei, Liang Zou. Progress in research of intestinal Behcet's disease[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(02): 220-226.

肠白塞病是白塞病累及胃肠道,以肠道溃疡性病变导致胃肠道症状为特征的白塞病特殊亚型。目前仍缺少评估疾病活动的客观工具和单一的特异性生物标志物,主要依靠内镜、活组织检查和CT扫描进行诊断、鉴别诊断、评估预后。皮质类固醇及氨基水杨酸制剂仍为一线和标准治疗方案,对皮质类固醇依赖者可联合使用免疫抑制剂或肿瘤坏死因子抑制剂。治疗过程中需要严格外科手术指征,但出现严重且危及生命的并发症,无法通过保守治疗控制时需要行外科手术治疗。本文就有关肠白塞病的诱发因素与发病机制、临床特征、常见并发症与合并症、鉴别诊断、辅助检查(实验室、肠镜和影像学)、组织病理学特征、治疗及预后予以综述,以期为临床提供一定的参考。

Intestinal Behcet's disease is a special subtype of Behcet's disease that involves the gastrointestinal tract and is characterized by gastrointestinal symptoms caused by intestinal ulcer lesions. At present, there is still a lack of objective tools and any single specific biomarker to assess disease activity. The diagnosis, differential diagnosis, and prognosis assessment are mainly based on endoscopy, biopsy, and CT scanning. Corticosteroids and aminosalicylic acid preparations are still the first-line and standard treatment options. For corticosteroid-dependent patients, immunosuppressants or tumor necrosis factor (TNF) inhibitors (TNF-i) can be used in combination. Strict surgical indications are required during the treatment process, but when severe and life-threatening complications that cannot be controlled by conservative treatments Occur, surgical treatment is required. This article reviews the predisposing factors and pathogenesis, clinical features, common complications and comorbidities, differential diagnosis, auxiliary examinations (laboratory, colonoscopic, and imaging), histopathological features, treatment, and prognosis of Behcet's disease, with an aim to provide some reference for clinicians.

1
陈永, 刘文静, 邹峻, 等. 白塞病合并肠道病变的临床回顾性分析 [J]. 复旦学报(医学版), 2017, 44(4): 493-497.
2
Park YE, Cheon JH. Updated treatment strategies for intestinal Behçet's disease [J]. Korean J Intern Med, 2018, 33(1): 1-19.
3
Tanida S, Mizoshita T, Nishie H, et al. Long-term efficacy of adalimumab in patients with intestinal Behcet's disease: eight consecutive cases [J]. J Clin Med Res, 2016, 8(4): 334-337.
4
Wu QJ, Zhang FC, Zhang X. Adamantiades-Behcet's disease-complicated gastroenteropathy [J]. World J Gastroenterol, 2012, 18(7): 609-615.
5
Park JJ, Kim WH, Cheon JH. Outcome predictors for intestinal Behçet's disease [J]. Yonsei Med J, 2013, 54(5): 1084-1090.
6
Kovacs DB, Ray DK, Dasqupta K, et al. Intestinal complications of Behçet's disease [J].BMJ Case Rep, 2013, 2013: bcr2013200253.
7
Cheon JH, Kim ES, Shin SJ, et al. Development and validation of novel diagnostic criteria for intestinal Behcet's disease in Korean patients with ileocolnic ulcers [J]. Am J Gastroenterol, 2009, 104(10): 2492-2499.
8
Lee HJ, Shin HS, Jang HW, et al. Correlation between soluble triggering receptor expressed on myeloid cells-1 and endoscopic activity in intestinal Behçet's disease [J]. Yonsei Med J, 2014, 55(4): 960-966.
9
Jun S, Takao K, Erika T, et al. Bifidobacteria abundance-featured gut microbiota compositional Change in patients with Behcet's disease [J]. PloS One, 2016, 11(4): e0153746.
10
Lopalco G, Rigante D, Venerito V, et al. Update on the medical management of gastrointestinal Behçet's disease [J]. Mediators Inflamm, 2017, 2017: 1460491.
11
Kim DH, Cheon JH. Intestinal Behçet's disease: A true inflammatory bowel disease or merely an intestinal complication of systemic vasculitis? [J]. Yonsei Med J, 2016, 57(1): 22-32.
