柳氮磺胺吡啶对溃疡性结肠炎病理学特征和分级的影响  

Effect of sulfasalazine on biopsy mucosal pathology and histological grading of patients with the mild and moderate active ulcerative colitis

作　　者：钟英强[1] 朱兆华[1] 陈其奎[1] 占俊[1] 李楚强[1] 王连源[1] 陈为宪[1] 幸连春[2] 

机构地区：[1]中山大学附属第二医院消化内科,广州510120 [2]中山大学附属第二医院病理科,广州510120

出　　处：《中华消化杂志》2003年第1期23-26,共4页Chinese Journal of Digestion

摘　　要：目的　从病理学角度探讨柳氮磺胺吡啶 (SASP)治疗溃疡性结肠炎 (UC)的部分机制。方法　应用SASP 1g ,每日 3次 ,治疗活动期UC 6周 ,观察治疗前后的病理特征和组织学分级的变化。 结果　轻度UC治疗前黏膜固有层血管炎为 48.2 % ,治疗后为 17.4% (P <0 .0 0 1) ;中度UC治疗前为6 8.0 % ,治疗后为 2 6 .7% (P <0 .0 0 1)。治疗前 ,血管壁轻度坏死 1例 ,中度 2例 ;血栓形成中度 2例 ;在6周末 ,所有标本均未发现有血管壁坏死和血栓形成。治疗前轻度UC腺体异常为 30 .4% ,治疗后为13 .0 % (P <0 .0 5 ) ;治疗前中度UC为 42 .0 % ,治疗后为 40 .0 % (P >0 .0 5 )。轻度UC治疗前嗜酸性粒细胞浸润为 98.2 % ,治疗后为 80 .4% (P <0 .0 1) ;中度UC治疗前为 10 0 .0 % ,治疗后为 91.1% (P <0 .0 5 )。对隐窝脓肿的影响 ,轻度 :从 2 1.4%降到 4.4% (P <0 .0 5 ) ;中度 :从 48.0 %降到 13 .3% (P <0 .0 0 1)。黏膜组织学分级轻度 :治疗前为 2 .0 0± 0 .84,治疗后为 0 .91± 0 .46 (P <0 .0 0 1) ;中度 :治疗前为 2 .49± 0 .84,治疗后为 1.31± 0 .75 (P <0 .0 0 1)。结论　SASP能明显改善UC炎症黏膜的小血管病变与黏膜腺隐窝脓肿 ,减少中性粒细胞和嗜酸性粒细胞的浸润 ,从而减少炎症性反应物产生与前列腺素的合成 ,Objective To investigate the pathological mechanism of sulfasalazine (SASP) used to treat ulcerative colitis (UC). Methods The changes of pathological signs and histological grades of UC were observed before and after the treatment with SASP 1 g three times daily for six weeks. Results The effect of SASP on rates of small vessel inflammation was 48.2% vs. 17.4% in the mild UC (P<0.001) and 68.0% vs. 26.7% in the moderate UC (P<0.001) before and after treatment. Fiberoid necrosis of vessel wall: one case was found in the mild UC before treatment and none was found after treatment; two cases was found in the moderate UC before treatment and none was found after treatment. Thrombous formation: none was found in the mild UC before treatment and after treatment; one case was found in the moderate UC before treatment and none was found after treatment. Effect on rates of mucosal glandular abnormality: 30.4% vs. 13.0% in the mild UC(P>0.05) and 42.0% vs. 40.0% in the moderate UC (P>0.05) before and after treatment. The rates of eosinophil infiltration: 98.2% vs. 80.4% in the mild UC (P<0.01) and 100.0% vs. 91.1% in the moderate UC(P<0.05) before and after treatment. Effect on rates of crypt abscess: 21.4% vs. 4.4% in the mild UC (P<0.05) and 48.0% vs. 13.3% in the moderate UC (P<0.001). Effect on rates of mucosal patho-histological grade: 2.00±0.84 vs. 0.91±0.46 in the mild UC(P<0.001) and 2.49 ±0.84 vs. 1.31±0.75 in the moderate UC(P<0.001) before and after treatment. Conclusions SASP can significantly alleviate small vessel lesions and crypt abscesses and reduce neutrophilic and eosinophilic leukocyte infiltration in lamina propria. Therefore, SASP can reduce inflammatory responses and production of prostaglandin so as to help the inflammatory mucosa to heal up.

关 键 词：柳氮磺胺吡啶 溃疡性结肠炎 病理组织学 

分 类 号：R574.62[医药卫生—消化系统]