活动期溃疡性结肠炎活检黏膜的组织学分级与临床分级和内镜分级的关系

Grading of mucosal histological biopsies, clinical appearances and endoscopies in patients with active ulcerative colitis

目的 研究活动期溃疡性结肠炎(AUC)患者的活检黏膜的组织学分级与临床分级和内镜下分级的相互关系及其在疗效评价中的作用。方法 采用分级的方法来描述133例AUC患者的病理、临床和内镜特征,采用记分方法描述各临床表现,运用Spearman等级相关系数进行相关分析。结果 133例AUC的组织学分级为Ⅰ级29例,Ⅱ级45例,Ⅲ级37例,Ⅳ级22例;临床分级为Ⅰ级85例,Ⅱ级39例,Ⅲ级9例;肠镜分级为Ⅰ级8例,Ⅱ级30例,Ⅲ级16例,Ⅳ级79例。组织学分级与血便程度(r=0.49,P=0.000)、排便次数(r=0.30,P=0.001)、血沉(r=0.42,P=0.000)、临床活动指数(r=0.56,P=0.000)、临床分级(r=0.52,P=0.000)、结肠镜分级(r=0.35,P=0.000)均有正相关性,与血清白蛋白(r=-0.31,P=0.000)有负相关性,而与血红蛋白(r=-0.13,P=0.125)无明显相关。轻中度患者经柳氮磺胺吡啶治疗6周后,在临床为完全缓解的68例中,组织学分级为0级仅19例,肠镜分级为0级仅16例,大部分患者仍有组织学与肠镜分级Ⅰ级的改变。临床缓解和肠镜分级为0级的16例中,仍有7例组织学分级为Ⅰ级。临床缓解、肠镜分级和组织学分级均为0级者仅有9例。结论 AUC患者的组织学分级和临床分级、内镜分级的分布有不一致性。组织学分级与血便的程度、大便的次数、血沉、临床活动指数、临床分级和?

Objective To investigate the correlations between histological grading of the mucosal biopsies, clinical appearances and endoscopies of patients with active ulcerative colitis ( AUC) , and their roles in the therapeutic outcomes. Methods To analyze the grading in pathological, endoscopic and clinical manifestations of 133 patients, and use the scores to estimate each clinical appearance. A prospective study and Spearman correlation coefficients analysis were taken in this study. Results Among 133 patients, the grading of histological, clinical and endoscopic results in grades Ⅰ ,Ⅱ , Ⅲ , andⅣwere 29,45 ,37 and 22; 85 , 39,9 and 0; 8,30,16 and 79 cases respectively. There were significant positive correlations between histological grading and the following parameters; melena ( r =0. 49, P= 0. 000) , bowel movement ( r =0. 30, P = 0.001) , ESR (r=0. 42, P =0.000) , AI(r=0.56, P=0.000) , clinical grade (r=0.52, P=0.000) endoscopic grade (r = 0. 35 , P =0. 000). And no significant negative correlation with Hb (r = -0. 13, P = 0. 125). In 68 mild and moderate cases after administered SASP for 6 weeks with clinical remission there were 16 and 19 cases with 0 grade in endoscopies and histology respectively, and in the former group 7 cases fall in histological grade I . Conclusion There was no agreement in the clinical, endoscopic and histological grades of the AUC patients. For the evaluation of therapy, the sequence of priority is histological grade, endoscopic grade, and then clinical grade.