抗生素相关性结肠炎伴发溃疡性结肠炎的探讨

Study of Ulcerative Colitis accompanying with Antibiotic Associated Colitis

目的 观察抗生素相关性结肠炎伴发溃疡性结肠炎的临床特点及两者关系。方法 分析、总结7例(男3例,女4例;年龄48～83岁,平均66岁)确诊为抗生素相关性结肠炎同时伴发溃疡性结肠炎患者的临床资料、结肠镜报告、病理报告等,追踪其治疗效果。结果 7例患者既往无慢性腹泻病史;因原发病在较长时间内(6～20天,平均15天)接受1～3种广谱抗生素治疗后出现腹痛、腹泻、发热等症状;大便常规检查均见多量的粘液和红白细胞;大便细菌培养均为阴性;5例外周血白细胞显著升高、以中性粒细胞为主;结肠镜及病理检查可见特异的抗生素相关性结肠炎和溃疡性结肠炎表现;按抗生素相关性结肠炎治疗后,病情可得到控制,其中 3例需要使用柳氮磺胺吡啶(SASP)治疗,愈合良好。结论 抗生素相关性结肠炎可同时伴有溃疡性结肠炎发生,可能与它们有相似的发病机制有关。

Objective To observe the clinical feature of ulcerative colitis accompanied withantibiotic associated colitis and the relationship between these two diseases.Methods The clinicaland endoscopic data 、 pathologic reports and theraptic outcome of 6 patients (3 male and 4 female,average age 66) suffering from ulcerative colitis accompanying with antibiotic associated colitis wereanalyzed.Results Seven cases who had no medical history of chronic diarrhea began with the symptomsof abdominal pain , diarrhea, fever and so on after being treated with 2 or 3 wide-spectrum antibioticsin 6 to 20 days. Stool routine tests found a large amount of mucus, white blood cell and red blood cell;Stool bacterium cultures were negative; Peripheral blood leukocyte, especially neutrophil increasedremarkably in 4 cases; Specific endoscopic and pathologic changes of antibiotic associated colitis andulcerative colitis could be identified; All patients' symptoms could be controlled after being treatedas antibiotic associated colitis and 3 cases being treated with SASP.Conclusion Antibiotic associatedcolitis might be accompanied by ulcerative colitis because of the similar machanism.