白塞病合并肠道病变的临床回顾性分析

Intestinal pathological changes in Behcet's disease:a clinical retrospective study

目的分析白塞病合并的肠道病变类型,为进一步诊治白塞病合并肠道病变提供参考依据。方法收集401例完成纤维结肠镜检查的白塞病患者的基本资料、肠镜、病理及血液学检查情况,对肠道病变进行统计描述,并分析不同肠道病变的部位及血液学指标的差异。结果401例白塞病患者中有肠道改变者88例(21.95%)。肠溃疡(包括活动期及愈合期)52例(12.97%),以回盲部多见,其中62.86%(占白塞病患者5.49%,22/401)未诉胃肠道相关症状。溃疡活动期炎症指标较愈合期高,其中C反应蛋白(C reactive protein,CRP)差异具有统计学意义(P=0.028)。腺瘤(包括管状腺瘤、锯齿状腺瘤、绒毛状腺瘤)33例(8.23%),以直、乙状结肠,尤其是直乙交界处最为常见;腺瘤主要发生于年龄较大者,与白塞病无肠道病变或合并溃疡者差异有统计学意义(P=0.022,0.000),天冬氨酸氨基转移酶(aspartate aminotransferase,AST)、γ-谷氨酰基转移酶(gamma-glutansferase,GGT)及尿酸(uric acid,UA)升高,临床实验室检查差异与年龄增高相关。另见2例大肠黑变病及1例盲肠憩室。结论白塞病合并肠溃疡或腺瘤占相当一部分比例,且白塞肠病或白塞病合并腺瘤患者常未诉相关症状,故行常规肠镜检查对白塞病的诊治是必要的。

Objective To analyze the characteristics of Behcet’s disease （BD） with intestinal lesions to provides further reference for the diagnosis and treatment. Methods Four hundred and one cases of BD patients’ data were collected including basic data, colonoscopy report, pathology diagnosis and hematologic examination. Statistical description of intestinal lesions was applied and analyzed for the differences between the locations and blood examinations of intestinal lesions. Results Within these 401 BD patients, 88 （21.95%） with intestinal lesions. Intestinal ulcerations, including both active and inactive phase, appeared in 52 cases （12.97%） mostly founded in ileocecum, in which 62.86% （22/401, 5.49% of all BD patients） without the abdominal discomfort. Compared with inactive phase, the active phase intestinal BD patients have higher inflammation indexes with C reactive protein （CRP） increased of statistical significance （P=0.028）. Thirty-three cases （8.23%） with adenomas were founded, including tubular adenoma, serrated adenoma and villous adenoma. Mostly occurred in rectum, sigmoid colon, especially the sigmoid colon rectum junction. Adenomas were seen in elder patients with statistical significance compared to BD patients without intestinal lesion or with intestinal ulceration （P=0.022, 0.000）, and exhibited elder changes of lab tests, such as increas in aspartate aminotransferase （AST）, gamma-glutamyl transferase （GGT） and uric acid （UA）. In addition, 2 cases of melanosis coli and 1 case of caecal diverticulum were also founded. Conclusions BD patients with intestinal ulcer or adenoma takes a fairly high ratio, and most intestinal BD and BD with adenoma patients did not complaint related symptoms, so colonoscopy as a screening method for diagnosis and treatment of BD is necessary.