161例缺血性结肠炎的临床分析

Clinical analysis of 161 cases of ischemic colitis

目的分析探讨及对比分析不同年龄患者缺血性结肠炎的临床病理特征及临床转归,以增强对该病的认识。方法回顾性分析2017年1月至2022年12月我院161例结肠镜确诊为缺血性结肠炎患者的临床特点、危险因素、实验室检查、影像学、结肠镜和病理组织学、缺血程度及临床转归,同时根据年龄分为中青年组(<60岁,68例)和老年组(≥60岁,93例),并进行对比分析不同年龄间相关因素的差异。结果161例缺血性结肠炎患者年龄(62.19±11.22)岁,以女性为主(58.4%),老年组占57.8%,多合并高血压、腹部手术史、恶性肿瘤病史等危险因素,两组在合并高血压上差异有统计学意义(P<0.05)。主要临床表现为腹痛,其次为血便、腹泻。不同年龄组在临床表现上差异无统计学意义。实验室检查以大便潜血阳性、D-二聚体升高及CRP升高为主。影像学检查超声阳性率较低,CT表现主要为肠壁炎症性改变。内镜下病变主要累及左半结肠(73.3%),其中以乙状结肠(72.7%)为主,两组在累及右半结肠和广泛结肠上差异有统计学意义(P<0.05)。结肠镜下表现分期均为Ⅰ期或Ⅱ期,两组在分期上的差异无统计学意义(P>0.05)。内镜下主要表现为黏膜充血水肿、糜烂及多发溃疡形成,组织病理学多为黏膜急慢性炎症,不同年龄组在缺血程度方面差异有统计学意义(P<0.05)。159例(98.8%)患者治疗后好转。结论缺血性结肠炎好发于老年,多合并高血压、腹部手术史、恶性肿瘤病史等危险因素。老年患者缺血程度更重,更多累及右半结肠,中青年患者缺血程度轻,更多累及广泛结肠。缺血性肠炎为自限性疾病,治疗及时预后良好。

Objective To analyze and compare the clinicopathologic features and clinical outcomes of ischemic colitis in patients of different ages,so as to enhance the understanding of the disease.Methods The clinical features,risk factors,laboratory examination,imaging,colonoscopy and histopathology,ischemic degree and clinical outcomes of 161 patients diagnosed with ischemic colitis by colonoscopy in our hospital from Jan.2017 to Dec.2022 were retrospectively analyzed.At the same time,according to age,they were divided into the young and middle-aged group(68 cases<60 years old)and the elderly group(93 cases≥60 years old),and the differences of relevant factors between different ages were analyzed.Results The age of 161 patients with ischemic colitis was(62.19±11.22)years old,mainly female(58.4%),and the elderly group accounted for 57.8%.It is often combined with risk factors such as hypertension,history of abdominal surgery,and history of malignant tumor,and there were statistically significant differences in hypertension between the two groups(P<0.05).The main clinical manifestations were abdominal pain,followed by hematochezia and diarrhea.There was no statistically significant difference in clinical manifestations among different age groups.The laboratory tests were mainly positive for fecal occult blood,elevated D-dimer and CRP.The positive rate of ultrasonography was low,and the findings of CT were mainly inflammatory changes of intestinal wall.Endoscopic lesions mainly involved the left half colon(73.3%),and the sigmoid colon(72.7%)was the main lesion,and the differences between the two groups in the right colon and extensive colon were statistically significant(P<0.05).The stage of colonoscopy was stageⅠorⅡ,and there was no significant difference in stage between the two groups(P>0.05).Under endoscopy,the main manifestations were mucosal hyperemia and edema,erosion and multiple ulcers,and the histopathology was mostly acute and chronic mucosal inflammation.There were statistically significant differences in the degree of ischemia among different age groups(P<0.05).A total of 159 patients(98.8%)improved after treatment.Conclusion Ischemic colitis usually occurs in the elderly and is associated with high blood pressure,history of abdominal surgery,history of malignant tumor and other risk factors.The degree of ischemia in elderly patients is more severe and more involved in the right half colon.The degree of ischemia in young and middle-aged patients is mild,more involving extensive colon.Ischemic enteritis is a self-limited disease,and the prognosis is good after timely treatment.