隐源性多灶性溃疡性狭窄性小肠炎临床特征荟萃分析及TNF-α在其肠组织中的表达

发布时间：2018-03-29 01:23

  本文选题：隐源性多灶性溃疡性狭窄性小肠炎　切入点：慢性非特异性多灶性小肠溃疡　出处：《河北医科大学》2014年硕士论文

【摘要】：隐源性多灶性溃疡性狭窄性小肠炎(cryptogenic multifocal ulcerousstenosing enteritis, CMUSE)是一种临床罕见的小肠慢性疾病，目前病因尚不明确。以反复发作的小肠不全性梗阻为主要表现，常伴随腹痛、黑便、缺铁性贫血、低蛋白血症、水肿、生长发育迟缓等症状，病理表现为小肠多发浅表溃疡，可见慢性炎性细胞浸润伴少量嗜酸性粒细胞，溃疡仅侵犯粘膜及粘膜下层，不累及肌层等深层组织，可伴有纤维组织增生。临床易误诊为克罗恩病、肠结核及非甾体抗炎药相关性小肠病。糖皮质激素治疗有效，但是容易产生激素依赖，目前仍未找到促进粘膜愈合的有效治疗，针对肠道狭窄，多需要借助外科手术。 CMUSE在全球范围内尚属少见，见诸报道的确诊病例仅60余例。目前对该病没有统一的诊断治疗意见。本研究主要通过对CMUSE病例进行荟萃分析，总结归纳其主要临床表现、影像学及内镜下特点及病理特点，以期为该病的诊断与治疗提供依据。同时结合我院确诊的CMUSE病例，研究TNF-α在病变肠组织中的表达，探讨该病的发病机制，以期为该病的治疗提供新思路。 第一部分隐源性多灶性溃疡性狭窄性小肠炎1例报道 目的：分析我院1例CMUSE患者病例特点，并检测TNF-α在其肠组织中的表达。 方法：选择河北医科大学第二医院经病理证实的CMUSE患者1例，搜集临床资料及术后标本，回顾性分析其临床特点及病理特征，应用组织染色技术观察病变肠组织炎症程度及纤维组织增生情况，应用免疫组织化学染色技术观察病变肠组织TNF-α的表达情况。 结果：该例CMUSE患者为中年女性，以反复缺铁性贫血、肠梗阻、黑便及低蛋白血症为主要症状，腹部CT表现为脐水平腹腔右侧及左下腹肠管壁环形增厚，肠腔狭窄伴明显强化。胶囊内镜显示小肠节段性粘膜水肿及溃疡，溃疡大小不等，较表浅，多为纵行，表面覆黄白苔。剖腹探查术可见回肠节段性狭窄，内有胶囊状物（滞留于肠内的胶囊内镜）1枚，遂行小肠部分切除，小肠-小肠端侧吻合术，术后病理示小肠粘膜部分渗出、坏死及肉芽，符合溃疡，肠系膜淋巴结13枚反应性增生。小肠病变部位HE染色可见粘膜及粘膜下层炎性细胞浸润，Masson染色及天狼星红染色可见纤维组织明显增生，免疫组织化学染色可见粘膜及粘膜下层TNF-α表达增加。 结论：本例小肠病变患者诊断为CMUSE，符合目前国内外CMUSE诊断要点；病变肠组织TNF-α表达增加。 第二部分隐源性多灶性溃疡性狭窄性小肠炎临床特征荟萃分析 目的：通过分析国内外文献报道病例，总结CMUSE临床特征，，并分析亚洲与欧洲CMUSE病例临床特征的异同。 方法：通过中国生物医学文献服务系统、万方数据库、维普中文科技期刊数据库、中国知网及PubMed检索国内外公开发表的CMUSE病例报道文献，对符合入选标准的病例的临床表现、实验室检查、影像学检查、内镜学检查、病理组织学检查结果、治疗及预后情况进行归纳总结。 结果：查阅发表于1996年-2013年间的入选文章，入选的CMUSE病例共18例，其中男性占38.9%，女性占61.1%，男女比为1:1.6。确诊时平均年龄为36岁。临床症状以腹痛、缺铁性贫血、体重下降、黑便为主。实验室检查以血红蛋白降低、白蛋白降低、大便潜血阳性为特征，CRP及ESR等炎症指标多正常，自身抗体多为阴性，1例患者检测纤维化4项明显升高，1例血浆补体C2降低。3例患者可经影像学检查发现肠道梗阻及溃疡性病变表现，全消化道造影较腹部CT及X线更易发现病变。胃镜及肠镜检查多不能发现病变，除非病变位于十二指肠或回肠末端。小肠镜及胶囊内镜检出率较高。病变部位多位于回肠，呈多灶性，亦可见单发溃疡或狭窄，病理标本均表现为浅表溃疡，仅侵及粘膜及粘膜下层，不向肌层及深层组织浸润，而纤维化和炎性浸润可达到深层组织，粘膜下层可因纤维化增厚，以轻-中度炎症改变为主，可见中性粒细胞、单核细胞、嗜酸性粒细胞及浆细胞浸润，无肉芽肿形成，无绒毛萎缩、淋巴增殖、巨细胞肉芽肿及阿弗他或裂隙溃疡表现。部分病例可见小静脉增厚、炎性浸润、血栓成形或静脉内膜炎。患者多数误诊为克罗恩病，部分患者难以与溃疡性回肠炎或肠结核鉴别。7例患者接受激素治疗有效，有效率53.8%。3例患者出现激素依赖，3例激素抵抗。9例患者接受手术治疗，术后4例患者复发，复发率44.4%。1例患者伴有雷诺氏综合症、干燥综合症、哮喘、关节肿痛等多器官损伤。1例患者伴有消化道肿瘤。 结论：CMUSE女性多发，临床以腹痛、缺铁性贫血、体重下降、黑便为主为主要特点，部分患者可有乏力、腹泻、低热、水肿、呕吐、便秘等症状；病理特点为累及小肠的多灶性浅表溃疡，溃疡仅侵及粘膜及粘膜下层，不向肌层及深层组织浸润，而纤维化和炎性浸润可达到深层组织，粘膜下层可因纤维化增厚，以轻-中度炎症改变为主，无肉芽肿形成，无绒毛萎缩、淋巴增殖、巨细胞肉芽肿及阿弗他或裂隙溃疡表现；欧洲及亚洲患者CMUSE临床特征基本相似。
[Abstract]:Cryptogenic multifocal ulcerative colitis ( CMUSE ) is a rare small intestinal chronic disease . It is a rare small intestinal chronic disease . It is characterized by recurrent small intestinal obstruction . It can be seen as chronic inflammatory cell infiltration with a small amount of eosinophils . It is easy to be misdiagnosed as Crohn ' s disease , intestinal tuberculosis and non - steroidal anti - inflammatory drug - related small bowel disease . It is easy to be misdiagnosed as Crohn ' s disease , intestinal tuberculosis and non - steroidal anti - inflammatory drug - related small bowel disease .

