285例溃疡性结肠炎临床及病理回顾性分析

发布时间：2018-04-27 05:43

本文选题：溃疡性结肠炎 + 临床特点　；参考：《山东大学》2017年硕士论文

【摘要】：背景:溃疡性结肠炎(ulcerative colitis,UC)是主要累及结直肠的慢性炎性疾病,属于炎症性肠病,病因至今未完全阐明。该病为西方国家的常见疾病,既往报道中我国相对少见。近30年来我国UC发病率不断上升,UC患者罹患结直肠癌的风险也较正常人群显著升高。我国目前尚缺乏UC癌变的大规模临床调查资料,结肠黏膜不典型增生作为UC癌变的基础病变进程正逐渐引起广泛的关注。目的:回顾我院20年来UC住院患者的临床资料,分析UC的临床特点,重点分析病理呈不典型增生的病例,为UC的诊治以及UC相关性结直肠癌(UC-CRC)的早诊早治提供一定参考。方法:搜集山东省立医院消化内科1996年1月至2016年9月住院治疗的285例UC患者的临床资料,均有详细内镜及病理结果,记录其性别、年龄、主要症状、病程、家族史、吸烟史、病变范围、疾病严重程度、实验室检查、肠镜及病理结果,采用SPSS 20.0软件对数据进行分析。结果:1.一般情况:UC患者285例,男女之比为1.26:1。病程1年者最常见(46.3%),40-49岁为发病高峰年龄。临床表现:腹痛(69.5%)、脓血便(65.3%)、腹泻(61.4%)最为常见。1.7%患者有阳性家族史,22.8%有吸烟史。病变范围:直肠6.7%,左半结肠20.0%,广泛结肠73.3%。缓解期患者11.6%,活动期88.4%,活动期患者中,轻度 17.1%(43/252),中度 25.4%(64/252),重度 57.5%(145/252)。疾病分型:初发型30.9%,慢性复发型69.1%。伴有肠外表现者18例(6.3%),其中关节痛15例,坏疽性脓皮病1例,虹膜睫状体炎1例,双下肢血栓1例。伴有并发症者6例(2.1%)。2.肠镜表现:主要有黏膜充血水肿(87.0%)、黏膜糜烂(89.1%)、溃疡形成(73.7%)和假息肉(37.2%)等。病理表现主要有:黏膜慢性炎(67.0%)、溃疡形成(22.1%)、隐窝脓肿(9.8%)和炎性息肉(7.7%)等。3.不典型增生和癌变:共计70例(24.6%),包括轻度不典型增生(16.1%)、中度不典型增生(6.7%)、重度不典型增生(1.4%)和腺癌(0.4%)。不典型增生和癌变患者中,疾病累及范围以广泛结肠型(68.6%)为主,疾病分型以慢性复发型(71.4%)为主,疾病严重程度以重度(42.9%)为主,病程以1年(47.1%)最为常见。4.治疗:氨基水杨酸制剂93.0%,糖皮质激素76.8%,免疫抑制剂1.8%,生物制剂1.1%。7例(2.5%)患者接受外科治疗,原因为内科治疗效果差(5例),发生肠穿孔(1例)和发现重度不典型增生(1例)。结论:1.我院UC住院患者具有病情重、病变范围广的特点。女性病情重于男性。广泛结肠炎患者病情主要为重度,左半结肠炎和直肠炎患者多为轻中度。实验室检查中HGB、ALB和ESR可反映病变范围。中老年、轻度患者有吸烟史的所占比例较高。青年组和中重度患者全身应用糖皮质激素的比例较高。2.不典型增生和癌变率低于西方国家。患者不典型增生的程度在年龄、性别、临床分型、病变范围、病情严重程度、吸烟史、家族史、病程、并发症、肠外表现、药物及手术治疗等方面均无统计学差异。3.氨基水杨酸制剂是UC患者的基础用药,远端结肠炎多联合应用局部灌肠或栓剂治疗,广泛结肠炎患者多联合糖皮质激素治疗,免疫抑制剂、生物制剂使用率和手术率均较低。
[Abstract]:Background: ulcerative colitis (UC) is a chronic inflammatory disease involving the colon, which is an inflammatory bowel disease. The cause of the disease is not fully elucidated. The disease is a common disease in the western countries. It is relatively rare in our country. In the past 30 years, the incidence of UC in China is rising, and the risk of colorectal cancer in UC patients is also higher. There is a significant increase in normal population. There is still a lack of large scale clinical data of UC carcinogenesis in our country. The atypical hyperplasia of colon mucosa is the basic pathological process of UC carcinogenesis. Objective: To review the clinical data of the patients in the hospital for 20 years in our hospital, to analyze the characteristics of the UC in the hospital, and to analyze the atypical hyperplasia of the pathology in the pathology. This case provides a reference for the diagnosis and treatment of UC and the early diagnosis and early treatment of UC related colorectal cancer (UC-CRC). Methods: the clinical data of 285 cases of UC patients hospitalized in the digestive department of Shangdong Province-owned Hospital from January 1996 to September 2016 were collected, with detailed endoscopic and pathological results, and the sex, age, main symptoms, course of disease, family history and smoking were recorded. History, extent of disease, laboratory examination, enteroscopy, and pathological results, the data were analyzed with SPSS 20 software. Results: 1. general conditions: 285 cases of UC patients, the most common (46.3%) of men and women for 1 years of 1.26:1., 40-49 years old