缺血性结肠炎患者临床和结肠镜特点分析

摘要

目的 分析缺血性结肠炎(IC)患者的临床和结肠镜特点,以协助更好地诊断和治疗.方法 回顾性分析2009—2016年于首都医科大学附属北京世纪坛医院住院的初发IC患者的临床资料,分析患者的一般资料、临床表现、实验室检查和结肠镜检查特点.结果 共纳入74例初发IC患者,女40例(54.1%),平均年龄(68.3±11.3)岁,≥65岁45例(60.8%).主要临床症状有便血〔89.2%(66/74)〕、下腹痛〔83.8%(62/74)〕、恶心〔25.7%(19/74)〕、便秘〔24.3%(18/74)〕、腹胀〔24.3%(18/74)〕.伴随的基础疾病有高血压〔60.8%(45/74)〕、外周动脉硬化〔41.9%(31/74)〕、高脂血症〔35.1%(26/74)〕、腹部手术史〔32.4%(24/74)〕和冠状动脉粥样硬化性心脏病〔29.7%(22/74)〕.结肠镜下主要表现为充血、水肿、出血、糜烂和溃疡.52例患者为左半结肠受累,4例合并结肠恶性肿瘤.部分患者血糖、C反应蛋白、D-二聚体水平升高.20例患者血管超声和/或CT血管造影发现了不同程度的腹腔血管狭窄.结论 IC好发于女性和老年人,左半结肠是最常见的受累部位,存在IC合并结肠恶性肿瘤的情况,应重视结肠镜检查以减少误诊和漏诊,同时注意预防可逆因素所致IC.%Objective To analyze the clinical and endoscopic features of ischemic colitis (IC),in order to provide a reference for the diagnosis and treatment of the disease.Methods We retrospectively analyzed the demographic data, clinical manifestations,results of laboratory examination and colonoscopy characteristics of the IC patients with who received initial treatment in Beijing Shijitan Hospital,CMU from 2009 to 2016.Results Totaled 74 cases of IC were enrolled.Among them,54.1%(40/74) were females,60.8%(45/74) aged ≥ 65,the mean age was (68.3±11.3) years.Their main clinical manifestations were hematochezia 〔89.2%(66/74)〕,hypogastralgia〔83.8%(62/74)〕,nausea〔25.7% (19/74)〕,constipation〔24.3%(18/74)〕 and abdominal distension 〔24.3%(18/74)〕.The common accompanying basic diseases found in them were hypertension 〔60.8%(45/74)〕,peripheral artery atherosclerosis 〔41.9%(31/74)〕, hyperlipidemia 〔35.1%(26/74)〕,history of abdominal surgery〔32.4%(24/74)〕 and coronary heart disease 〔29.7% (22/74)〕.The colonoscopy identified hyperemia,edema,hemorrhage,erosion and ulcer in the colon.Fifty-two patients had left colonic involvement,and 4 of them were accompanied by malignant colonic neoplasm.The levels of fasting blood glucose, C-reactive protein and D-dimer were increased in some patients.Twenty patients were found with different degrees of abdominal artery stenosis by vascular ultrasound /CT angiography.Conclusion IC occurs mostly in the female and the elderly.The left colon is one of the most involved areas.Some patients with IC have malignant colonic neoplasm.It is important to bear in mind that colonoscopy can reduce the possibilities of misdiagnosis and missed diagnosis and the reversible factors that can lead to IC.