溃疡性结肠炎相关性胃十二指肠病变患者临床特征分析  

Clinical characteristics analysis of patients with gastroduodenitis associated with ulcerative colitis

作　　者：宋慧 李玥[1] 周炜洵[3] 石钰洁[1] 徐蕙 钱家鸣[1] Song Hui;Li Yue;Zhou Weixun;Shi Yujie;Xu Hui;Qian Jiaming(Department of Gastroenterology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Gastroenterology,Cangzhou Central Hospital,Cangzhou 061001,China;Department of Pathology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院消化内科,北京100730 [2]沧州市中心医院消化内科,沧州061001 [3]中国医学科学院,北京协和医学院,北京协和医院病理科,北京100730

出　　处：《中华炎性肠病杂志（中英文）》2022年第4期317-322,共6页Chinese Journal of Inflammatory Bowel Diseases

基　　金：北京市自然科学基金(7212078);中国医学科学院医学与健康科技创新工程(2020-I2M-C&T-B-005)。

摘　　要：目的探讨溃疡性结肠炎相关性胃十二指肠病变(GDUC)患者的临床特征。方法采用描述性病例系列研究方法。回顾性收集2016年1月至2020年12月北京协和医院诊治的6例GDUC患者的临床资料并分析临床特征。结果男性3例,女性3例;溃疡性结肠炎(UC)的发病年龄32.1(20.0~51.0)岁,GDUC的发病年龄36.5(25.0~51.0)岁;UC发病至累及上消化道的时间为4.4(0~12.0)年。UC发病时病变范围E2型(左半结肠)2例,E3型(广泛结肠)4例,改良Mayo评分9.2(8.0~12.0)分。出现GDUC时,改良Mayo评分9.8(8.0~12.0)分,病变累及胃3例,十二指肠受累6例,未见食管受累。2例患者在肠道手术后出现上消化道受累表现。5例患者存在至少1种肠外表现。超敏C-反应蛋白43.2(15.9~77.0)mg/L,红细胞沉降率41.7(12.0~74.0)mm/1 h,血红蛋白108.2(80.0~117.0)g/L。胃镜下表现为胃弥漫性充血、水肿;十二指肠弥漫性充血、点状糜烂等。结肠镜显示,病变范围E2型1例,E3型4例,Mayo内镜评分3分。1例在结直肠切除+回肠储袋肛管吻合+回肠造口术后经结肠镜提示储袋炎。6例患者均应用糖皮质激素诱导缓解,其中2例病情反复后应用英夫利西单克隆抗体诱导缓解并维持治疗,4例缓解期接受免疫抑制剂维持治疗。6例患者随访2.5(0.5~3.5)年,上消化道病变完全缓解4例,部分缓解2例;改良Mayo评分2.8(0~7.0)分。上消化道病变与结肠炎活动度均下降,两者活动度平行。结论GDUC患者具有起病年龄轻、病情重度活动、广泛结肠炎、伴随肠外表现的临床特点,升级治疗后上消化道炎症程度与结肠炎活动度均下降。Objective To investigate the clinical characteristics of patients with gastroduodenitis associated with ulcerative colitis(GDUC).Methods A descriptive case series study was performed.The clinical data of 6 patients with GDUC in Peking Union Medical College Hospital from January 2016 to December 2020 were collected retrospectively and the clinical characteristics were analyzed.Results There were 3 males and 3 females.The age of UC onset was 32.1(20.0-51.0)years old,the age of GDUC onset was 36.5(25.0-51.0)years old,and the time from UC onset to GDUC onset was 4.4(0-12.0)years.At the onset of UC,there were 2 patients of E2 type(left colon)and 4 of E3 type(extensive colon),and the modified Mayo score was 9.2(8.0-12.0)points.At the onset of GDUC,the modified Mayo score was 9.8(8.0-12.0)points,the lesions involved the stomach in 3 patients,duodenum in 6 and no esophagus was involved.Two patients had upper gastrointestinal involvement after bowel surgery.Five patients had at least one extraintestinal manifestation.The high-sensitivity C-reactive protein was 43.2(15.9-77.0)mg/L,the erythrocyte sedimentation rate was 41.7(12.0-74.0)mm/1 h,and the hemoglobin was 108.2(80.0-117.0)g/L.The diffuse gastric congestion and edema,duodenal diffuse congestion and punctate erosions were observed under gastroscope.The UC extent was E2 type in 1 patient and E3 type in 4 by colonoscope examination.The average Mayo endoscopic score was 3 points.The colonoscope result indicated that pouchitis was observed in 1 patient after colorectal resection+ileal pouch-anal anastomosis(IPAA)+ileostomy.All of the patients with GDUC were treated with glucocorticoids to induce remission,2 of them were treated with infliximab to induce remission and maintain remission after relapse,and 4 of them received immunosuppressive maintenance therapy during remission.Six patients were followed up for 2.5(0.5-3.5)years,4 patients had complete remission of upper gastrointestinal lesions and 2 had partial remission,the modified Mayo score was 2.8(0-7.0)points.The a

关 键 词：溃疡性结肠炎相关性胃十二指肠病变 溃疡性结肠炎 临床特征 

分 类 号：R574.62[医药卫生—消化系统]