老年溃疡性结肠炎与老年缺血性结肠炎临床特点比较

A comparison of clinical characteristics in elderly patients with ulcerative colitis and ischemic colitis

目的 探讨老年溃疡性结肠炎（UC）与老年缺血性结肠炎（IC）临床特点的异同.方法 回顾性分析2004年9月至2015年6月在北京协和医院诊治的43例老年UC患者和36例老年IC患者（年龄≥60岁）临床资料,比较二者的临床特点.结果 与IC组比较,UC组病程较长,有心脑血管基础疾病者较少（P值均＜0.05）.UC组腹泻和黏液脓血便的发生率高于IC组[90.7％（39/43）比44.4％ （16/36）,79.1％（34/43）比5.6％（2/36）,P值均＜0.01],而IC组单纯血便的发生率较高[61.1％ （22/36）比7.0％ （3/43）,P＜0.01].UC组肠外表现的发生率高于IC组[18.6％（8/43）比0（0/36）],而并发症发生率低于IC组[11.6％ （5/43）比30.6％（11/36）,P＜0.05].UC组PLT高于IC组[（294.38±104.83）×10^9/L比（235.47 ±94.82）×10^9/L,P=0.01],核周型抗中性粒细胞胞质抗体（p-ANCA）阳性率高于IC组[50.0％（15/30）比10.0％ （2/20）,P＜0.05].IC组病变部位多位于降结肠和/或乙状结肠,直肠受累少见,病变与正常肠道黏膜分界清楚;UC组以全结肠受累多见,病变多起源于直肠,为倒灌连续性.IC组特征性病理表现为血管闭塞和血管内血栓形成,老年UC组多表现为隐窝脓肿.结论 老年UC与老年IC患者临床特点有诸多相似,但不乏可供鉴别之处.

Objective To analyze the discrepancy and similarities of clinical characteristics in elderly patients with ulcerative colitis （UC） and ischemic colitis （IC）.Methods A total of 43 elderly patients （age≥60 yrs） with UC and 36 elderly patients with IC were enrolled from 2004 to 2015 at Peking Union Medical College Hospital.The clinical characteristics were retrospectively analyzed and compared between the two groups.Results Compared with IC group,the disease course was longer with lower incidence of cardiovascular comorbidities in UC patients （P 〈 0.05）.In UC group,more patients presented with diarrhea,mucopurulent bloody stool [39 （90.7%） vs 16 （44.4%） and 34 （79.1%） vs 2 （5.6%）respectively,both P 〈 0.01].Yet bloody stool as the only symptom was seen in more IC patients than UC patients [61.1% （22/36） vs 7.0% （3/43）,P 〈 0.01].The ratio of extra-intestinal manifestations was higher [18.6% （8/43） vs 0 （0/36）] in UC patients,while complications were lower [11.6% （5/43） vs 30.6% （11/36）,P 〈 0.05].As to the laboratory parameters,median platelet count [（294.38 ± 104.83） × 10^9/L vs （235.47±94.82） × 10^9/L,P 〈0.05] was higher in UC group.In addition,more patients with UC had positive perinuclear antineutrophil cytoplasmic antibody （p-ANCA） [50.0% （15/30） vs 10.0% （2/20）,P 〈 0.05].The most commonly involved regions of IC were descending colon and sigmoid colon,in which the lesions were clearly demarcated with the normal mucosa.Lesions in patients with UC mainly originated from rectum and might spread to the whole colon.Vascular occlusion and micro thrombosis were characteristic pathological findings of IC.The crypt abscesses were frequently seen in the UC group.Conclusion Even though UC and IC have some similar manifestations in the elderly patients,clinical and pathological discrepancy is still helpful to differentiate each other.