Expert consensus on diagnosis and treatment of the "remission-recurrence" critical state of ulcerative colitis
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摘要: 溃疡性结肠炎是消化系统的重大疑难疾病，严重影响患者的生活质量。近年来，由于生活方式及环境因素的转变，UC的全球发病率呈上升趋势，目前最新治疗虽然在溃疡性结肠炎的诱导缓解等方面取得了一定的进展，但在如何阻断或延缓本病的复发方面，依然没有取得重大突破，是当今临床治疗中的瓶颈和重要挑战。为了有效应对这一挑战，本共识创新提出了溃疡性结肠炎“缓解-复发”临界态的新概念，并对其特征进行了深入探讨。共识体现了具有中国特色的中西医结合的医学特点，主要内容包括溃疡性结肠炎的病因和发病机制、临界态的实用识别方法、主要关键中医证候的诊断、临界态中医药干预和调摄策略等。本共识结合了最新的研究成果，旨在为临床医生提供全面的指导，以便更有效地管理溃疡性结肠炎患者，降低疾病复发率，从而改善患者的整体预后。Abstract: Ulcerative colitis(UC) is a significant and challenging disease in the digestive system that severely affects the quality of life for patients. In recent years, due to changes in lifestyle and environmental factors, the global incidence of UC has been on the rise. Although the latest treatments have made certain progress in inducing remission of UC, there has been no significant breakthrough in preventing or delaying the recurrence of the disease, which remains a bottleneck and a major challenge in clinical treatment today. To effectively address this challenge, this consensus innovatively proposes the new concept of the "remission-recurrence" critical state in UC and conducts an in-depth discussion of its characteristics. The consensus reflects the medical characteristics of the integration of Chinese and Western medicine with Chinese characteristics, mainly including the etiology and pathogenesis of UC, practical identification methods for the critical state, diagnosis of the main key Chinese medicine syndromes, and intervention and regulation strategies for traditional Chinese medicine in the critical state. Combining the latest research findings, this consensus aims to provide comprehensive guidance for clinicians to more effectively manage patients with UC, reduce the rate of disease relapse, and thereby improve the overall prognosis of patients.
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表 1 MES评分系统
评分/分 内镜下表现 0 正常或缓解期 1 轻度活动：红斑，血管纹理模糊，黏膜轻度易脆性 2 中度活动：明显红斑，血管纹理消失，黏膜易脆，糜烂 3 重度活动：溃疡形成，自发性出血 
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表 2 UC“缓解-复发”临界态复发风险评估量表
项目 指标 评分 诱发因素
(5分)饮食因素(患者自我判断近期进食可能影响UC进展的食物) 无：0分；有：1分 情绪不良(患者自我判断近期出现焦虑、抑郁等可能影响UC进展的情绪变化) 无：0分；有：1分 睡眠障碍 无：0分；有：1分 体重变化(患者自我判断近期出现可能影响UC进展的体重变化) 无：0分；有：1分 环境问题(患者自我判断近期经历可能影响UC进展的外界环境变化) 无：0分；有：1分 临床症状 排便次数增加 无：0分；有：1分 (14分) 大便性状改变 无：0分；有：1分 腹痛 无：0分；有：1分 腹胀 无：0分；有：1分 肠鸣 无：0分；有：1分 排气增多 无：0分；有：1分 肛门灼热 无：0分；有：1分 里急后重 无：0分；有：1分 排便不尽 无：0分；有：1分 发热 无：0分；有：1分 心悸 无：0分；有：1分 纳呆 无：0分；有：1分 乏力 无：0分；有：1分 口干口苦 无：0分；有：1分 实验室检查指标 FC < 200 μg/g：0分；≥200 μg/g：1分 (6分) CRP 正常：0分；升高：1分 ESR 正常：0分；升高：1分 维生素D 正常：0分；降低：1分 NLR 正常：0分；升高：1分 便常规、便隐血试验 正常：0分；异常：1分 内镜表现
(1分)MES评分 MES评分为0：0分；MES评分为1：1分 中医辨证 如符合脾肾阳虚兼有湿热内蕴证的诊断标准，提示具有较高复发风险
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