CMUSE is rare in the global scope . There are only 60 cases of confirmed cases . There is no unified diagnosis and treatment for the disease . The main clinical manifestation , imaging and endoscopic features and pathological characteristics of CMUSE cases are summarized . The expression of TNF - 伪 in the intestinal tissue of the lesion is studied by combining CMUSE cases diagnosed by our hospital .

The first part of cryptogenic multifocal ulcerative colitis : a report of 1 case

Objective : To analyze the characteristics of one CMUSE patient in our hospital and to detect the expression of TNF - 伪 in its intestinal tissue .

Methods : 1 case of CMUSE patient confirmed by pathology was selected from the Second Affiliated Hospital of Hebei Medical University . Clinical data and postoperative specimens were collected . The clinical characteristics and pathological characteristics were analyzed retrospectively . The expression of TNF - 伪 was observed by immunohistochemical staining .

Results : The CMUSE patient was a middle - aged female with recurrent iron deficiency anemia , intestinal obstruction , black stool and hypoproteinaemia as the main symptoms . The abdominal CT findings were as follows : the small intestine segmental mucosa edema and ulcer , the intestinal canal stenosis accompanied by obvious enhancement .

Conclusion : The diagnosis of small intestinal lesion is CMUSE , which accords with the present diagnostic points of CMUSE at home and abroad .
The expression of TNF - 伪 in diseased intestinal tissue was increased .

Meta - analysis of clinical features of second partial cryptogenic multifocal ulcerative colitis

Objective : To summarize the clinical features of CMUSE and analyze the similarities and differences between the clinical features of CMUSE cases in Asia and Europe .

Methods : The clinical manifestation , laboratory examination , imaging examination , endoscopic examination , pathological histology examination result , treatment and prognosis of cases with inclusion criteria were summarized through the literature of CMUSE cases published at home and abroad through the Chinese Biomedical Literature Service System , Wanfang Database , Vip Chinese Sci - tech Periodical Database , China Knowledge Network and the Chinese Medicine .

Results : There were 18 cases of CMUSE published between 1996 and 2013 , including 38 . 9 % for men , 61 . 1 % for women , 1 鈭

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