31例缺血性肠病的临床特点分析及D-二聚体在其诊断中的价值  

Clinical Features of Ischemic Colitis and Diagnostic Value of Plasma D-dimer:An Analysis of 31Cases

作　　者：童明富[1] 蔡长春[1] 王细金[1] 欧阳卫泽[1] 叶向荣[1] 

机构地区：[1]九江学院附属医院消化内科,江西九江332000

出　　处：《南昌大学学报（医学版）》2014年第8期47-49,F0003,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的总结缺血性肠病的临床特点并检测血浆D-二聚体水平,探讨其对诊断缺血性肠病的价值。方法总结并分析资料完整且经临床确诊的31例缺血性肠病患者的临床资料。结果 31例缺血性肠病中,缺血位于乙状结肠7例、降结肠6例、降结肠+乙状结肠14例、横结肠2例、横结肠+降结肠2例;有冠心病史13例,有糖尿病史11例,有高血压病史23例,有高脂血症14例,有肝硬化病史2例,曾有类风湿性关节炎病史多年1例,合并心房纤颤9例。确诊方法:腹部CTA提示肠系膜上动脉完全闭塞5例,肠系膜动脉狭窄12例;腹部血管彩超提示肠系膜上动脉起始部狭窄8例;6例腹部CTA未见肠系膜血管狭窄、闭塞,结合病史、D-二聚体、结肠镜下表现诊断缺血性肠病。26例经过内科保守治疗好转,4例因腹痛加重经外科手术治疗后好转,1例病情加重放弃治疗。结肠镜下表现为充血、水肿、糜烂及溃疡,呈节段性分布,病变黏膜与正常黏膜分界清楚。除黏膜活检提示黏膜下层含铁血黄素细胞对诊断有意义外,其他病理学表现无特异性。血浆D-二聚体水平为(1 450±242)μg·L-1,明显高于正常水平(正常值<0.3μg·L-1)。结论缺血性肠病绝大多数患者临床伴有其他基础疾病;血浆D-二聚体水平的升高有助提高对缺血性肠病的诊断率;缺血性肠病应当早期诊断,内科保守治疗可好转,部分需外科手术治疗。Objective To summarize the clinical features of ischemic colitis,and to evaluate the value of plasma D-dimer detection in the diagnosis of ischemic colitis.Methods Clinical data of 31 patients with ischemic colitis were analyzed retrospectively.Results Among the 31 patients,bow-el ischemia was located in sigmoid colon in 7,in descending colon in 6,in both descending colon and sigmoid colon in 14,in transverse colon in 2,and in both transverse colon and transverse colon in 2.Thirteen of the 13 patients had history of coronary heart disease,11 had history of diabetes, 23 had history of hypertension,14 had hyperlipidemia,2 had history of liver cirrhosis,1 had histo-ry of rheumatoid arthritis,and 9 had atrial fibrillation.Abdominal CTA showed complete superior mesenteric artery occlusion in 5 patients and mesenteric artery stenosis in 12.Abdominal color Doppler ultrasound showed superior mesenteric artery stenosis in the initial portion in 8 patients. No mesenteric artery stenosis and occlusion were observed by abdominal CTA but ischemic colitis was diagnosed by a combination of medical history,D-dimer detection and colonoscopy in 6 pa-tients.Of the 31 patients,26 achieved improvement after conservative treatment,4 achieved im-provement after surgical treatment for abdominal pain aggravation,and 1 abandoned treatment be-cause of disease exacerbation.Colonoscopic features included congestion,edema,erosion,ulcera-tion,segmental distribution,and clear demarcation between diseased mucosa and normal mucosa.＆amp;nbsp;Mucosal biopsy showed pathologic characteristics except for submucosal hemosiderin-containing cells.The level of D-dimer[（1 450±242）μg·L^-1 ]was significantly higher than the normal（〈0.3 μg·L^-1 ）.Conclusion Most of patients with ischemic colitis have other basic diseases.The increase in plasma D-dimer level helps to improve the diagnosis of ischemic colitis.Early diagnosis should be performed and conservative treatment can lead to improvement in patients with ische-mic colitis.However,some pa

关 键 词：缺血性肠病 临床特点 结肠镜 D-二聚体 

分 类 号：R574[医药卫生—消化系统]