血浆同型半胱氨酸、D-二聚体水平与缺血性结肠炎关系的临床研究

Clinical Study on Relationship between Plasma Levels of Homocysteine,D-Dimer and Ischemic Colitis

背景:缺血性结肠炎(IC)临床表现缺乏特异性,早期易误诊、漏诊。同型半胱氨酸(Hcy)是血栓形成的危险因素,D-二聚体(D-D)是反映凝血和纤溶活化的分子标记物。目的:探讨血浆Hcy、D-D水平与IC的关系。方法:纳入2012年1月—2014年1月上海交通大学医学院附属新华医院崇明分院收治的IC患者72例作为IC组,并纳入同期健康体检者65名作为对照组。根据临床表现和内镜特征对IC组患者的病情严重程度进行评分,分为轻、中、重三组。记录患者12 h缓解率和住院天数。IC组于入院第1天检测血浆Hcy和D-D水平,并于3个月和6个月后复测血浆Hcy水平;对照组随机检测1次血浆Hcy和D-D水平。结果:入院第1天,血浆Hcy水平在IC轻、中、重度组间差异显著(P<0.05),随病情严重程度加重而升高;血浆D-D水平仅在轻度组与重度组间差异显著(P<0.05)。IC组入院第1天和3个月后的血浆Hcy水平显著高于对照组(P<0.01),但6个月后两组间差异无统计学意义(P>0.05)。IC组与对照组间血浆D-D水平差异无统计学意义(P>0.05)。结论:血浆Hcy水平有助于IC的诊断和病情评估,而血浆D-D水平不能作为评判IC病情的有效指标。结合IC患者的临床表现和内镜特征建立的病情评分系统可用于评估IC疾病严重程度。

Background： Misdiagnosis and missed diagnosis of ischemic colitis（ IC） in its early stage are frequent because of lacking specific clinical manifestations. Homocysteine（ Hcy） is a risk factor for thrombosis and D-dimer（ D-D） is a molecular marker of coagulation and activation of fibrinolysis. Aims： To investigate the relationship between plasma levels of Hcy,D-D and IC. Methods： A total of 72 IC patients from January 2012 to January 2014 at Chongming Branch of Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were enrolled in this study. Sixty-five healthy subjects were served as controls. Disease severity of IC was evaluated by a scoring system based on clinical manifestations and endoscopic features,and the patients were assigned into mild,moderate and severe groups. 12 h remission rate and hospitalized days were recorded. Plasma levels of Hcy and D-D in IC group were detected on admission,and plasma levels of Hcy were reexamined at the third month and sixth month after admission. Plasma levels of Hcy and D-D in control group were randomly detected. Results： Plasma level of Hcy on admission was significantly different among mild,moderate and severe IC groups（ P〈0. 05）,and showed an increasing trend along with the disease severity; however,significant difference in plasma level of D-D was found only between mild and severe groups（ P〈0. 05）. Plasma levels of Hcy in IC group on admission and at the third month after admission were significantly higher than those in control group（ P〈0. 01）,but no significant difference was found between the two groups at the sixth month after admission（ P〉0. 05）. No significant difference in plasma level of D-D was found between IC group and control group（ P〉0. 05）. Conclusions：Plasma level of Hcy is helpful for the diagnosis and severity evaluation of IC,however,plasma level of D-D could not be served as an effective index to evaluate IC. The scoring system based on clinical manifestations and endoscopic features could be used to evaluate the disease severity of IC.