摘要
目的探讨缺血性结肠炎（IC）的临床表现、内镜和病理特征及其可能的危险因素。方法对89例确诊为Ic的住院患者进行回顾性分析。对IC发病的危险因素进行logistic回归分析。结果本组IC患者多具有高血压、心脏病、高脂血症及糖尿病等病史，临床主要表现为腹痛（80．9％，72／89）、便血（76．4％，68／89）等症状。结肠镜下可见结肠黏膜病变呈区域性分布（83．1％，74／89），表现为点状出血、水肿、散在糜烂和多形性溃疡，病变边缘清楚，严重者表现管腔狭窄（13．5％，12／89）。病理组织学表现为黏膜水肿、坏死、出血、溃疡形成，炎性细胞浸润，黏膜下出血等。实验室检查可表现为血白细胞、中性粒细胞、血清纤维蛋白原、D-二聚体、血清TC、TG、血清载脂蛋白B高于正常。47例患者进行了钡灌肠检查，可见结肠黏膜粗糙、拇指印征等征象；严重者肠管局限性痉挛、狭窄或缩短。29例患者进行了肠系膜动脉造影，见结肠壁增厚，但未能发现狭窄或闭塞的血管。Logistic回归分析显示：高血压、糖尿病、高TG、心房颤动等因素与IC发病关系密切（P值均〈0．05）。结论IC症状不典型，应尽早行结肠镜检查明确诊断。高血压、糖尿病、高脂血症、心房颤动是IC发病的危险因素。
Objective To investigate the clinical manifestations, pathological features by endoscopy and possible risk factors of ischemic colitis （ IC ）. Methods A retrospective analysis was made upon 89 hospitalized patients diagnosed as IC. Logistic regression analysis was performed to determine morbidity risk factors. Results The majority of patients with IC in our study group had histories of hypertension, heart disease, hyperlipidemia, diabetes, etc. The common features included abdominal pain （ 80. 9% , 72/89 ） , hematochezia （76.4%, 68/89 ）, etc. Colonic mucosal lesions presented regional distribution under colonoscope （ 80% , 72/89 ） , with manifestations of petechial hemorrhages, edema, segmental erosion, pleomorphism ulcerations, visible lesion edge and sharply defined segment of involvement, even be characterized by lumens stricture （13.5% , 12/89）. Histopathological examination revealed mucosa edema, necrosis, hemorrhage and formation of ulceration, inflammatory cell infiltration, and submucous hemorrhage, etc. Laboratory examination showed that white blood cells, neutrophils, serum fibrin, D-Dimer, serum TC, TG and serum apolipoprotein B were higher than normal. Colonic mucosal roughness, thumbmark symptoms, etc, and even bowel limited spasm, stricture or curtailment were visible in 47 patients underwent barium enema. Colonic wall thickening was visible in 29 patients underwent mesentericography, however, strictured or closed blood vessels were not found logistic regression analysis showed that hypertension, diabetes, higher TG, atrial fibrillation were strongly associated with onset of IC （ all P values 〈 0. 05 ）. Conclusions Since IC symptoms are not typical, it requires early colonoscopy to clarify diagnosis. Hypertension, diabetes, hyperlipidemia, and atrial fibrillation are risk factors for IC.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2012年第10期769-773,共5页
Chinese Journal of Internal Medicine
