抗生素相关性出血性肠炎的临床及内镜特点

Clinical features and endoscopic findings of antibiotic-associated hemorrhagic colitis

目的 分析抗生素相关性出血性肠炎的临床特点、内镜表现和治疗预后。方法 对 6例阿莫西林(羟氨苄青霉素 )及其他青霉素衍生物治疗后发生的出血性肠炎患者的临床表现、实验室检查、内镜特点、治疗疗效及随访情况进行分析。结果 发病前 1周内口服阿莫西林及其他青霉素衍生物史 ;急性起病 ,血便伴腹绞痛或腹部不适 ;实验室检查外周血白细胞总数增高 ( 6 7% ) ;结肠镜检查 ,肠黏膜出血、糜烂 ,病变主要在右半结肠 ;病理组织学检查提示黏膜慢性炎症 ,间质出血 ;停用口服抗生素 ,静脉短程激素治疗及支持治疗 ;病情恢复快 ,无合并症发生。结论 对于便血患者应仔细询问服药史 ,尤其是有无服用阿莫西林及青霉素衍生物。明确服药史 。

Objective: To evaluate the clinic pathological spectrum of antibiotic-associated hemorrhagic colitis. Methods: We have observed six patients with hemorrhagic colitis associated with the use of amoxicillin or penicillin derivatives. Clinical manifestation, laboratory tests, colonoscopy examination, treatment and prognosis were analysed. Results: All patients had been given amoxicillin or penicillin derivatives, symptoms of colitis started within 1 week; The onset was sudden, with hematochezia and abdominal cramps or discomfort; Laboratory test manifested leukocytosis (67%); The mucosal change which included diffuse mucosal hemorrhage and erosion was mostly located at the right colon by colonoscopy; Histopathologic examination showed chronic inflammatory of colonic mucosa and redcell infiltrating into the interstitial; Stopped oral antibiotic, support treatment and glucocorticoid were given for short times by transfusion; The patients recovered quickly without any complications. Conclusion:It is very important to ask the history of take medicine when patients suffered with blood diarrhea, especially about amoxicillin and penicillin derivatives. The history of antibiotic therapy and early total colonoscopy examination are the key of establishing diagnosis.