炎症性肠病诊断与治疗的共识意见(2012年·广州)病理诊断部分解读

Interpretation of the Consensus on Diagnosis and Management of Inflammatory Bowel Disease(Guangzhou,2012) from the Perspective of Pathological Diagnosis

炎症性肠病(IBD)是一组病因尚不十分清楚的慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎(UC)和克罗恩病(CD)。UC在病理学上可表现为黏膜糜烂、浅溃疡、固有膜内重度弥漫性急性、慢性炎性细胞浸润、隐窝脓肿等,但缺乏特征性改变;CD可有透壁性炎症、裂隙状溃疡/阿弗他溃疡、非干酪样坏死性肉芽肿、神经节细胞增生等改变,但亦无诊断金标准。因此,UC和CD的确诊均不能单纯依靠病理检查,尤其是黏膜活检标本病理检查,而需结合临床、内镜、影像学和组织病理学表现进行综合分析并随访观察,在排除感染性和其他非感染性结肠炎的基础上作出诊断。

Inflammatory bowel disease （IBD） , including ulcerative colitis （UC） and Crohn＇ s disease （ CD）, is a group of chronic non-specific intestinal inflammatory diseases with uncertain etiology. Pathologically, UC usually exhibits changes like mucosal erosion, superficial ulcer, diffuse and severe infiltration of acute and chronic inflammatory cells in lamina propria and crypt abscess, however, none of these changes is specific. CD shows transmural inflammation, fissure/ aphthous ulcer, non-caseating necrotic granuloma and ganglion cell hyperplasia, but there is no gold standard for diagnosis either. As a result, definite diagnosis of UC and CD cannot be simply relied on pathology, especially the pathological examination of mueosal biopsy specimens. Comprehensive analysis combining clinical manifestations, endoscopic findings, imagings and histopathological changes is essential, and patient＇ s follow-up is indispensable for the diagnosis of IBD. Before establishing the diagnosis of IBD, infectious and other non-infectious colitis should be ruled out.