12
Emmi G, Silvestri E, Bella CD, et al. Cytotoxic Th1 and Th17 cells infiltrate the intestinal mucosa of Behcet patients and exhibit high levels of TNF-a in early phases of the disease [J].Medicine (Baltimore), 2016, 95(49): e5516.
13
Kim SW, Jung YS, Ahn JB, et al. Identification of genetic susceptibility loci for intestinal Behçet's disease [J]. Sci Rep, 2017, 7: 39850.
14
罗丹, 申艳, 邹峻, 等. Th17/Treg相关细胞因子在肠白塞病发病机制中的作用 [J]. 复旦学报(医学版), 2016, 43(2): 154-158.
15
刘月, 杨艳, 苏芮, 等. 肠道菌群调控白塞病中辅助性T细胞17/调节性T细胞免疫平衡的研究进展 [J]. 中华风湿病学杂志, 2019, 23(8): 558-561.
16
Ahmadi M, Yousefi M, Abbaspour-Aghdam S, et a1. Disturbed Thl7/treg balance, cytokines, and miRNAs in peripheral blood of patients with Behcet'disease [J]. J Cell Physiol, 2019, 234(4): 3985-3994.
17
Imamura Y, Kurokawa MS, Yoshikawa H, et al. Involvement of Th1 cells and heat shock protein 60 in the pathogenesis of intestinal Behçet's disease [J]. Clin Exp Immunol, 2005, 139(2): 371-378.
18
孟德钎, 李璐, 刘金晶, 等. 英夫利西单克隆抗体治疗重症/难治性肠型白塞病的疗效分析: 单中心回顾性研究 [J]. 协和医学杂志, 2019, 10(3): 237-242.
19
王媛, 李建国, 周志轩, 等. 胃肠道受累的儿童白塞病临床特点分析 [J]. 中华风湿病学杂志, 2018, 22(11): 744-747.
20
田珂, 王晶桐, 朱元民, 等. 具有消化系统表现的白塞病的临床特点 [J]. 胃肠病学和肝病学杂志, 2014, 23(2): 208-212.
21
Watanabe K, Tanida S, Inoue N, et al. Evidence-based diagnosis and clinical practice guidelines for intestinal Behcet's disease 2020 edited by intractable diseases, the health and labour sciences research grants [J]. J Gastroenterol, 2020, 55(7): 679-700.
22
Vicente CS, Freitas AD. Surgical treatment of intestinal perforation in Behçet syndrome: an unusual presentation [J]. Pan Afr Med J, 2018, 30: 230.
23
Özşeker B, Şahin C, Özşeker HS, et al. The role of fecal calprotectin in evaluating intestinal involvement of Behçet's disease [J]. Dis Mark, 2016, 2016: 5423043.
24
Lee HJ, Cheon JH. Optimal diagnosis and disease activity monitoring of intestinal Behçet's disease [J]. Intest Res, 2017, 15(3): 311-317.
25
Kötter I, Lötscher F. Behçet's syndrome apart from the triple symptom complex: vascular,neurologic, gastrointestinal, and musculoskeletal manifestations [J]. Front Med(Lausanne): 2021, 8: 639758.
26
肖雨, 周炜洵, 王维斌, 等. 肠道贝赫切物综合征的临床病理 [J]. 协和医学杂志, 2012, 3(1): 56-59.
27
Miyagawa I, Nakano K, Iwata S, et al. Comparative study of corticosteroid monotherapy,and TNF inhibitors with or without corticosteroid in patients with refractory entero-Behcet's disease [J]. Arthritis Res Ther, 2019, 21: 151.
28
宋迪, 毛庆聪, 邵伟新. 肠型白塞病的CT表现 [J]. 医学影像学杂志, 2016, 26(1): 151-153.
29
Li J, Li P, Bai J, et al. Discriminating potential of extraintestinal systemic manifestations and colonoscopic features in Chinese patients with intestinal Behçet's disease and Crohn's disease [J]. Chin Med J(Engl), 2015, 128(2): 233-238.
30
Zhu ZH, Shu X, Long SH, et al. Ulcerative colitis followed by the development of typical intestinal Behçet disease [J]. Medicine (Baltimore), 2018, 97(7): e9882.