for the peak age. Clinical manifestations: abdominal pain (69.5%), pus and blood stool (65.3%) and diarrhea (61.4%) The common.1.7% patients had a history of positive family, 22.8% with a history of smoking: 6.7% of the rectum, 20% in left semicolon, 11.6% in the extensive colonic remission period, 88.4% in the active period, 17.1% (43/252), 25.4% (64/252), and 57.5% (145/ 252) in the active period. The disease type was 30.9%, and the chronic relapse of 69.1%. was accompanied by the appearance of intestinal appearance. There were 18 cases (6.3%), of which 15 cases of joint pain, 1 cases of gangrenous pyoderma, 1 cases of iris ciliary body inflammation, 1 cases of double lower limb thrombosis. 6 cases with complications (2.1%).2. enteroscopy: mainly mucous congestion edema (87%), mucous erosion (89.1%), ulcer formation (73.7%) and false polyps (37.2%). Pathological manifestations mainly include mucous chronic inflammation (67%), ulcers .3. atypical hyperplasia and carcinogenesis were formed (22.1%), recess abscess (9.8%) and inflammatory polyp (7.7%): a total of 70 cases (24.6%), including mild atypical hyperplasia (16.1%), moderate atypical hyperplasia (6.7%), severe atypical hyperplasia (1.4%) and adenocarcinoma (0.4%). Among the patients with atypical hyperplasia and carcinogenesis, the range of disease involved in the widespread colonic type (68.6%), disease. The main type was chronic relapse (71.4%), the severity of disease was mainly severe (42.9%), the course of disease was 1 years (47.1%) the most common.4. treatment: aminosalicylic acid 93%, glucocorticoid 76.8%, immunosuppressant 1.8%, and biological agent 1.1%.7 (2.5%) patients received surgical treatment, the reason for the poor effect of internal medicine (5 cases), intestinal perforation (1 cases) 1 cases of severe atypical hyperplasia (1 cases) were found. 1. in our hospital, the patients in our hospital have a severe condition and a wide range of disease. The condition of the female is heavier than that of the male. The disease is mainly severe in the patients with extensive colitis, and most of the patients with left hemi colitis and proctitis are mild and moderate. In the laboratory examination, HGB, ALB and ESR can reflect the extent of the disease. The proportion of the history of smoking is higher. The proportion of corticosteroids in the young and middle and severe patients is higher than that in the western countries. The atypical hyperplasia and canceration rate of.2. is lower than that of the western countries. The degree of atypical hyperplasia in the patients is age, sex, clinical typing, the extent of disease, the severity of the disease, the history of smoking, family history, course of disease, complications, enteral manifestations, and drugs. .3. amino salicylic acid preparation is the basic drug for UC patients. Distal colitis is combined with local enema or suppository therapy. The patients with extensive colitis are combined with glucocorticoid, immunosuppressive agents, biological agents use and operation rate are low.

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

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