不明原因回肠末端病变与过敏性疾病关系研究  

Relationship between terminal ileum lesions of unknown etiology and allergic diseases

作　　者：林琳[1] 刘红[1] 刘揆亮[1] 王沧海[1] 魏南[1] 蔺武[1] 姜国俊[1] 吴静[1,2] LIN Lin;LIU Hong;LIU Kui-liang;WANG Cang-hai;WEI Nan;LIN Wu;JIANG Guo-jun;WU Jing(Department of Gastroenterology,Beijing Shijilan Hospital,Capital Medical University,Heijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院消化内科,北京100038 [2]首都医科大学附属北京友谊医院消化内科国家消化系统疾病临床医学研究中心北京市消化疾病中心消化疾病癌前病变北京市重点实验室,北京100050

出　　处：《中国实用内科杂志》2020年第7期563-566,共4页Chinese Journal of Practical Internal Medicine

基　　金：2015院青年基金(2015-q17);北京市卫生系统215高层次人才基金-学术带头人消化专业。

摘　　要：目的分析不明原因回肠末端病变临床、内镜特点,探讨不明原因回肠末端病变与过敏性疾病的关系。方法选择2009年01月至2019年09月于首都医科大学附属北京世纪坛医院进行全结肠镜检查并首次发现回肠末端病变且诊断不明确的患者为研究对象。排除自身免疫性疾病史、应用非甾体类抗炎药(NSAIDs)相关药物史、各种原因未活检行病理检查者、回肠末端病变结合临床和病理明确诊断其他疾病者。收集患者的一般资料、既往过敏性疾病史、接受结肠镜检查的原因、结肠镜下表现、活检病理、胃镜结果、随访等进行分析。结果共纳入286例患者,男性192例(67.1%),女性94例(32.9%),平均年龄(46.4±13.5)岁(13~83岁)。回肠末端病变内镜下表现为:黏膜糜烂169例(59.1%)、溃疡46例(16.1%)、黏膜充血肿胀50例(17.5%)、多发黏膜隆起18例(6.3%)、绒毛粗大或变短3例(1.0%)。其中36例(12.6%)活检病理提示嗜酸性粒细胞计数增多。79例(27.6%)存在过敏性疾病史:其中过敏性鼻炎38例、支气管哮喘5例、湿疹27例、荨麻疹7例和过敏性结膜炎2例;结肠镜下以黏膜糜烂为主要表现(60.8%,48/79),16.5%(13/79)活检病理提示嗜酸性粒细胞计数增多。有无过敏性疾病史患者的临床、内镜特征差异均无统计学意义。结论回肠末端病变诊断困难,需注意甄别过敏性疾病相关的回肠末端病变;结肠镜检查发现回肠末端病变除病变处进行活检外,还应结肠多点活检,为临床诊断提供病理学依据。Objective To analyze the clinical and endoscopic features of terminal ileum lesions of unknown etiology in order to explore the relationship between and terminal ileum lesions of unknown etiology and allergic diseases. Methods Patients who were found with terminal ileum lesions of unknown etiology for the first time by colonoscopy in Beijing Shijitan Hospital from January 2009 to September 2019 were enrolled. Patients who had the history of autoimmune diseases,the use of NSAIDs-related drugs,the absence of pathological examination for various reasons,or the diagnosis of other diseases were excluded.The demographic data,the history of allergic diseases,the causes for receiving colonoscopic,colonoscopic manifestations,pathology of biopsy,gastroscopic results and follow-up data were collected and analyzed. Results A total of286 patients were enrolled,including 192 males(67.1%),with an average age of(46.4 ± 13.5)years(13-83 years).Endoscopic manifestations of terminal ileum lesions were:169 cases(59.1%)of mucosal erosion,46 cases(16.1%)of ulcer,50 cases(17.5%)of mucosal congestion and swelling,18 cases(6.3%)of multiple mucosal bulges,and 3 cases(1.0%)of thick or short villi. In 36 cases(12.6%),pathology of biopsy indicated an increase in eosnophils count. Totally 79 cases(27.6%)had a history of allergic diseases,including 38 cases of allergic rhinitis,5 cases of bronchial asthma,27 cases of eczema,7 cases of urticaria and 2 cases of allergic conjunctivitis;mucosal erosion was the main manifestation under colonoscopy (60.8%,48/79),and pathology of biopsy indicated an increase in eosnophils count in 13 cases(16.5%). There were no statistical differences in clinical or endoscopic characteristics between patients with and those without a history of allergic diseases. Conclusion The diagnosis of terminal ileum lesions is difficult,and attention should be paid to the screening of terminal ileum lesions related to allergic diseases. Biopsy of multiple points in terminal ileum and colorectum should be made in addition to th

关 键 词：回肠末端病变 不明原因 结肠镜 小肠 过敏性疾病 

分 类 号：R574.53[医药卫生—消化系统]