缺血性肠病224例临床分析  

Analysis of clinical features of 224 patients with ischemic bowel diseases

作　　者：张艳飞[1,2] 顾芳[1] 

机构地区：[1]北京大学第三医院消化内科,北京市100191 [2]内蒙古医科大学附属医院消化内科,内蒙古自治区呼和浩特市010050

出　　处：《实用老年医学》2017年第6期536-539,547,共5页Practical Geriatrics

摘　　要：目的总结缺血性肠病的临床特点,对老年和非老年病人进行对比分析。方法回顾性分析224例缺血性肠病的临床资料,比较不同影像学检查的诊断价值,对老年组(≥60岁,127例)和非老年组(<60岁,97例)的既往病史、临床症状及结肠镜下表现进行对比分析。结果缺血性结肠炎、急性肠系膜缺血和慢性肠系膜缺血所占的比例分别为70.5%、16.1%和13.4%。B超、CTA及血管造影对缺血性肠病的阳性发现率、血管病变发现率差异具有统计学意义(P<0.05)。老年组与非老年组的临床症状差异无统计学意义,2组间在吸烟(P<0.01)、风湿性心脏病(P=0.046)、真性红细胞增多症(P=0.046)、原发性血小板增多症(P=0.021)、横结肠受累(P=0.021)、升结肠受累(P=0.006)、溃疡形成(P=0.034)、肠腔狭窄(P=0.021)等方面差异有统计学意义。结论缺血性肠病中以缺血性结肠炎最常见,好发于老年女性,临床表现无特异性。不同影像学检查对不同类型缺血性肠病诊断价值不同,怀疑缺血性结肠炎首选结肠镜,怀疑急性及慢性肠系膜缺血者则首选CTA及血管造影。吸烟、风湿性心脏病、真性红细胞增多症、原发性血小板增多症是中青年病人的易患因素。老年病人横结肠和升结肠受累更多见,更易出现肠道溃疡及狭窄,病情相对重,应给与积极治疗。Objective To investigate the clinical features of patients with ischemic bowel disease, and to compare the clinical features between the young patients and the elderly. Methods The clinical data of 224 patients diagnosed as ischemic bowel disease was retrospectively analyzed. The disease history, clinical features, results of imaging examinations and colonoscopy were investigated. The statistical analysis was applied to different subtypes and different age groups. Results Among 224 patients,ischemic colitis accounted for 70.5%, acute mesenteric ischemia accounting for 16. 1% and chronic mesenteric ischemia accounting for 13.4%. Patients older than 60 years accounted for 56.7%. The positive rate of B mode ultrasonography, CTA and angiography showed statistical difference （P〈0.05）.There was no statistical difference in the clinical symptoms between the young and the elderly. While the incidence rate of smoking （P〈0. 001 ）, rheumatic heart disease （P= 0. 046）, polycythemia vera （ P= 0. 046）, primary thrombocytosis disease （ P= 0. 021 ）, transverse colon involvement （P = 0. 021 ）, ascending colon involvement （ P= 0. 006）, ulceration （ P = 0. 034） and narrow lumen （P= 0. 021 ） showed statistical difference between young patients and elderly. Conclusions Ischemic colitis is the most common type of ischemic bowel disease, with no specific clinical symptoms. Colonoscopy should be chosen as the first line examination for the patients suspected as ischemic colitis, while CTA and angiography should be a priority for the patients suspected as acute mesenteric ischemia or chronic mesenteric ischemia. Smoking, rheumatic heart disease, polycythemia vera and primary thrombocytosis disease are risk factors in the young. Transverse colon involvement and ascending colon involvement, ulceration and narrow lumen were common in the elderly, which suggest the severity of the disease.

关 键 词：缺血性肠病 急性肠系膜缺血 慢性肠系膜缺血 缺血性结肠炎 临床特点 老年人 

分 类 号：R574[医药卫生—消化系统]