许丽娟　陆华美

[摘要] 目的 研究老年缺血性結肠炎（IC）与老年溃疡性结肠炎（UC）临床特征的差异。 方法 回顾性分析2010年7月～2015年12月我院收治的54例老年IC患者和50例老年UC患者的临床资料，比较两组患者的临床特征。结果 两组患者基础疾病、临床表现、结肠镜检查及病理学检查、实验室检查等比较，差异具有统计学意义（P<0.05）。与IC组比较，UC组患者病程较长，存在心脑血管等基础疾病者较少（P<0.05）。UC组腹泻和黏液脓血便发生率较高，而IC组单纯血便的发生率较高（P<0.05）。结肠镜及病理组织检查结果显示，IC组患者病变部位多累及乙状结肠和/或降结肠，直肠受累少见；病变为区域局限性，正常黏膜与病变黏膜分界清楚，溃疡为纵行或不规则形，病理特异性表现为含铁血黄素沉积和血管内血栓形成。UC组病变多起源于直肠，累及肠壁全周，病变呈连续性分布，溃疡呈散在针尖地图样，病理特异性表现为隐窝脓肿。实验室检查结果显示，IC组D-二聚体水平明显高于UC组，C反应蛋白（CRP）和血小板计数（PLT）水平明显低于UC组（P<0.05）。 结论 根据基础疾病、临床表现、实验室检查、结肠镜及病理特征进行综合分析，有助于IC和UC的鉴别诊断。

[关键词] 缺血性结肠炎；溃疡性结肠炎；老年；临床特征

[中图分类号] R574 [文献标识码] B [文章编号] 1673-9701（2017）24-0049-04

[Abstract] Objective To study the difference of clinical characteristics of elderly ischemic colitis（IC） and elderly ulcerative colitis （UC）. Methods The clinical data of 54 elderly patients with IC and 50 elderly patients with UC who admitted to our hospital from July 2010 to December 2015 were analyzed retrospectively. The clinical characteristics of the two groups were compared. Results The differences of the basic diseases， clinical manifestations， colonoscopy and pathology， and laboratory examination were statistically significant between the two groups of patients（P<0.05）. Compared with IC group， the course of disease was longer in the UC group， and there were less patients with cardiovascular and other basic diseases（P<0.05）. UC group had a higher incidence of diarrhea and mucus stool and bloody purulent stool， while IC group had a higher incidence of bloody stool alone（P<0.05）. Colonoscopy and histopathological examination results showed that the location of lesions was mostly involved in the sigmoid colon and/or descending colon， while rectal involvement was rare； lesions were regional limitations， and normal mucosa and lesion mucosa had clear boundaries. Ulcers showed longitudinal or irregular shape. The pathologically specific manifestations were hemosiderin deposition and intravascular thrombosis. UC group lesions were mostly originated in the rectum， involving the whole wall of the bowel， with the lesion distributed continuously. Ulcers were scattered in the needle pattern， and pathological specific manifestation was crypt abscess. The results of laboratory tests showed that the D-dimer level in IC group was significantly higher than that in UC group. The levels of C-reactive protein （CRP） and platelet count （PLT） were significantly lower than those in UC group（P<0.05）. Conclusion The comprehensive analysis based on the basic disease， clinical manifestations， laboratory tests， colonoscopy and pathological characteristics contributes to the differential diagnosis of IC and UC.endprint

[Key words] Ischemic colitis （IC）； Ulcerative colitis （UC）； Elderly； Clinical characteristics

溃疡性结肠炎（ulcerative colitis，UC）是一种临床常见的以慢性炎症和溃疡形成为主要病理特点的非特异性慢性结肠炎，其确切的发病机制目前尚不清楚，可发生在任何年龄，且病程缠绵难愈，易反复发作[1-2]。缺血性结肠炎（ischemic colitis，IC）是由于肠道血液供应不足或回流受阻导致的结肠缺血性损伤，是消化道缺血性疾病最常见的形式，其中以动脉硬化所致者最为多见，发病者以老年人群居多[3-4]。IC患者典型临床症状为腹痛、腹泻、便血，因其临床表现与UC较为相似，容易引起误诊，加之两种疾病的治疗方法不同，故早期的鉴别诊断尤为重要。

1 资料与方法

1.1 临床资料

回顾性分析2010年7月～2015年12月我院收治的54例老年IC患者和50例老年UC患者的临床资料，其中IC组患者男29例，女25例，年龄65～81岁，平均（68.26±11.32）岁；UC组患者男23例，女27例，年龄66～78岁，平均（67.34±10.87）岁，两组患者年龄、性别等一般资料比较，差异均无统计学意义（均P>0.05）。IC诊断参照《老年人缺血性肠病诊治中国专家建议（2011）》[5]。UC诊断参照《炎症性肠病诊断与治疗的共识意见（2012）》[6]。本研究经医院伦理委员会通过，患者知情同意并签署知情同意书。