Therapeutic _'s prevention and health care of glucocorticoid resisting type and relying on ulcer colitis

Therapeutic _'s prevention and health care of glucocorticoid resisting type and relying on ulcer colitis
First, define
The glucocorticoid resisting type refers to ulcer colitis of any position, have adopted medicine of all kinds of acid of amino bigcatkin willow of maximum dose to be taken orally and/or the part to failed to respond to any medical treatment, though adopt glucocorticoid treatment, the persons who are not relieved of symptom yet. The reliance type of glucocorticoid means the glucocorticoid treatment is effective, but the patient whose decrement recured promptly.
Two, onset situation
Inflammation intestines ill ' Including ulcer colitis and Crohn's disease) Drug therapy common without being failed,America and Europe,etc. need further performing the operation colitis and 50% Crohn disease patient country about 20% ulcer. About 1/3 are the glucocorticoid reliance in Crohn's disease patient, 1/5 are shown as and able to bear medicines, about 60% able to bear medicine patient, 30% drug dependence patient need surgery in therapeutic a 6 months such as glucocorticoid among them. According to the statistics of ours, in 10 218 domestic ulcer colitis patients, the treatments of 6859 example patients are described, there are only patient's surgery treatments (1.3%) of 87 examples ,There are two treatment few reasons to perform the operation at home: First, our country's serious disease patient is more rare than countries such as America and Europe,etc., second, the domestic counterpart treats the attitude to surgery very conservative, curing disease that can it is one kind not to think ulcer colitis, colon excises the skill and adds the ileum - rectum and stores bag anastomosis (colectomy with ileo-anal pouch anastomosis) It is an important substituting therapeutic method of internal medicine department of chronic activity or difficult curing colon and pathological change of treatment. To in being domestic, patients severe,often application in glucocorticoid, and modulator and inhibitor (6- MP)s immune Wait for few application.
Mechanism that third, glucocorticoid resists
Though new therapeutic method is emerging constantly, the ulcer colitis patient's medicine controls the state to still allow of no optimist, the reason why glucocorticoid fails to respond to any medical treatment is not so obvious. In recent years, many medicine resisting expressions (MDR) The relation of resisting with glucocorticoid or able to bear medicine begins to cause the concern.
MDR describes a behavioral term of tumour cell biology, namely once tumour cells are able to bear medicines to a cell toxic preparation, can be able to bear medicines to toxic preparations of many kinds of cells alternately. MDR whether one the intersection of afterbirth and membrane transship pump, can transship, produce afterbirth the intersection of MDR and substrate in the cell in genetic Pgp-170 of code, thus reduce the density in their afterbirth. Pgp-170 leather cell at peripheral blood lymphocyte and intestines mucous membrane expressed on the surface the most, and the two are that known medicines act on target cells, several kinds of main medicines are MDR substrate. External experiment verify, MDR high to express glucocorticoid, the intersection of ring and the intersection of phosphorus and amide in the cell, transship actively outside the first ammonia butterfly's purine afterbirth, thus make the density in its afterbirth obviously reduce. Rodin is bright (rhodamine) 123 and gentle erythromycin (daunorubicin) Fluoro dye brief MDR on to be high to express with Pgp-170 transshipping active, correlated with, body inner and external experiment prove, the medicine of MDR inhibitor reversible Pgp-170 pumps function. We find, compared with normal people, Pgp-170 obviously rises in the difficult curing ulcer patient's blood of colitis under study for action, it is the substrate of Pgp-170 because of glucocorticoid, the ulcer colitis patient that the medicine fails to respond to any medical treatment relates to MDR expression. There is not significance difference in blood and tissue, point out the peripheral blood MDR to express steadily, free of disease activity or hormone treatment, and the skin cell expression is the positive correlation with colon. Farrell RJ express patient, carry on Pgp-170 inhibit to inflammation the intersection of intestines and the intersection of disease and the intersection of intestines and the intersection of mucous membrane and MDR from, treat, hydrogenation cortisone and the intersection of ring and the intersection of phosphorus and amide pump the function and is inhibited obviously. So, MDR may play an important role in the ulcer colitis patient's therapeutic response to hormone. Peripheral the intersection of blood and lymphocyte and enteric MDR of mucous membrane express state, determine inflammation enteric the intersection of disease and patient have important function at the validity in glucocorticoid.
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