Ronaldo Teixeira da Silva Júnior, Jonathan Santos Apolonio, Jessica Oliveira de Souza Nascimento, Bruna Teixeira da Costa, L. H. Malheiro, Marcel Silva Luz, Lorena Sousa De Carvalho, Cleiton da Silva Santos, Fabrício Freire de Melo
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引用次数: 0
摘要
克罗恩病(CD)是一种炎症性肠病,其特点是免疫介导。其病因是遗传、环境和微生物因素相互作用的结果。在病理生理学方面,它涉及高水平的白细胞介素(IL)-12、IL-17 和 Th1 特征,以及耐受机制的丧失、促炎性白细胞介素的增加,超出了影响胃肠道任何部位的可能性。其症状包括腹痛、慢性腹泻、体重减轻、厌食和疲劳,以及便血或直肠出血。此外,包括肌肉骨骼、皮肤、眼部、肝脏和血液学改变在内的病症也可能与这种情况有关,还可能出现肠道外表现,如结节性红斑、前葡萄膜炎、骨质疏松症和关节炎。如今,临床病史、粪便钙蛋白检查、回肠结肠镜检查和胶囊内镜检查均可用于诊断调查,同时还可采用治疗方法诱导和维持病情缓解。从这个意义上说,抗炎药物,如皮质类固醇、免疫调节剂和生物制剂,以及手术和非药物干预在治疗中都发挥着作用。本综述旨在为 CD 的临床治疗提供更多最新证据,并简要讨论其病理生理学、监测和相关疾病的各个方面。
Crohn's disease and clinical management today: How it does?
Crohn’s Disease (CD) is an Inflammatory Bowel Disease and is characterized by an immune-mediated nature. Its etiology results from the interaction between genetic, enviromental and microbial factors. Regarding pathophysiology, it involves high levels of interleukin (IL)-12, IL-17, and Th1 profile, along with loss of tolerance mechanisms, an increase in pro-inflammatory interleukins, beyond the possibility to affect any part of the gastrointestinal tract. Its symptoms include abdominal pain, chronic diarrhea, weight loss, anorexia, and fatigue, as well as blood in the stool or rectum. Additionally, conditions comprising musculoskeletal, cutaneous, ocular, hepatic, and hematological alterations may be associated with this scenario and extra-intestinal presentation, such as erythema nodosum, anterior uveitis, osteoporosis, and arthritis can also occur. Today, clinical history, exams as fecal calprotectin, ileocolonocopy, and capsule endoscopy can be performed in the diagnosis investigation, along with treatments to induce and maintain remission. In this sense, anti-inflammatory drugs, such as corticosteroids, immunomodulators, and biological agents, as well as surgery and non-pharmacological interventions plays a role in its therapy. The aim of this review is to bring more current evidence to clinical management of CD, as well as to briefly discuss aspects of its pathophysiology, surveillance, and associated disorders.