美沙拉嗪对轻中度溃疡性结肠炎病理学特征和组织学分级的影响

Effect of mesalazine on biopsy mucosal pathology and histological grading of patients with the mild and moderate active ulcerative colitis

目的探讨美沙拉嗪对溃疡性结肠炎(UC)患者的病理学特征及组织学分级的影响。方法应用美沙拉嗪1g,每日3次,治疗轻中度活动期UC8周。观察治疗前后的病理学特征和组织学分级的变化。结果8周后,轻度UC治疗前后黏膜固有层血管炎分别为50.0%和18.8%(P<0.01)。中度UC治疗前后黏膜固有层血管炎分别为69.6%和23.9%(P<0.01)。治疗前血管壁坏死轻度UC1例,中度UC2例;血栓形成中度UC3例;8周末均未发现血管壁坏死和血栓形成。轻度UC腺体异常治疗前后分别为37.5%和14.6%(P<0.05);中度UC腺体异常分别为43.5%和39.1%(P>0.05)。轻度UC治疗前后嗜酸粒细胞浸润分别为95.8%和37.5%(P<0.01);中度UC治疗前后分别为100.0%和32.6%(P<0.01)。隐窝脓肿轻度UC治疗前后分别为20.8%和4.2%(P<0.05);中度UC治疗前后分别为47.8%和10.9%(P<0.01)。黏膜组织学分级轻度UC治疗前后分别为(2.16±0.95)分和(0.88±0.52)分(P<0.01);中度UC治疗前后分别为(2.86±0.83)分和(1.06±0.67)分(P<0.01)。结论美沙拉嗪能明显改善轻中度UC炎症黏膜的小血管病变与隐窝脓肿,减少中性粒细胞、嗜酸性粒细胞浸润,促进炎症黏膜的愈合。

Objective To investigate the effect of mesalazine on biopsy mucosal pathology and histological grading of patients with the mild and moderate active ulcerative colitis（UC）.Methods The changes of pathological signs and histological grades of UC were observed before and after the treatment with mesalazine 1 g three times daily for 8 weeks.Results After 8 weeks,the effect of mesalazine on rates of small vessel inflammation was 50.0 vs.18.8 in the mild UC（P〈0.01）and 69.6 vs.23.9 in the moderate UC（P〈0.01）before and after treatment.Fiberoid necrosis of vessel wall：2 cases was found in the mild UC before treatment and none was found after treatment;3 cases was found in the moderate UC before treatment and none was found after treatment.Thrombogenesis：none was found in the mild UC before and after treatment;3 cases was found in the moderate UC before treatment and none was found after treatment.Effect on rates of mucosal glandular abnormality：37.5 vs.14.6 in the mild UC （P〈0.05）and 43.5 vs.39.1 in the moderate UC（P〉0.05）before and after treatment.The rates of eosinophil infiltration：95.4 vs.37.5 in the mild UC （P〈0.01） and 100.0 vs.32.6 in the moderate UC（P〈0.01）before and after treatment.Effect on rates of crypt abscess：20.8 vs.4.2 in the mild UC （P〈0.05）and 47.8 vs.10.9 in the moderate UC（P〈0.01）.Effect on rates of mucosal patho-histological grade：2.16±0.95 vs.0.88±0.52 in the mild UC（P〈0.01）and 2.86±0.83 vs.1.06±0.67 in the moderate UC（P〈0.01）before and after treatment.Conclusions Mesalazine can significantly alleviate small vessel lesions and crypt abscesses and reduce neutrophilic and eosinophilic leukocyte infiltration in lamina propria.Therefore,mesalazine can promotion healing of inflammation.