缺血性结肠炎与溃疡性结肠炎的临床鉴别诊断

背景:缺血性结肠炎(IC)与溃疡性结肠炎(UC,左半结肠型)在临床和内镜表现上有一定相似之处,对于临床表现不典型者,初步诊断颇具难度。目的:分析IC与UC的临i床鉴别诊断要点。方法:收集武汉大学中南医院2008年1月～2009年12月确诊为IC或UC左半结肠炎的住院患者,对其病史资料进行回顾性分析。结果:21例IC和25例UC患者纳入研究。IC患者以老年女性居多,病程相对较短,常伴有高血压和糖尿病,最突出的临床表现为突发腹痛后24 h内出现便血,贫血少见;UC患者的主要临床表现为黏液血便伴腹痛,贫血常见。IC病变多仅累及单一肠段,直肠受累少见,溃疡小而表浅,病理学表现为慢性炎,隐窝炎罕见;UC病变多起源于直肠,呈连续性,溃疡弥漫,病理学表现为慢性炎伴多种炎性细胞浸润,隐窝炎、隐窝脓肿常见。结论:根据性别、年龄、病程以及临床、实验室、内镜和病理检查结果进行综合分析,有助于IC与U C的鉴别诊断。

Clinical Differential Diagnosis of Ischemic Colitis with Ulcerative Colitis

Background： To some extent, the clinical and endoscopic features of ischemic colitis （IC） might be similar to that of left-sided ulcerative colitis （UC）; therefore, in patients with atypical clinical features the initial diagnosis might be quite difficult. Aims： To analyze the differential clinical points of IC with UC. Methods： Clinical materials of inpatients diagnosed as IC or left-sided UC from Jan. 200g to Dec. 2009 in Zhongnan Hospital of Wuhan University were analyzed retrospectively. Results： A total of 46 cases, including 21 IC and 25 UC were enrolled. IC was more prevalent in elderly females; the disease course was relatively short and often associated with hypertension and diabetes. The prominent clinical manifestation of IC was abrupt acute abdominal pain with hematochezia occurring within 24 hours, anemia was seldomly seen. Whereas the clinical manifestations of UC were mainly abdominal pain, bloody mucus stool and anemia. Under eolonoscopy, IC lesion frequently involved only a single segment with small and superficial ulcers and rectum was rarely involved; histologically there was chronic inflammation, but eryptitis was rarely seen. In contrast, UC was usually originated from rectum with continuous mucosal inflammation and diffuse ulcer; histologically there was chronic inflammation with muhiple types inflammatory cells infiltration, and cryptitis and crypt abscess were frequently seen. Conclusions： Integrated analysis of gender, age of onset, disease eourse, clinical manifestations, and the laboratory, endoscopic and histological findings would be helpful for the differential diagnosis of IC with UC.