溃疡性结肠炎与结肠克罗恩病病理诊断的鉴别要点

溃疡性结肠炎（UC）和克罗恩病（Crohn病，CD）的鉴别诊断一直是一大难题，随着对结肠镜窥视下和活检病理形态改变的认识不断加深，人们开始重视肠黏膜活检病理诊断在UC和CD鉴别中的应用价值。本文分别从病变的分布，大体表现，组织学特征三方面对UC和CD的病理鉴别诊断要点进行分析总结，并对国外目前内镜下活检取材的要求做一简要介绍。     

CT小肠造影对克罗恩病的临床价值

目的:探讨对克罗恩病实施CT小肠造影的临床价值.方法:选取我院从2016年1月—2021年1月收治的80例克罗恩病患者,所选患者均实施C T小肠造影检查,分析检查结果.结果:经C T小肠造影检查,77例得到确诊,诊断符合率为96.25％.从发病部位分析,经C T小肠造影检查发现病变部位主要为回肠末端.从肠壁增厚情况分析...     

克罗恩病与溃疡性结肠炎鉴别诊断的临床病例分析

目的探讨克罗恩病和溃疡性结肠炎的鉴别诊断。方法收集了18例克罗恩病和29例溃疡性结肠炎,回顾分析两者的临床、内镜及病理特点。结果血便以溃疡性结肠炎明显多见（P〈0．01）,消瘦以克罗恩病多见（P〈0．05）;腹痛、腹泻、发热等两者无显著差异。克罗恩病、溃疡性结肠炎内镜检查,内镜下卵石样改变、裂隙样溃疡及菜花样肿快仅见于克罗恩病（P〈0．05）;肠黏膜充血水肿、糜烂、假性息肉等两者无显著差异。克罗恩病可累及整个胃肠道,主要以回盲部为主;而溃疡性结肠炎仅累及结肠与直肠。结论血便、消瘦等临床表现对两者的鉴别诊断有重要的参考意义,而裂隙样溃疡、瘘管、非干酪性肉芽肿是克罗恩病的特征性表现,确诊需依靠内镜和病理。     

CT小肠造影技术在诊断小肠克罗恩病中的临床应用

目的:分析CT小肠造影技术在诊断小肠克罗恩病中的临床应用效果.方法:将本院于2019年1月—2020年12月收治的89例小肠克罗恩病患者作为研究对象,全体患者均接受X射线小肠碘水造影检查和CT小肠造影检查,比较两组检查方式对克罗恩病的病变诊断情况以及诊断准确率.结果:CT小肠造影技术在腹腔囊肿、炎性包块及蜂窝织炎的诊断...     

双源CT小肠增强造影在炎症性肠病中的诊断价值研究

目的:探讨疑患炎症性肠病的患者采用双源CT小肠增强造影诊断技术的价值.方法:选择我院2019年1月—2021年1月收治的疑似炎症性肠病患者50例,采用双源CT小肠增强造影对所有患者实施检查,以病理诊断结果为金标准,观察该方法对克罗恩病、溃疡性结肠炎的诊断灵敏度、特异度、准确度.结果:本次所选择的疑似炎症性肠病患者50例...     

小肠CT成像对克罗恩病活动性的评估价值

目的 评估小肠CT成像(CTE)与克罗恩病临床症状之间的相关性.方法 收集2016年9月至2019年9月60例克罗恩病患者CTE数据,并对患者的临床参数进行回顾性分析.其中CTE参数包括:肠壁增厚和强化,肠系膜脂肪增生,血管增多和并发症(瘘管、狭窄、脓肿).克罗恩病疾病活动性评估采用克罗恩病活动指数(CDAI)和临床生...     

CT影像学检查对克罗恩病患者病情活动度的诊断价值

目的 探讨CT影像学检查对克罗恩病(CD)患者病情活动度的诊断价值.方法 收集2015年12月至2019年9月在上海市普陀区人民医院进行CT小肠成像检查的36例CD患者病例资料,根据克罗恩病活动指数(CDAI)将患者分为活动期组(CDAI≥150分,n=18)和缓解期组(CDAI<150分,n=18),将同期在医院进行...     

多层螺旋CT小肠造影对克罗恩病的诊断分析

目的 探讨多层螺旋CT小肠造影对胃肠道克罗恩病（CD）的诊断价值.方法 回顾性分析16例确诊CD患者的全腹部MSCT平扫及双期增强检查的CT表现,并以20例肠道无异常的受检者作对照.检查前清洁肠道,肌注654-2液10-20mg,分时段口服大剂量2.5%等渗甘露醇溶液充分充盈肠管,结合多平面重建（MPR）和最大密度投影（MIP）观察.结果 16例CD（病例组）2.13例经结肠镜及病理结果确诊,3例经临床确诊.在16例CD中,CT上均出现病变段肠壁异常强化及病灶节段性分布特点,肠壁增厚15例,黏膜溃疡6例,黏膜鹅卵石征3例,假憩室征2例;肠系膜病变＂梳状征＂9例,肠系膜淋巴结增生4例;瘘管1例;肿块2例,不全性梗阻2例.结论 多层螺旋CT小肠造影双期增强扫描结合重建技术对胃肠道CD,尤其是小肠CD的诊断、病变分期的判断和临床疗效的评价方面有重要的临床应用价值.     

