摘要
目的研究缺血性结肠炎（ischemic colitis，IC）与溃疡性结肠炎（ulcerative colitis，UC）临床及组织病理学的差异，有助两者的鉴别诊断，利于临床治疗。方法收集20例IC和30例UC患者，对其临床及组织病理学等资料进行对比分析。结果IC组发病时间[（5±7）d]明显较UC组发病时间[（953±1354）d]短。IC组中65％的患者伴有高血压、冠状动脉性心脏病、心房颤动、房性早搏、腹部手术史等疾病史中的一项或几项，明显高于UC组的20％；IC组以急性发病、腹痛（85％）、血便（60％）及腹泻（50％）多见，而UC且以腹痛（83％）、腹泻（63％）、黏液脓血便（57％）及里急后重（20％）为主要临床表现；在内镜表现方面，IC多以沿肠系膜侧分布的纵形溃疡为主（60％），且病变多仅累及肠腔的1／4～1／2周（80％），呈节段性分布（60％），与邻近正常黏膜分界清楚（75％），而UC则以弥漫性地图状溃疡为主（43％），病变多累及肠腔全周（90％），炎性息肉明显多见（37％）。在组织病理学方面，血管扩张充血（90％）、间质严重水肿（95％）在IC中多见，血管壁增厚（50％）是其特征性表现，隐窝脓肿（47％）则在UC中多见。两组以上差异均有统计学意义（P〈0．05）。结论组织病理学特点、肠镜下表现以及患者临床特征的差异，为IC和UC的鉴别提供了有力依据。
Objective To study the differences of clinical and histopathologic features between ischemic colitis （IC） and ulcerative colitis （UC）, which can make for the differential diagnosis and treatments. Methods Comparative analysis were focused on the clinical and histopathologic data of IC patients （20 cases） and UC patients （30 cases）. Results The onset duration of IC [（5±7） d] was significantly shorter than that of UC [（953 ± 1354） d]. IC patients tended to have history of cadiovascular diseases or abdominal surgery （65%）. The typical clinical manifestations of IC were sudden onset of abdominal pain （85%）, hematochezia （60%）and diarrhea （50%）, but UC usually presented with abdominal pain （83%）, diarrhea （63%）, bloody mueopurulent stool （57%） and tenesmus （20%）. Colonoscopy showed longitudinal ulceration （60%）on the mesenteric side, the segmental lesions usually involved only 1/4 - 1/2 of the perimeter of the lumen （80%）, and the boundary of lesions was clear （75%） in IC patients. On the contrary, the ulcer of UC was usually map-like （43%）, the lesions usually involved the entire lumen （90%）, and the pseudopolyp （37%） was another colonoscopic feature of UC. The histopathologic study revealed that dilation and hyperaemia of vessels （90%） were common in IC. Severe edema of mucosa （95%） was usually presented in IC, and the thickened vascular wall （50 %） was the histopathologic characteristic of IC. Crypt abscesses （47%） usually appeared in UC. Conclusions The histopathologic characteristics and differences of colonoscopic findings and clinical features provide strong bases for the differential diagnosis between IC and UC.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2009年第2期97-100,共4页
Chinese Journal of Digestion
基金
浙江省自然基金资助项目（Y208001）,国家公益卫生行业专项基金资助项目（200802112）,浙江省卫生厅科技基金资助项目（2007A093）
