共聚焦激光显微内镜对溃疡性结肠炎患者肠黏膜功能状态的评估研究

发布时间：2018-03-10 15:12

本文选题：溃疡性结肠炎　切入点：共聚焦激光显微内镜　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:溃疡性结肠炎(UC)是一种主要累及直肠、结肠黏膜和黏膜下层的慢性非特异性炎症性肠道疾病,近年来UC在我国的发病率呈上升趋势。内镜下评估UC结肠黏膜愈合程度作为一项评估疾病活动性、治疗目标、关键预后指标和临床治疗终点的重要措施越来越被人们所接受。UC黏膜愈合判断主要是通过传统白光内镜,然而,即便是白光内镜下认为结肠黏膜"完全愈合"的溃疡性结肠炎患者,仍有相当比例的患者疾病复发,这表明白光内镜评估的黏膜愈合不是完全等同于正常黏膜。共聚焦激光显微内镜(CLE)已被证明可以可靠地用于评估UC的疾病活动程度,同时可通过观察细胞的脱落和黏膜屏障的缺失来预测UC的复发。本研究通过CLE下UC患者不同肠段肠黏膜与正常人群肠黏膜荧光素渗出情况进行检测对比分析,并由此了解CLE在评判UC疾病功能修复状态的优势作用。方法:研究组为2014.7～2016.12间于浙江大学医学院附属第一医院确诊并治疗后复查的30名UC患者。对照组选取同期在浙江大学医学院附属第一医院肠镜检查发现结肠息肉、并拟行结肠息肉摘除术患者10名。研究组先进行白光内镜检查,轻柔缓慢进镜至回盲部,沿途进镜仔细观察全结肠并进行黏膜愈合程度评估。到达回盲部盲底后通过静脉通路缓慢注射5毫升10%荧光素钠,10分钟后进行CLE检查。左半结肠(脾曲及以下结肠肠段)白光内镜下显示正常但CLE下显示异常的结肠黏膜活检送常规病理组织学检查。CLE检查全程图像均系统自动视频录像,收集视频后期回放、读片分析,据CLE下荧光素钠渗出计数评估研究组结肠肠段屏障功能破坏评估情况。对照组:操作过程与研究组基本相同。结果:研究组Boston评分与对照组2组白光内镜观察肠道准备清洁度均达到合格标准,无统计学差异(p0.05).研究组30例UC患者中有10例白光内镜下全结肠肠段黏膜正常。另20例均存在结肠部分肠段黏膜异常。对照组中10例全结肠肠段黏膜白光内镜下均显示正常。研究组白光内镜正常患者CLE下结肠荧光素钠渗出评分与对照组CLE下荧光素钠渗出评分两组间存在显著差异(p0.05)。研究组白光内镜正常CLE显示异常的占70%,对照组白光内镜正常CLE显示异常占l0%。研究组白光内镜正常患者与对照组CLE下表现有统计学差异(p0.05)。研究组20例活动期溃疡性结肠炎患者中,白光内镜异常肠段CLE荧光素钠渗出评分与白光内镜正常肠段CLE下荧光素钠渗出评分2组间存在统计学差异(p0.05)。普通白光内镜下黏膜正常患者的左半结肠黏膜CLE下荧光素钠渗出评分与活检组织病理组织学结果HI分级指数Spearman等级相关性分析相关系数rs=0.394,p=0.260.05,尚不能认为CLE下荧光素钠渗出评分与病理组织学HI分级指数的相关系数有统计学意义。结论:通过CLE可发现UC患者黏膜愈合先为结构修复,白光内镜下黏膜愈合并不能代表功能修复。在观察亚细胞结构水平方面CLE检查评估黏膜屏障功能改变优于组织活检病理检查。CLE可以准确地做出UC黏膜修复过程中结构和功能状态的判定,今后有望成为判断UC患者黏膜功能修复的"金标准"。
[Abstract]:Objective: ulcerative colitis (UC) is a major involvement of rectum, colon mucosa and submucosa of chronic non-specific inflammatory bowel disease, in recent years, UC incidence in our country is on the rise. Endoscopic evaluation of UC colonic mucosal healing as an assessment of disease activity and treatment goals, important measures the key prognostic factors and clinical treatment of the end point has been more and more accepted.UC mucosal healing judgment mainly is through the traditional white light endoscopy, however, even the white light endoscopic colonic mucosa "healed" ulcerative colitis patients, there is still a considerable proportion of patients with disease recurrence, suggesting that endoscopic assessment of mucosal healing light not exactly the same in the normal mucosa. Confocal laser endomicroscopy (CLE) has been shown to reliably for disease activity assessment of UC, at the same time through the observation of exfoliative cells and mucosal screen The lack of barriers to predict UC recurrence. This study was detected through the analysis and comparison of intestinal mucosal CLE UC patients in different intestinal segments of intestinal mucosa and normal fluorescein leak case, and thus understand the advantages of CLE in function evaluation of UC disease repair. Methods: the study group is 2014.7 to 2016.12 at the Zhejiang University School of medicine was diagnosed the First Affiliated Hospital and after treatment of 30 patients with UC were selected. The control group found that colonic polyps with colonoscopy First Affiliated Hospital of Zhejiang University Medical College, and underwent polypectomy in 10 patients. The first group of white light endoscopy, slowly and gently into the mirror to ileocecus, along the way into the mirror carefully observe the whole colon and to evaluate the degree of mucosal healing. At the ileocecal valve through venous access after the end of the blind slow injection of 5 ml of 10% sodium fluorescein, 10 minutes after CLE examination. The left colon and splenic flexure (the following node Intestinal endoscopy showed normal white) but CLE showed abnormal colonic mucosal biopsy for routine histopathological examination.CLE scan images were full system automatic video collection, video playback later, film reading analysis, according to the CLE of sodium fluorescein exudation count assessment study group colon segment barrier function damage assessment. The control group: operation process and research groups were basically the same. Results: the Boston score of study group and control group 2 groups of white light endoscopic observation of intestinal preparation cleanliness reached the standard, no significant difference (P0.05). The study group of 30 cases of UC patients with 10 cases of white light endoscopic total colonic intestinal mucosa was normal. The other 20 cases of colon intestinal mucosal abnormalities. In the control group 10 cases total colon colon mucosa under endoscopy showed normal white. CLE patients with normal colon endoscopy study group of sodium fluorescein exudation as compared with the control group CLE. Light sodium exudation score there was significant difference between two groups (P0.05). The study group CLE normal white light endoscopy showed abnormal accounted for 70%, the control group CLE showed normal white light endoscopy abnormal in patients with normal l0%. group and control group CLE under endoscopy showed significant difference (P0.05). The study group of 20 cases of active ulcer in patients with ulcerative colitis, abnormal intestinal endoscopy CLE fluorescein exudation score and endoscopy normal bowel CLE fluorescein exudation score there was significant difference between the 2 groups (P0.05). The left colon mucosa of patients with normal white light endoscopic mucosal CLE fluorescein exudation score and biopsy histopathological results of HI grading index Spearman rank correlation analysis correlation coefficient rs=0.394, p=0.260.05, still can not believe that the correlation coefficient CLE under fluorescein sodium exudation and histopathological grading index HI score was statistically significant. Conclusion: the CLE can be found in UC patients with mucosal healing first for repair, white light endoscopic mucosal healing and functional restoration. The evaluation is not representative of the mucosal barrier function changes than tissue biopsy and.CLE can accurately judge the structure and function of UC in the process of observing mucosal repair level subcellular CLE examination, is expected to become the future judge UC mucosa in patients with functional recovery of "gold standard".

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.62

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