2018年 · 第38卷第11期

Biologics and immunomodulators are important drugs for inducing and maintaining IBD disease remission. Appropriate drug concentration has important clinical significance for improving curative effect and reducing adverse reactions. therapeutic drug monitoring (TDM) during IBD treatment can optimize drug use to the maximum extent and better guide the selection of treatment strategies. In 2017, the American Gastroenterological Association (AGA) published a TDM consensus for IBD, and Australia also published a TDM consensus for anti-TNF-α preparations in the same year. In recent years, the number of IBD patients in China has gradually increased. How to better combine the actual situation in China to optimize the treatment to achieve the best treatment effect has become a common problem that clinicians must face. In view of this, the Inflammatory Bowel Disease Group of the Gastroenterology Branch of the Chinese Medical Association organized some experts in the field of IBD in China to hold a TDM seminar on IBD in Xi' an on August 24, 2018, reviewing international and domestic TDM-related data on IBD, and reached the following TDM consensus opinions on IBD in China.

Portal hypertension is an important factor affecting the clinical prognosis of patients with liver cirrhosis, and its severity determines the occurrence and development of complications of liver cirrhosis (such as esophagogastric variceal bleeding, peritoneal effusion, hepatorenal syndrome, etc.)^[1,2]。 According to reports, the number of liver disease patients in China has exceeded 400 million, which is the country with the heaviest burden of liver disease in the world. Among them, about 106 million people are positive for hepatitis B virus surface antigen or hepatitis C virus antibody, about 60 million people are alcoholic liver disease, and about 200 million people are non-alcoholic fatty liver disease^[3,4]。 Although the incidence of infectious liver disease has decreased from before, the number of patients with non-alcoholic fatty liver disease has shown a steady upward trend and is expected to exceed 310 million by 2030^[5]。 Viral hepatitis, alcoholic hepatitis and non-alcoholic steatohepatitis may progress to cirrhosis. The future situation of prevention and treatment of liver cirrhosis in China is grim, but there is still a lack of multi-center and large sample size epidemiological survey data related to liver cirrhosis and portal hypertension in China. Wang et al.^[6]The data analysis of more than 8,000 patients with liver cirrhosis in a single center in China in the past 10 years showed that the incidence of esophagogastric variceal bleeding, as the most important complication of liver cirrhosis and portal hypertension, was as high as 55.6%.

chronic pancreatitis (CP) is a prolonged and refractory disease, which requires lifelong treatment because of stubborn symptoms, which seriously affects the quality of life of patients and greatly increases the public medical burden of society. In recent years, the global incidence of CP has been increasing, and its etiology, mechanism and diagnosis and treatment methods have been constantly updated. Japan, the United States and Europe have successively issued clinical diagnosis and treatment guidelines. The Chronic Pancreatitis Committee of the Pancreatic Disease Professional Committee of Chinese Medical Doctors Association took the lead in organizing multidisciplinary experts such as gastroenterology, biliary and pancreatic surgery, endocrinology, imaging and pathology. Based on the latest evidence-based medical evidence and the latest research results at home and abroad, and with reference to many international CP guidelines, China's "Guidelines for the Diagnosis and Treatment of Chronic Pancreatitis (2012, Shanghai)"^[1]Revised.

Microecology refers to microbial ecology or the ecology of microhabitats. Human micro-ecology specifically refers to the study of the ecology of human microorganisms, which can be classified according to human body parts. Intestinal micro-ecology has received more attention earlier and more^[1]。 The research object of human microecology is microbiota or microbiome, and the scope includes the characteristics of microbiota (group) and its interaction with the host (Figure 1)。 The purpose of this paper is to clarify the concept of microbiota (group), the interaction and regulation mode between microbiota (group) and host, and to summarize the existing research techniques, and to point out the urgent problems and development directions in the field of human micro-ecology research.

Intestinal flora is "another organ" of the human body, which plays an important role in metabolism, immunity, tumor and so on. Amplicon sequencing represented by 16S rRNA gene is widely used in human symbiotic flora studies due to low cost and easy analysis of sequencing. However, only metagenomic sequencing can unbiased display all the genetic information of bacteria, archaea, fungi, viruses, etc. in a certain sample, and not only provide more delicate microbial classification information than 16S rRNA, but also provide functional information. With the decreasing cost of sequencing, the development of bioinformatics tools, and the accumulation of non-traditional pathogenic functional studies, metagenomic sequencing has gradually been used to study human intestinal flora. The metagenome-wide association study (MWAS), pioneered in the study of type 2 diabetes, has made gratifying findings in the study of obesity, arteriosclerosis, cirrhosis, colorectal cancer, rheumatoid arthritis and other complex diseases^[1,2]。 It is worth noting that due to the dynamic characteristics of intestinal flora, controlling age, body weight, medication, disease course and other factors when collecting samples is the key to discovering real disease signals.

