重症溃疡性结肠炎119例临床和病理分析

Clinical and histological features in 119 patients with severe ulcerative colitis

目的对重症溃疡性结肠炎(UC)进行临床和病理分析并讨论其临床意义。方法重症溃疡性结肠炎患者119例,全部患者均符合2000年成都全国炎症性肠病会议修改的UC诊断标准,并经纤维结肠镜检查和X线钡灌肠检查,以及组织学检查确诊,连续粪培养2次排除细菌感染,同时排除阿米巴肠病、血吸虫病、肠道肿瘤和内分泌疾病。病变包括乙状结肠55例,降结肠31例,结肠脾曲20例和横结肠13例;临床类型包括初发型25例,慢性复发型54例和持续型40例。采取肠外静脉补充足够的营养,完全胃肠道休息,治疗4周后进行纤维肠镜检查。结果重症UC经过4周治疗后临床痊愈36例(30.3%),好转65例(54.6%),无效18例(15.1%),总有效率84.9%。初发型、复发型和持续型UC内镜下和组织学存在一定差异,但治疗总有效率无明显差异(P>0.05),分别为88.0%,87.0%和80.0%。全部患者血清AST、ALT在正常范围,血清白蛋白治疗后明显好转[g/L,(38.2±9.9)vs(22.4±8.8),P<0.01]。结论初发型、复发型和持续型UC内镜下和组织学存在一定差异,肠外静脉高营养疗法是一种有效可行的方法。

Objective To analyze clinical and histological features in patients with severe ulcerative colitis. Methods The patients with severe ulcerative colitis （n = 119, males 71, females 48, age 22-58 years） were finally diagnosed by fibercolonscopy, barium enema and histology, and consecutive twice stool cultures were performed to except bacterial infection. Ameba, schistosomiasis, intestinal tract cancer and endocrine diseases were also excluded. The lesion loci included sigmoid （n = 55）, descending colon （n = 31）, colon splenic flexure （ n = 20） and transverse colon （ n = 13）. The clinical types were in initial （ n = 25）, relapsing （ n = 54） and continuing （n = 40）. Gastrointestinal tract rested completely during parenteral hyperalimentation, and fibercolonscopy were made 4-week therapy. Results After 4-week therapy, 36 （30.3 % ） patients recovered, 65 （54.6 % ） improved, 18 not improved, the total effective rate was 84.9 %. For disease processes in initial, relapsing and continuing, the total effective rates were 88.0 %, 87.0 % and 80.0 % respectively. In all of the UC patients there were no significant differences in fibercolonscopy, histology. Serum aspartate aminotransferase （AST） and alanine aminotransferase （ALT） bad no change obviously （P 〉 0.05）. After therapy, the serum albumin increased [g/L,（24.4±8.8） vs （38.2±9.9）,P〈0.01]. Conclusion There is difference in fibercolonscopy and histology for UC in initial, relapsing and continuing type patients. The parenteral hyperalimentation therapy is effective for patients with severe ulcerative colitis.