溃疡性结肠炎的诊断与鉴别诊断课件

,溃疡性结肠炎的诊断和鉴别诊断,溃疡性结肠炎的诊断和鉴别诊断,Clinical Presentation,Intestinal Symptoms,70%of patients with UC report 5,bowel movements,during acute phases.,The main reason,for diarrhea is colonic inflammation,but bile acid and,food malabsorption secondary to inflammation in the,terminal ileum or the proximal small bowel can contribute,to this symptom.,A history of surgical resections can,be seminal in explaining symptoms.,Acute phases of UC,almost always present with,bloody diarrhea,(“hematochezia”).,Active inflammatory anorectal lesions,result in urgency of defecation and cramps around defecation,(“,tenesmus,”).UC patients often complain of,lower left quadrant pain,.,Extraintestinal Manifestations,Wafik El-Diery and David Metz,Section Editors,Diagnostics of Inflammatory Bowel Disease,Gastroenterology,，2007;133:16701689,Clinical PresentationIntestina,肠外表现(,Extraintestinal,manifestations,),肠外表现包括：,皮肤黏膜表现(如口腔溃疡、结节性红斑和坏疽性脓皮病),关节损害(如外周关节炎、脊柱关节炎等),眼部病变(如虹膜炎、巩膜炎、葡萄膜炎等)、,肝胆疾病(如脂肪肝、原发性硬化性胆管炎、胆石症等),血栓栓塞性疾病等。,Mendoza JL,Lana R,Taxonera C et al.Extraintestinal,manifestations in inflammatory bowel disease:differences between,Crohns disease and ulcerative colitis.Med.Clin.(Barc.)2005;125:,297300.,肠外表现(Extraintestinal manifesta,并发症(,Complications,),并发症包括：,中毒性巨结肠（toxic megacolon）,肠穿孔,下消化道大出血,上皮内瘤变和癌变,钱家鸣,等,.,溃疡性结肠炎合并中毒性巨结肠六例及文献复习,.,中华内科杂志,J.2012,，,51(9):694-697/,Chow DK，Leong RW，Tsoi KK,et a1Longterm followup,of ulcerative colitis in the Chinese populationAm J,Gastroenterol，2009，104：647-654,并发症(Complications)并发症包括：,Serological markers,The two most widely studied serological markers in,inflammatory bowel disease in recent years have been,p-ANCA and ASCA.The clinical utility of p-ANCA or ASCA,testing in the diagnosis of inflammatory bowel disease,in,patients with non-specific gastrointestinal symptoms,is,limited because of the varying seroprevalence of these,antibodies in patients with inflammatory bowel disease and,the inadequate sensitivity of the assays.,Reese GE,Constantinides VA,Simillis C et al.Diagnostic precision,of anti-Saccharomyces cerevisiae antibodies and perinuclear,antineutrophil cytoplasmic antibodies in inflammatory bowel,disease.Am J Gastroenterol.2006(Oct);101(10):241022.,Serological markersThe two mo,尿白蛋白,目的：探讨炎症性肠病患者尿中白蛋白的临床意义。,方法：对临床确诊的32例IBD患者（UC 27例，CD 5 例)在疾病的不同时期,，用免疫放射比浊法测定尿中白蛋白，并结合临床,Harvey 和 Bradshaw 指数进行综合分析，选取25例健康人为正常对照。,结果：患者尿白蛋白活动期比缓解期明显增高（0.002），Harvey 和 Bradshaw 指数呈正相关（活动期 r=0.76,P0.001；静止期 r=0.73,P0.001）。患者尿中白蛋白明显高于正常人（活动期 P0.001,缓解期,P0.005）。,结论,：患者尿中白蛋白可作为判断,患者疾病活动情况的指标。,邓长生.炎症性肠病患者尿白蛋白的临床意义.武汉大学学报.200,2,，,23,(,1,)：,88-89,.,尿白蛋白目的：探讨炎症性肠病患者尿中白蛋白的临床意义。,Fe,cal markers,Calprotectin,(FCP),a heterocomplex of S100A8 and S100A9,is a calcium-binding protein with antimicrobial protective properties derived predominately from neutrophils,and to a lesser extent,from monocytes and reactive macrophages.It constitutes approximately 5%of the total protein and up to 60%of the cytosolic protein in human neutrophils.As such,the fecal calprotectin concentration is proportional to the influx of neutrophils into the intestinal tract,a hallmark of active IBD.,Lactoferrin,is an iron-binding glycoprotein identified in the secretions overlying most mucosal surfaces that interact directly with external pathogens,including saliva,tears,vaginal secretions,feces,synovial fluid,and mammalian breast milk.It is a major component of the secondary granules of polymorphonuclear neutrophils and is shown to be a primary factor in the acute inflammatory response.In the intestinal lumen,fecal lactoferrin levels quickly increase with the influx of neutrophils during inflammation.,Sugi and colleagues investigated lactoferrin,polymorphonuclear neutrophil(,PMN,)elastase,and,lysozyme,together with myeloperoxidase in fecal material and whole-gut lavage fluid from IBD patients.,Langhorst J,Elsenbruch S,Mueller T et al.Comparison of 4 neutrophil-derived proteins in feces as indicators of disease activity in ulcerative colitis.Inflamm.Bowel Dis.2005;11:108591.,Fecal markersCalprotectin(FCP,钡剂灌肠,检查所见的主要改变为：,(1)黏膜粗乱和(或)颗粒样改变；,(2)肠管边缘呈锯齿状或毛刺样，肠壁有多发性小充盈缺损；,(3)肠管短缩，袋囊消失呈铅管样。,钡剂灌肠检查所见的主要改变为：,CT,Ulcerative colitis with,backwash ileitis,.Axial CT enterographic sections show continuous involvement of the large bowel(white arrrows)and backwash ileitis(black arrow in b).,Elsayes KM，AIHawary MM，Jagdish J，et a1CT enterography：principles，trends，and interpretation of findingsRadiographics，2010，30：19551970,CTUlcerative colitis with back,结肠镜检查,Danese S,，,Fiocehi C,Ulcerative colitis,N Engl J Med,，,2011,365,：,1713 1725,结肠镜检查并活组织检查(后文简称活检)是UC诊断的主要依据。,结肠镜下UC病变多从,直,肠开始，呈连续性、弥漫性分布，表现为：,(1)黏膜血管纹理模糊、紊乱或消失，黏膜充血、水肿、质脆、自发或接触出血和脓性分泌物附着，亦常见黏膜粗糙、呈细颗粒状；,(2)病变明显处可见弥漫性、多发性糜烂或溃疡；,(3)可见结肠袋变浅、变钝或消失以及假息肉、桥黏膜等。,结肠镜检查Danese S，Fiocehi CUlcera,Typical endoscopic findings,(A)UC with mild inflammation and reduced haustration,vascular transparency is,missing.,(B)Moderate inflammation with reduced haustration.The mucosa is edematous,covered with fibrin,and shows multiple erosions.,(C),Severe