After birth, due to the exposure of surrounding environment and diet, human beings gradually establish stable intestinal microbial micro-ecology. The intestine has nearly 1×10¹⁴Including a complex microbial ecosystem of more than 1,000 anaerobic and aerobic bacteria. The vast microbial system contains 100 times more genetic diversity than the body's own genome. Intestinal symbiotic flora can assist food digestion, assist the development of intestinal mucosal immune system, inhibit the growth of harmful microbiota, thus affecting the body's metabolic, cognitive and immune regulatory functions.

Colorectal cancer is one of the common malignant tumors. According to the Estimated Cancer Incidence, Mortality and Prevalence Worldwide (GLOBOCAN), the number of new cases of colorectal Cancer reaches 1.36 million and the number of deaths is about 700,000 every year. Globally, colorectal cancer incidence and mortality rank 3rd and 4th among men and 2nd and 3rd among women, respectively. According to the report "2015 China Cancer Statistics", colorectal cancer ranks 5th and 4th among the most common tumors in men and women in China, respectively. In 2015, there were about 380,000 new cases and 190,000 deaths, and the incidence rate is increasing year by year.

The concept of intestinal microecology has been put forward for half a century. With the progress of detection technology such as metagenome sequencing, it has become a new hot spot in biomedical field recently^[1]。 The intestinal microorganisms and the intestinal mucosal barrier together constitute the intestinal micro-ecosystem. In view of the close anatomical and functional connection between intestinal tract and liver, the role of intestinal microecology in liver diseases has gradually attracted attention. Recent studies have revealed that intestinal microecology disorders are involved in the occurrence and development of chronic liver disease, and intestinal microecology has become a new marker for the diagnosis of liver cirrhosis and a new target for treatment.

The imbalance of intestinal microecology can affect the development of liver lesions through immune, metabolic and nutritional pathways, and may even promote the formation of hepatocellular carcinoma (HCC)^[1,2]。 At the same time, chronic liver disease will not only cause damage to intestinal mucosa, but also lead to imbalance of intestinal flora and metabolic abnormalities. transcatheter arterial chemoembolization (TACE) is considered to be the preferred treatment option for unresectable HCC^[3,4]However, it is unclear whether TACE treatment of HCC can improve the disorder of intestinal flora in patients, and whether there is an association between intestinal microecology and TACE efficacy and patient survival benefit. This study observed the changes of serum lipopolysaccharide and TLR4 levels in HCC patients after TACE treatment, and the effects of TACE on intestinal flora, which are reported below.

Diarrhea is a common clinical symptom. A child with "diarrhea, abdominal pain and fever" as the main manifestations was diagnosed with interleukin-10 receptor A (interleukin-10 receptor A,IL-10RA) gene variation-related IBD complicated with infectious enteritis, aiming to clarify the diagnosis and treatment of chronic diarrhea and colon ulcer, and increase theIL-10RAThe knowledge of IBD caused by gene mutation, so as to improve the diagnosis and treatment level of clinicians.

There are a large number of microorganisms in the human gut, including bacteria, fungi, archaea and viruses, which are mutually beneficial and symbiotic with the human body. Under normal circumstances, the quantity and composition of various microorganisms in the intestine are relatively stable, and they jointly maintain the balance of intestinal microecology. Intestinal dysbiosis not only causes local gastrointestinal dysfunction, but also affects metabolic diseases, liver diseases, cardiovascular diseases, respiratory and nervous system diseases, etc^[1]。

The intestinal flora is the largest microbial community in the human body, and there are hundreds of known flora species at present, mainly Firmicobacteria and Bacteroides. These floras are widely distributed in the gastrointestinal tract, with a density of about 1×10 per gram of intestinal content in the jejunum and proximal ileum²～1×10³CFU, 1×10 in the terminal ileum⁷～1×10⁸CFU, 1×10 in the ascending colon¹¹～1×10¹²CFU^[1]。 intestinal stem cells are the source of various types of cells in the intestinal mucosa. They are located at the bottom of mucosal crypts and differentiate into epithelial absorbent cells, Pan cells, goblet cells, endocrine cells and other intestinal mucosal cells under the regulation of various signals. Intestinal flora affects various types of intestinal mucosal cells including intestinal stem cells through various mechanisms, which play an important role in the maintenance of human health and in the process of disease. The interaction and regulation mechanism of intestinal stem cells and intestinal flora are reviewed.