60例缺血性结肠炎患者的临床特征分析

程宪永 王凯 李彦敏

[摘要]目的 总结分析缺血性结肠炎（IC）的临床特征，提高对该病的认识及临床诊治水平。方法 回顾性分析2016年1月～2019年8月我院收治的60例IC患者作为研究对象，收集所有患者的年龄、基础疾病、临床症状、辅助检查、肠镜特征、治疗方式及转归等资料，并对其进行描述性研究。结果 IC好发于50岁及以上中老年患者（83.33%），有41例（68.33%）患者存在1种及以上基础疾病，其中高血压最多，占43.33%，其次为高脂血症（26.67%）、糖尿病（20.00%）。腹痛和血便是IC最主要的临床症状表现。76.67%的患者出现D-二聚体升高，影像学检查如超声、CT增强扫描或CT血管成像（CTA）诊断敏感性不高。肠镜下病变范围以左半結肠受累为主。治疗方面1例患者合并结肠癌转科行手术治疗，其余患者均经内科保守治疗痊愈出院。结论 IC好发于50岁及以上有基础疾病的中老年患者，实验室及影像学检查价值有限，如怀疑IC诊断，应尽早完善结肠镜检查并及时干预，多数患者预后良好。

[关键词]缺血性结肠炎;临床特征;D-二聚体;结肠镜;回顾性研究

[中图分类号] R574.62          [文献标识码] A          [文章编号] 1674-4721（2020）6（b）-0058-04

[Abstract] Objective To summarize and analyze the clinical features of ischemic colitis （IC） to improve the understanding of the disease and the level of clinical diagnosis and treatment. Methods Retrospective analysis of the data including age， basic diseases， clinical symptoms， auxiliary examination， characteristics of colonoscopy， treatment methods， and prognosis in 60 patients with IC admitted to our hospital from January 2016 to August 2019 was conducted in a descriptive way. Results IC occurred in 50 years old or older （83.33%）. Forty-one patients （68.33%） had one or more underlying diseases， with hypertension being the largest， accounting for 43.33%， followed by hyperlipidemia （26.67%） and diabetes （20.00%）. Abdominal pain and bloody stool were the main clinical manifestations of IC. Elevated D-dimer was present in 76.67% of patients， and imaging tests such as ultrasound， CT enhanced scan， or CT angiography （CTA） were not sensitive. The scope of the lesion under enteroscope was mainly affected in left colon. In terms of treatment， one patient was transferred to surgery due to complication of colon cancer， and the remaining patients were cured by conservative medical treatments and discharged. Conclusion IC mostly occurs in middle-aged and elderly patients （≥ 50 years old） with underlying diseases. Laboratory and imaging tests are of limited value. If doubting the IC diagnosis， colonoscopy and timely intervention should be carried out as soon as possible. Most patients have a good prognosis.

[Key words] Ischemic colitis; Clinical characteristics; D-dimer; Colonoscopy; Retrospective study

缺血性结肠炎（ischemic colitis，IC）是由于各种原因引起肠道血液供应不足或者回流障碍导致的结肠炎性病变，包括局限性炎症、表浅损伤及全层坏死，是缺血性肠病中最为常见的临床类型，也是下消化道出血的常见原因之一。随着人口老龄化、动脉硬化相关疾病发病率的增加，缺血性肠病的患病率也有所增加[1]。IC常无特异性临床表现，误诊率、漏诊率较高，其发病率存在明显的低估[2]。……