溃疡性结肠炎与克罗恩病的病因与临床病理探讨  

Exploration of the etiologies and clinical pathology of ulcerative colitis and Crohn disease

作　　者：鲁香凤[1] 秦伟娜[2] LU Xiangfeng;QIN Weina(Department of Pathology,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Quality Control Office,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院病理科,北京100700 [2]北京中医药大学东直门医院质量控制办公室,北京100700

出　　处：《中华中医药杂志》2024年第12期6830-6834,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：北京中医药大学东直门医院自发课题(No.2022DZMEC-314-02)。

摘　　要：溃疡性结肠炎(UC)与克罗恩病(CD)临床表现及病理变化等均有异同,其原因不明,课题组研究并复习文献,发现二者活动期血清1,3-β-D-葡聚糖(BDG)与内毒素水平均明显增高,且与病情严重程度呈正相关,与中医证型及其演变规律密切相关,BDG是真菌细胞壁主要成分,故认为二者病因均是侵袭性真菌感染与内毒素血症;白念珠菌致病力弱,可与内毒素共同损伤血管,引起大肠表浅溃疡及便血,是UC病因;马拉色菌侵袭力强,可释放毒素并穿透肠壁,引起裂隙样深溃疡、上皮样肉芽肿、瘘管形成及肛周脓肿等病变,可累及全消化道及消化道外,常损伤淋巴管并累及肠系膜淋巴结;内毒素有毒及免疫原性,是强致炎剂,可引起炎症、免疫功能紊乱、微循环障碍、细胞凋亡、焦亡、自噬及基因异常导致肿瘤等。Ulcerative colitis(UC)and Crohn disease(CD)have similarities and differences in clinical manifestations and pathological changes etc.Previously believed to have unknown reasons,after researching and reviewing literature,the research team found that the levels of serum 1,3-β-D-glucan(BDG)and endotoxin were significantly increased in the patients with active UC and CD,and were positively correlated with the severity of the disease,was closely related to traditional Chinese medicine syndrome types and their evolutionary patterns.BDG is the main component of fungal cell wall.Therefore,it is believed that both diseases are caused by invasive fungal infections and endotoxemia;Candida albicans has weak pathogenicity and can damage blood vessels together with endotoxins,causing superficial ulcers and hematochezia.Both are the causes of UC.Malassezia has strong invasion ability,can release toxins and penetrate the intestinal wall,causing CD lesions such as fissure like deep ulcers,epithelioid granulomas,fistula formation,and perianal abscesses etc.It can involve the entire digestive tract and beyond,often damaging lymphatic vessels and mesenteric lymph nodes.Endotoxins are toxic and immunogenic,and are potent pro-inflammatory agents that can cause inflammation,immune dysfunction,microcirculatory disorders,cell apoptosis,pyroptosis,autophagy,and genetic abnormalities leading to tumors etc..

关 键 词：溃疡性结肠炎 白念珠菌 克罗恩病 马拉色菌 内毒素血症 

分 类 号：R73[医药卫生—肿瘤]