结肠双对比造影对溃疡性结肠炎的诊断价值(附48例报告)

溃疡性结肠炎为一种原因不明的结肠黏膜的慢性炎症性病变,以溃疡糜烂为主,累及结肠的大部分。本文收集近几年内本院结肠双对比造影诊断为溃疡性结肠炎的病例48例,作一回顾和分析。1资料与方法48例中,男性32例,女性16例。年龄15~66岁,平均35岁,高发年龄为20~40岁,病程为1~20年。     

结肠克罗恩病的X线和CT诊断(附6例报告)

克罗恩病又称局限性肠炎、节段性肠炎和肉芽肿性肠炎,是一种原因不明的肠道炎性病变。在整个胃肠道的任何部位均可发病,但好发于末端回肠和右半结肠。收集我院资料,将发生于结肠的6例报告如下。1　资料与方法本组6例,男1例,女5例。年龄29～67岁,平均41岁。5例经手术病理证实,1例经结肠镜检查证实。6例均经Ｘ线全消化道钡餐和钡灌肠检查。2例经ＣＴ检查。ＣＴ扫描前1小时口服15%泛影葡胺800ｍｌ,然后清洁灌肠2～3遍,扫描前再用500ｍｌ15%的泛影葡胺灌肠。2　结果Ｘ线检查发生于横结肠者表现为3～6ｃｍ的狭窄区,最窄处直径03～04ｃｍ,近段肠管…     

The expression of OX40 in immunologically mediated diseases of the gastrointestinal tract (celiac disease, Crohn's disease, ulcerative colitis)

BACKGROUND: The membrane bound receptor OX40 (CD134) - a member of the TNF-R/NGF-R superfamily - is expressed on activated CD4+-T cells in humans and rodents. The interaction of OX40 with its ligand (OX40L) has been shown to be important in T-cell dependent B cell-stimulation and T-cell costimulation in vitro and in vivo. Several studies in experimental animal models for immunologically mediated GI-diseases have stressed the important role of the OX40-OX40L interaction for their manifestations. To assess if the OX40-OX40L interaction is also crucial in the pathogenesis of immunologically mediated diseases of the human gastrointestinal tract (e.g. celiac disease, Crohn's disease, ulcerative colitis) we investigated, in a first line of experiments, the expression of OX40 in biopsy specimens of patients suffering from these diseases. METHODS: The biopsies were formalin fixed and paraffin-embedded and cut into 5 microm slides. To demask the antigen, the slides were consecutively cooked in citrate buffer for 20 min. Binding of anti-OX40 antibody was detected using the alkaline phosphatase-anti-alkaline phosphatase (APAAP) method. RESULTS: Nine of 11 biopsy specimens of patients with celiac disease were OX40-positive; none of the 20 control duodenal biopsies demonstrated OX40-positivity; and all biopsies of patients with ulcerative colitis (n = 11) or Crohn's disease (n = 11), respectively, stained positively for OX40. One of the 20 control biopsies showed OX40 staining. DISCUSSION: OX40 is highly expressed in the gastrointestinal tissue of patients with immunologically mediated bowel diseases. Together with previous studies in animal models for these diseases, the present results point to a potential role of OX40 in their pathogenesis.     

Diagnosis of acute ulcerative colitis and colonic Crohn's disease by colonic sonography

By instilling water into the large intestine, sonographic visualization of the whole length of the colon from the rectosigmoid to the cecum can be achieved. Furthermore, using this method, it is possible to evaluate the lumen, the intestinal wall, and the surrounding connective tissue in detail. In our study, severe, active colonic Crohn's disease and ulcerative colitis could be detected by diagnostic sonography of the colon with a sensitivity of 91% and 89%, respectively. Pathological changes were subsequently confirmed by colonoscopy. Differing echo patterns made differentiation of these two diseases possible. Our results thus show that colonic sonography is a diagnostic procedure that promises to greatly facilitate the evaluation and differentiation of inflammatory large bowel diseases.     

