内镜下多点活检鉴别诊断克罗恩病和溃疡性结肠炎的临床价值

Clinical value of endoscopic multipoint biopsy in differential diagnosis of Crohn's disease and ulcerative colitis

摘要:

目的 探讨在克罗恩病（CD）和溃疡性结肠炎（UC）的鉴别诊断中内镜下多点活检的临床意义。方法 回顾性分析2019年3月—2022年3月在徐州医科大学附属淮安医院就诊的47例CD患者（CD组）及53例UC患者（UC组）的临床资料，并收集其内镜下活检病理切片。比较两组临床资料、实验室指标、临床表现、内镜下表现及内镜下活检病理学诊断结果。结果 CD组与UC组的性别构成、发病年龄、病程、血小板计数、红细胞沉降率比较，差异无统计学意义（P >0.05）。UC组腹泻率、血便率高于CD组，发热率、贫血率及肠外表现率低于CD组（P <0.05）。两组内镜下表现中，UC组乙状结肠病变、直肠病变、病变连续分布、环行溃疡构成比高于CD组（P <0.05），回盲部病变、升结肠病变、病变节段分布、纵行溃疡、结节样增生、阿弗他溃疡、鹅卵石征构成比低于CD组（P <0.05）。两组内镜下活检病理学诊断结果中，UC组黏膜结构表面不规则、绒毛样表面、腺体萎缩、腺体分枝、腺体扭曲或不规则，黏膜表面上皮糜烂或变扁、黏液细胞数量减少，急性隐窝炎、隐窝脓肿、固有层中性粒细胞数量增多构成比高于CD组（P <0.05），黏膜上皮裂隙样溃疡、假幽门腺化生，黏膜局灶间断性炎性细胞浸润、肉芽肿样小结构成比低于CD组（P <0.05）。结论 在CD与UC的鉴别诊断中需将内镜下表现与多点活检病理学诊断结果进行综合分析，并结合临床表现，以提高诊断的准确性。

Abstract:

Objective To explore the clinical significance of endoscopic multipoint biopsy in the differential diagnosis of Crohn's disease (CD) and ulcerative colitis (UC).Methods The clinical data of 47 CD patients and 53 UC patients who were treated in the outpatient department of Huai'an Hospital Affiliated to Xuzhou Medical University from March 2019 to March 2022 were retrospectively analyzed, and their endoscopic biopsy pathological sections were collected. The CD patients were set as the CD group, and the UC patients were set as the UC group. The clinical data, laboratory indexes, clinical manifestations, endoscopic manifestations, and pathological manifestations of endoscopic biopsy were compared between the two groups.Results There were no significant differences in gender composition ratio, age of onset, disease duration, platelet count, and erythrocyte sedimentation rate between CD group and UC group (P > 0.05). The rates of diarrhea and bloody stool in the UC group were higher than those in the CD group, and the rates of fever, anemia, and extraintestinal manifestations were lower than those in the CD group (P < 0.05). In the endoscopic manifestations in the two groups, compared with the CD group, the composition of sigmoid colon lesions, rectal lesions, continuous distribution of lesions, and annular ulcers in the UC group were higher (P < 0.05); the composition of ileocecal lesions, ascending colon lesions, lesion segment distribution, and longitudinal lesions ulcer, nodular hyperplasia, aphthous ulcer, and cobblestone sign constituted in the UC group were lower (P < 0.05). In the pathological manifestations of endoscopic biopsy in the two groups, compared with the CD group, the composition of irregular mucosal structure surface, villous surface, gland atrophy, gland branching, gland distortion or irregularity, mucosal surface epithelial erosion or flattening, the number of mucous cells decreased; the composition of acute cryptitis, crypt abscess, and increased number of neutrophils in the lamina propria in the UC group were higher (P < 0.05); the composition of mucosal epithelial slit-like ulcers, pseudopyloric gland metaplasia, and focal intermittent inflammatory cells in the mucosa Infiltration and granuloma-like small structures in the UC group were lower (P < 0.05).Conclusion In the differential diagnosis of CD and UC, it is necessary to comprehensively analyze the endoscopic manifestations and the histopathological diagnosis results of multi-point biopsy, and combine the clinical manifestations to improve the accuracy of diagnosis.