10例阿米巴肠炎患者的临床特征和内镜下特征  

Clinical and endoscopic characteristics of 10 cases of amoebic colitis

作　　者：谢俏[1] 黎俊[1] 董丽凤[1] XIE Qiao;LI Jun;DONG Lifeng(Gastroenterology,Beijing Chuiyangliu Hospital,Beijing 100022,China)

机构地区：[1]北京市垂杨柳医院消化内科,北京100022

出　　处：《中国寄生虫学与寄生虫病杂志》2024年第4期496-501,共6页Chinese Journal of Parasitology and Parasitic Diseases

摘　　要：目的分析10例阿米巴肠炎患者的临床特征和内镜下特征。方法收集北京市某三级医院2021年5月至2024年5月确诊的10例阿米巴肠炎患者资料,包括临床表现、血常规、粪便常规、肝肾功能、内镜下结肠病变黏膜特征、病理学特征以及治疗和预后,对阿米巴肠炎的临床和内镜下特征进行总结。结果10例患者均为男性,平均年龄为(37.8±13.1)岁,最小28岁,最大70岁。其中4例有性传染病史[3例人类免疫缺陷病毒(HIV)感染者,1例梅毒感染者],1例有丙型肝炎史,1例高龄患者有高血压病史。临床症状均有排便习惯和粪便形状改变,表现为腹泻、便血,其中8例患者有腹痛症状。患者血常规、淋巴细胞计数均正常,仅1例患者嗜酸粒细胞比例升高(13.4%)。大便常规均未查见阿米巴包囊,便潜血均阳性,8例患者便红细胞和白细胞均阳性,2例患者便红细胞和白细胞均阴性。肾功能均正常,9例患者肝功能、胆红素正常,仅1例阿米巴肠炎合并肝脓肿患者胆红素升高(总胆红素为50µmol/L,直接胆红素为37.5µmol/L)。内镜检查结果显示,10例患者病变累及的肠段以回盲部、升结肠和直肠为主,均表现为散在、呈不规则地图样溃疡,溃疡可多达数十处,直径为5~30 mm;溃疡表面覆黄白苔或白苔,且白苔溢出溃疡表面,溃疡周边黏膜充血水肿并有血迹,溃疡间的肠黏膜正常;其中3例合并HIV感染者的溃疡面积较大。苏木精‑伊红(HE)染色结果显示,10例患者肠黏膜活组织切片均可见炎性肉芽组织,间质有大量嗜酸粒细胞、中性粒细胞浸润,炎性坏死物中、黏膜表面可见阿米巴滋养体。10例患者中,9例患者均给予甲硝唑(每次750 mg,一日3次)、二氯尼特(每次500 mg,一日3次)口服,疗程10 d;1例阿米巴肠炎合并肝脓肿的患者给予静脉注射甲硝唑(每次500 mg,每8小时1次)治疗14 d后,改为口服甲硝唑(每次750 mg,一日3次)10 d。经过治疗后,10例Objective To analyze the clinical and endoscopic characteristics of 10 cases of amoebic colitis.Methods Data on 10 cases of amoebic colitis diagnosed in a tertiary hospital in Beijing from May 2021 to May 2024 was collected,including clinical manifestations,blood routine,stool routine,liver and kidney function,endoscopic mucosal features of colonic lesions,pathological features,treatment and prognosis,to summarize the clinical and endo‑scopic characteristics of amoebic colitis.Results All 10 patients were male,with an average age of(37.8±13.1)years,ranging from 28 to 70 years among them,4 cases had a history of sexually transmitted disease[3 cases of hu‑man immunodeficiency virus(HIV)infection,1 case of syphilis],1 case had a history of hepatitis C,and 1 elderly pa‑tient had a history of hypertension.Clinical symptoms include changes in defecation habits and stool shape,manifested as diarrhea and bloody stools,with 8 patients experiencing abdominal pain.All cases had mild tenderness in the abdo‑men.Blood routine and lymphocyte count were both normal,with only one patient having an increased proportion of eo‑sinophils(13.4%).No amoebic cysts were found in the stool routine,and occult blood was positive in the stool.Eight patients had positive red blood cells and white blood cells in the stool,while two patients had negative results for both.Renal function was normal,and 9 patients had normal liver function and bilirubin levels.Only one patient with amoebic liver abscess had elevated bilirubin levels(total bilirubin 50µmol/L,direct bilirubin 37.5µmol/L).The endo‑scopic examination showed that the lesions in 10 patients mainly affected the ileocecal,ascending colon,and rectum segments,all presenting as scattered and irregular map‑like ulcers,numbered in dozens and sized 5-30 mm in diameter.The surface of the ulcer was covered with a yellow or white coating,and the white coating overflows from the ulcer sur‑face.The surrounding mucosa of the ulcer was congested,edematous and bloody,and the intestin

关 键 词：阿米巴肠炎 临床特征 内镜特征 病理诊断 

分 类 号：R531.19[医药卫生—内科学]