共聚焦显微内镜实时检测溃疡性结肠炎粘膜微循环血流动力学的研究

发布时间：2018-04-27 23:39

本文选题：探头式共聚焦激光显微内镜 + 溃疡性结肠炎　；参考：《山东大学》2014年硕士论文

【摘要】：研究背景及目的：近几年溃疡性结肠炎在我国的发病率呈上升趋势,疾病过程以缓解和复发交替进行为主要特点。目前对溃疡性结肠炎的诊断仍以临床表现结合内镜表现、组织病理学的综合诊断为标准。其粘膜炎症发生的病理生理机制尚不十分明确,以往的研究主要集中于病理组织学对上皮细胞、免疫细胞等形态学观察。有研究表明,溃疡性结肠炎患者血栓形成的风险较高,且处于长期炎症状态的肠道微血管内皮细胞出现由NO介导的舒张功能异常,提示溃疡性结肠炎患者肠粘膜微循环血流动力学可能存在异常。探头式共聚焦激光显微内镜在内镜检查的同时可以获得活体粘膜及粘膜下组织学动态图像,可实时动态观察肠粘膜血流动力学的改变。目前对溃疡性结肠炎肠粘膜微循环血流动力学的在体研究尚属空白。本研究的目的旨在利用探头式共聚焦激光显微内镜实时动态观察溃疡性结肠炎肠粘膜微循环血流动力学改变,并探讨其血流动力学改变与炎症程度的关系,为研究溃疡性结肠炎病理生理机制提供临床理论依据。研究方法：自2013年3月至2014年3月就诊于山东大学齐鲁医院行共聚焦显微内镜检查为溃疡性结肠炎的42例患者作为实验组,高清内镜检查未见明显异常的39例患者作为对照组纳入本研究。每位患者均由四名经验丰富的共聚焦内镜医师之一按照常规操作进行内镜检查,高清内镜检查前静脉注谢1mL2%的荧光素钠1作为皮试,进境至回肠末端后,静脉注射3mL10%的荧光素钠,以适宜力度将共聚焦探头接触患者肠粘膜获取共聚焦图像；实验组选取回肠末端及病变部位图像、对照组选取回肠末端及直乙交界处图像进行数据分析。每个图像记录微血管直径及面积两个静态指标及血细胞流动是否出现停滞、往返、聚集、缗钱样改变四个动态指标,并对实验组的每个患者进行临床评分(Mayo Clinical Score)、内镜评分(UCEIS)及共聚焦内镜炎症程度分级,观察溃疡性结肠炎患者微循环血流动力学特点的改变,并探究微血管血流动态学指标评分与微血管直径和面积、临床评分、内镜评分及共聚焦内镜下炎症程度之间的相关性。研究结果：实验组与对照组回肠末端血流动态学总分无明显差异,而实验组病变处血流动态学总分、微血管直径、微血管面积与对照组直乙交界处均有明显差异,p0.01。实验组Mayo I临床评分与内镜UCEIS评分有明显相关性(r=0.402,p0.01),且内镜UCEIS评分与共聚焦内镜炎症程度分级有明显相关性(r=0.444,p0.01)。病变部位血流动态学总分与内镜UCEIS评分呈正相关(r=0.395,p0.05),“停滞、往返、聚集、缗钱样改变”四项血流动态学指标与UCEIS评分的相关系数分别为：0.039、0.445、0.187、0.121。结论：探头式共聚焦激光显微内镜可实时观察溃疡性结肠炎患者肠粘膜微循环血流动力学的改变,溃疡性结肠炎患者病变处微血管管径、面积均较正常者增大,且存在明显血流瘀滞趋势,并与其炎症程度存在相关性,炎症程度愈重,其血流瘀滞程度愈大,微血栓形成的风险愈高。
[Abstract]:Background and purpose of the study :

In recent years , the incidence of ulcerative colitis has been increasing in our country , and the course of disease is characterized by the alternation of remission and recurrence . The pathological and physiological mechanism of mucosal inflammation is not very clear .

Study method :

Forty - two patients with ulcerative colitis were examined by confocal microscopy from March 2013 to March 2014 as experimental group . 39 patients with no obvious abnormality were examined by high - definition endoscopy as control group . One of the four experienced co - focus endoscopes was used as control group .
To study the changes of microcirculation hemodynamics in patients with ulcerative colitis , and to explore the correlation between the score of vascular hemodynamics and the degree of microvessels ' diameter and area , clinical score , endoscopic scoring and the degree of inflammation in confocal endoscope .

Results of the study :

There was no significant difference between the experimental group and the control group . There was no significant difference between the experimental group and the control group ( r = 0.402 , p0.01 ) , and the endoscopic UCEIS score was significantly correlated with the endoscopic UCEIS score ( r = 0.444 , p0.01 ) . There was positive correlation between the total score of blood flow dynamics and endoscopic UCEIS score ( r = 0.395 , p0.05 ) , and the correlation coefficients of four blood flow dynamic indexes and UCEIS scores were 0.039 , 0.445 , 0.187 and 0.121 , respectively .

Conclusion :

The probe - type confocal laser micro - endoscope can observe the changes of microcirculation in the intestinal mucosa of patients with ulcerative colitis in real time , and the diameter and area of the microvessels in the lesions of ulcerative colitis are higher than those of the normal ones , and there is a clear tendency of blood stasis and stagnation , and there is a correlation between the degree of inflammation and the degree of inflammation , the more the blood stasis is , the higher the risk of microthrombus formation .

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R574.62

【参考文献】