内镜及病理对胃肠道淀粉样变的诊断意义

Diagnostic significance of endoscopy and pathology in gastrointestinal amyloidosis

目的探讨淀粉样变的胃镜、肠镜表现特点以及粘膜活组织检查对其诊断的价值。方法分析内镜诊断的10例淀粉样变患者资料(男5例,女5例),分别总结胃镜、肠镜表现及其活组织检查特点。结果胃肠道淀粉样变患者的临床症状包括腹痛、便血或黑便、腹胀、慢性腹泻。5例接受胃镜检查的患者中,3例发现淀粉样变,阳性病变包括溃疡、结节、粘膜剥脱、瘢痕,还有1例患者在外观正常处取材确诊。8例接受肠镜检查的患者中,均发现淀粉样变,阳性病变包括息肉、溃疡、粘膜剥脱、结节不平及粘膜充血、水肿等。结论胃肠道是淀粉样变的好发部位之一,内镜检查可发现病变,其粘膜活组织检查具有重要的诊断价值。

Objective Gastrointestinal tract is commonly affected in amyloidosis.The deposition of amyloid protein may cause a variety of endoscopic changes in the gastrointestinal tract.The aim of this study was to investigate the endoscopic manifestations and evaluate the biopsy results in amyloidosis of the gastrointestinal tract.Methods The gastroscopy or colonoscopy records of ten patients with amyloidosis of gastrointestinal tract(five males,five females) were reviewed.The definitive diagnosis of amyloidosis was made by tissue biopsy.The endoscopic changes in the gastrointestinal tract were characterized. Results The frequent clinical symptoms related to amyloidosis of the gastrointestinal tract presented as:abdominal pain,hematochezia or melena,abdominal distension and chronic diarrhea.Five patients underwent gastroscopy and three of them were established the diagnosis.Gastroscopic examinations revealed ulcerations,granular appearance,mucosal denudations and scars except one patient in whom the mucosa appeared normal.Eight patients underwent colonoscopy or sigmoscopy and all of them got positive results.The endoscopy revealed polyps,ulcerations,mucosal denudations,granular appearance,mucosal hyperemia and edema.Two patients who suffered from abdominal pain and hematochezia were diagnosed as colonic ischemia clinically.The histopathological examination of one of the patients showed that there was amyloid deposits in the blood vessels.In another patient,amyloid was found in the stroma.This suggests that there are some relationship between amyloidosis and colonic ischemia. The amyloid deposition in the small vessels may decrease the blood flow of the colon,on the other hand,chronic ischemia may cause inflammation which may lead to amyloidosis.The relationship between amyloidosis and colonic ischemia needs to be further investigated.Conclusion Gastrointestinal tract is one of the predisposed organs in amyloidosis.Endoscopic examination may discover the lesion.Biopsy of gastrointestinal tract may greatly help the diagnosis of this disease.