结肠镜和组织病理学检查在炎症性肠病诊断中的价值

Colonoscopy and Histology in the Diagnosis of Inflammatory Bowel Disease

结肠镜检查和黏膜活检的组织病理学评估是诊断炎症性肠病(IBD)的主要方法。克罗恩病(CD)可累及口腔至肛门的任一部位,以节段性、透壁性炎症为主要特征;溃疡性结肠炎(UC)主要表现为由直肠向上延伸至盲肠的广泛黏膜炎症,可伴有或不伴倒灌性回肠炎。缺乏慢性炎症的组织学证据如隐窝变形、固有层单核细胞浸润、基底层淋巴细胞增多时,不能诊断为CD或UC。直肠、结肠、回肠末端的结肠镜黏膜活检是区分慢性与急性黏膜炎症、评估疾病分布以及鉴别诊断CD与UC的关键。UC的诊断可能较为直观,而诊断CD需结合临床表现、内镜表现、影像学和组织病理学结果。

Colonoscopy and biopsy-based histopathological evaluation are the main diagnostic modalities for inflammatory bowel disease （IBD）. Crohn＇ s disease （CD） is characterized with segmental, transmural inflammation with a possible involvement from the mouth to anus, while ulcerative colitis （UC） is featured with mucosal inflammation from the rectum extending proximately, up to the cecum with or without backwash ileitis. CD or UC could not be diagnosed without histologic evidence of chronic inflammation, including crypt distortion, mononuclear eell infiltration of lamina propria, and basal lymphoplasmacytosis. Index colonoscopy with biopsy of the rectum, colon, and terminal ileum is a key for the assessment of acute versus chronic mucosal inflammation and disease distribution, for the diagnosis and differential diagnosis of CD and UC. The diagnosis of UC may be straight forward, whereas the diagnosis of CD often requires a combined assessment of clinical, endoscopic, radiographic, and histologic assessment.