基于CT小肠成像预测中重度期克罗恩病的列线图模型构建

目的  探索中重度克罗恩病（CD）的CT小肠造影特征,构建预测中重度期CD的列线图。方法  收集2019年1月~2022年6月期间扬州大学附属医院收治的180例CD患者,随机分为训练组（n=120）和验证组（n=60）。依据克罗恩病简化内镜评分评估CD的活动性,分为缓解、轻度期（n=94）、中重度期（n=86）。比较分析训练组和验证组不同分期CT小肠造影征象差异,并使用Rstudio4.1.2软件R包构建模型,绘制ROC曲线、校准曲线及临床决策曲线。结果  二项Logistic回归分析CT小肠造影征象显示：肠壁厚度（OR=1.746,95% CI：1.085~2.811)、ΔV-P（ΔV-P =静脉期肠壁CT值-平扫肠壁CT值）（OR=1.148,95% CI：1.062~ 1.241）、肠壁分层强化（OR=14.183,95% CI：3.737~53.824）、肠系膜脂肪密度高（OR=5.332,95% CI：1.278~22.246）4个参数是诊断中重度度CD独立参数。模型在训练组和验证组ROC曲线下面积分别为0.952（95% CI：0.925~0.979,P < 0.05）、0.955（95% CI：0.911~0.997,P < 0.05）,模型校准曲线与理想曲线贴合良好,决策曲线显示在一定阈值范围内患者净收益较大。结论  肠壁厚度、ΔV-P、肠壁分层强化及肠系膜脂肪密度增高是诊断中重度期CD的独立因素,以此构建的列线图能够预测中重度期CD活动性。     

Macrophage migration inhibitory factor in the sera and at the colonic mucosa in patients with ulcerative colitis: clinical implications and pathogenic significance

BACKGROUND: Inflammatory cytokines produced by activated macrophages are implicated in the pathogenesis of ulcerative colitis (UC). With the theory that macrophage migration inhibitory factor (MIF) may have a role in the accumulation of macrophages, we studied MIF in UC. MATERIALS AND METHODS: A total of 27 patients with UC, 14 patients with Crohn's diseases (CD), 11 patients with other forms of colitis and 26 normal controls were enrolled in the study. The levels of MIF in the sera and culture supernatant were measured by an enzyme-linked immunosorbent assay. MIF, macrophages and T cells were localized at the colonic mucosa by immunohistochemistry. RESULTS: The levels of MIF in the sera were significantly higher in UC than in normal controls (P < 0.05), in serum C-reactive protein (CRP) -positive cases with UC than in CRP-negative cases with UC (P < 0.05), and in patients with severe colitis with UC than in mild colitis with UC (P < 0.05). There was a positive relationship between serum MIF levels with the CRP levels and activities of colitis. However, the levels of MIF in patients with CD and other forms of colitis were not significantly different from their levels in normal controls and UC. Infiltrating cells at the colonic mucosa in UC and CD expressed MIF. CONCLUSIONS: These data suggest a role of MIF in the pathogenesis of UC. MIF may be used as a marker of disease activity in UC and control of MIF production may have therapeutic implications.     

溃疡性结肠炎诊断与鉴别诊断要点解析

溃疡性结肠炎（ulcerative colitis, UC）是一种非特异性肠道炎性病变。近年来溃疡性结肠炎发病率逐年上升,但其临床表现多样化,诊断缺乏特异度,容易误诊及漏诊。本文就UC诊断和鉴别诊断要点及进展进行解析和综述。     

Clinical review of Crohn's disease

PURPOSE: This clinical review presents proposed theories regarding the etiology of Crohn's disease (CD), the pathophysiology of the disorder, and current diagnostic methods. DATA SOURCES: Pertinent publications in the literature, the Crohn's and Colitis Foundation web page, and relevant texts regarding pathophysiology of the gastrointestinal system. CONCLUSIONS: CD can be a devastating disease and difficult to diagnose. The advanced practice nurse (APRN) should be aware of the etiology, pathophysiology, diagnostic methods, and current treatment options of this disorder. IMPLICATIONS FOR PRACTICE: In collaboration with a gastroenterologist, APRNs can provide much needed information to the patient with CD. Practice recommendations include patient education, pain management, and support for quality of life issues.     

Serum levels of C-reactive protein in Crohn''s disease and ulcerative colitis

Prospective measurements were made of serum C-reactive protein levels and erythrocyte sedimentation rate in sixty-four patients with Crohn's disease and fifty with ulcerative colitis. The results were related to clinical assessment of disease activity. C-reactive protein levels were raised in both groups but were significantly higher in Crohn's disease than ulcerative colitis for all categories of disease severity: with mild disease the median and range of C-reactive protein concentration were 4, 0-65 mg/l in Crohn's disease v. 0, 0-15 mg/l in ulcerative colitis, P less than 0.01; in moderate disease the values were 15, 1-100 mg/l v. 3, 0-29 mg/l respectively, P less than 0.05 and in cases of severe disease, 85, 15-183 mg/l v. 12, 2-33 mg/l respectively, P less than 0.001. Erythrocyte sedimentation rate was also higher in Crohn's disease but did not closely reflect disease activity in individual patients. C-reactive protein levels corresponded closely with clinical and pathological indices of relapse, remission and response to therapy in patients with Crohn's disease. The precise assay of serum C-reactive protein provides an objective criterion of inflammatory activity, which may be useful in the assessment, management and study of Crohn's disease.     

Angiography of colonic Crohn's disease

The zoning sign can be demonstrated in 50% of angiographies in colonic Crohn's disease and provides a reliable differential diagnostic aid against ulcerative colitis. The composition of the sign has been enlarged by the recognition of a zone C. The application of angiography in the radiologic diagnosis of inflammatory disease of the colon is discussed.