显微镜结肠炎临床特征及其相关危险因素分析

Clinical features and risk factors in patients with microscopic colitis

摘要:

目的 分析慢性腹泻患者的临床、内镜及病理资料，探讨可能影响显微镜结肠炎（MC）的危险 因素。方法 前瞻性分析2016 年6 月-2017 年4 月该院门诊以水样腹泻为主诉患者的临床资料，常规结肠镜 检查，多点取肠黏膜活检，行组织病理HE 染色和Masson 染色，对患者的病史及病理进行分析。结果 102 例 水样腹泻患者中诊断为MC 3 例（3/102，2.94%），其中胶原性结肠炎（CC）3 例，全部为女性，年龄24 ～ 36 岁，淋巴细胞性结肠炎（LC）0 例。结肠镜下肠黏膜基本正常或仅表现为轻度的充血水肿；病理组织学表现 为上皮细胞损伤，上皮内淋巴细胞增多，固有层炎症细胞浸润，上皮下胶原带增厚。近期服用降糖药、质子泵 抑制剂（PPIs）、面食等因素可能与MC 发病关系密切。结论 MC 是慢性水样腹泻的重要原因，临床症状及 结肠镜表现均无特异性，慢性腹泻患者应尽早行结肠镜下多点活检明确诊断，其发病可能与使用某些药物（如 降糖药、PPIs）和某些食物（面筋）有关。

Abstract:

Objective To analyze the clinical, endoscopic and pathological data of patients with chronic diarrhea, and explore the possible risk factors of microscopic colitis (MC). Methods A prospective analysis of the clinical data of patients with complaints of watery diarrhea from June 2016 to April 2017 was conducted. All patients received colonoscopy examination with multi-point intestinal mucosal biopsy, histopathological and HE Masson staining. The history and pathology were analyzed. Results In 102 cases of watery diarrhea, MC was diagnosed in 3 cases (3/102, 2.94%), of which there were 3 cases of collagenous colitis (CC) in all these cases, all of them were female, aged 24~36 years old, and no lymphocytic colitis (LC) in all these cases. Mucous membrane of normal or mild hyperemia and edema showed only; histopathology showed epithelial cell injury, intraepithelial lymphocytosis, inflammatory cell infiltration in lamina propria, subepithelial collagen thickening. Recent hypoglycemic agents, PPIs, gluten and other factors may be closely related to the incidence of MC. Conclusion MC is an important cause of chronic diarrhea, the clinical symptoms and endoscopic manifestations are nonspecific, chronic diarrhea patients should undergo colonoscopy under multi-point biopsy, the incidence may be related to the use of certain drugs (such as hypoglycemic agents, PPIs) and some foods (gluten).