31
杨洋, 余叶, 林进. 肠白塞病生物标志物研究进展 [J]. 中华风湿病学杂志, 2021, 25(6): 426-430.
32
Zhang L, Tian Y, Ye JF, et al. Poor prognostic factors in patients with nwely diagnosed intestinal Adamantiades-Behcet's disease in the Shanghai Adamantiades-Behcet's disease database:a prospective cohort study [J]. Orphanet J Rare Dis, 2019, 14(1): 274-284.
33
沈颖, 杨辉, 金玉. 儿童肠型白塞病的诊断和治疗 [J]. 中华儿科杂志, 2019, 57(3): 235-237.
34
Jung YS, Kim SW, Yoon JY, et al. Expression of a soluble triggering receptor expressed on myeloid cells-1(Strem-1) correlates with clinical disease activity in intestinal Behcet's disease [J]. Inflamm Bowel Dis, 2011, 17(10): 2130-2137.
35
Hiregoudar AD, Battal MM, Vishwanath N, et al. Subtotal colectomy for intestinal Behcet's disease:a histopathological surprise [J]. Indian J Surg, 2009, 71(3): 159-161.
36
Kobayashi K, Ueno F, Bito S, et al. Development of consensus statements for the diagnosis and management of intestinal Behcet's disease using a modified Delphi approach [J]. J Gastroenterol, 2007, 42: 737-745.
37
Hisamatsu T, Hayashida M. Treatment and outcomes: medical and surgical treatment for intestinal Behçet's disease [J]. Intest Res, 2017, 15(3): 318-327.
38
Kaji M, Kishi T, Miyamae T, et al. Efficacy of adalimumab in a girl with refractory intestinal Behcet's disease [J]. Case Rep Rheumatol, 2015, 2015: 716138.
39
Park J, Cheon JH, Park Y, et al. Efficacy and tolerability of methotrexate therapy for refractory intestinal Behçet's disease:a single center experience [J]. Intest Res, 2018, 16(2): 315-318.
40
Hisamatsu T, Ueno F, Matsumoto T, et al. The 2nd edition of consensus statements for the diagnosis and management of intestinal Behcet's disease: indication of anti-TNFα monoclonal antibodies [J]. J Gastroenterol, 2014, 49(1): 156-162.
41
Jung YS, Hong SP, Kim TI, et al. Long-term clinical outcomes and factors predictive of relapse after 5-aminosalicylate or sulfasalazine therapy in patients with intestinal Behcet disease [J]. Inflamm Bowel Dis, 2012, 46(5): e38-e45.
42
Jung YS, Cheon JH, Hong SP, et al. Clinical outcomes and prognostic factors for thiopurine maintenance therapy in patients with intestinal Behcet's disease [J]. Inflamm Bowel Dis, 2012, 18(4): 750-757.
43
Iwata S, Saito K, Yamaoka K, et al. Efficacy of combination therapy of anti-TNF-α antibody infliximab and methotrexate in refractory entero-Behçet's disease [J]. Mod Rheumatol, 2011, 21: 184-191.
44
Tanida S, Inoue N, Kobayashi K, et al. Adalimumab for the treatment of Japanese patients with intestinal Behcet's disease [J]. Clin Gastroenterol Hepatol, 2015, 13: 940-948,e3.
45
Park J, Cheon JH. Could adalimumab be used safely and effectively in intestinal Behçet's disease refractory to conventional therapy? [J]. Intest Res, 2017, 15(3): 263-265.
46
Inoue N, Kobayashi K, Naganuma M, et al. Long-term safety and efficacy of adalimumab for intestinal Behçet's disease in the open label study following a phase 3 clinical trial [J]. Intest Res, 2017, 15(3): 395-401.
47
Li Y, Han ZL, Wang XF, et al. Combination therapy of infliximab and thalidomide for refractory entero-Behcet's disease:a case report [J]. BMC Gastroenterol, 2013, 13: 167.
48
Hibi T, Hirohata S, Kikuchi H, et al. Infliximab therapy for intestinal, neurological,and vascular involvement in Behcet disease:Efficacy,safety,and pharmacokinetics in a multicenter,prospective,open-label,single-arm phase 3 study [J]. Medicine (Baltimore), 2016, 9(24): e3863.
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