CD缓解期回肠及结肠活检组织学异常的临床意义

来源：医学界消化频道

翻译：火箭军总医院结直肠肛门外科 丁健华

Clinical Implications of HistologicAbnormalities in Ileocolonic Biopsies of Patients With Crohn’s Disease inRemission

背景：对处于临床缓解期的CD患者，内镜下回肠及结肠活检以评估疾病活动性的应用价值尚存在争议。

目的：研究该类患者内镜下组织学结果的临床意义。

方法：回顾性分析了2000-2013年，在VA医学中心就诊、处于临床缓解期行择期结肠镜检查的CD患者临床资料，并至少随访6个月以上。分别对内镜下疾病活动度及组织学疾病活动度与随访期间的再次发作进行了相关性分析。

结果：62例临床缓解期CD患者共进行了103次结肠镜检查。55次结肠镜提示内镜下痊愈，48次为疾病活动。随访6、12、24月，内镜下提示疾病活动的患者其疾病再发的比例并未高于内镜下提示痊愈者。相反，活检组织学提示存在5个急性炎症特征（糜烂、隐窝炎、隐窝脓肿、固有层中性粒细胞增多或嗜酸性粒细胞增多）任何之一的患者，其疾病再发率显著高于无上述特征者（p<0.05）。在各种组织学特征中，固有层嗜酸性粒细胞或中性粒细胞增多、隐窝炎有较高的再发率（p<0.05）。

结论：对处于临床缓解期行结肠镜检查的CD患者，较单纯镜下评估疾病活动度，活检可能会提供更重要的预后信息。尤其是固有层嗜酸性粒细胞或中性粒细胞增多、隐窝炎者，强烈提示1-2年内有较高临床再发风险。

三种预示可能复发的结肠镜组织学改变：

(A)固有层中嗜酸细胞增加

(B) 隐窝炎

(C)固有层中中性粒细胞增加

引自：Brennan GT, Melton SD, Spechler SJ, Feagins LA. Clinical implications of histologic abnormalities in ileocolonic biopsies of patients with Crohn’s disease in remission. J Clin Gastroenterol,2016

ABSREACT

Background:For patients with Crohn’s disease (CD) who have colonoscopy during periods of clinical remission, the utility of taking ileocolonic biopsy specimens to assess disease activity is disputed.

Goals:We explored the clinical implications of histologic disease activity in such patients.

Study: We reviewed medical records of CD patients who underwent elective colonoscopy while in clinical remission at our VA Medical Center from 2000 to 2013, and who had at least 6 months of followup. We correlated endoscopic and histologic disease activity with the subsequent development of flares.

Results:We identified 62 CD patients who had a total of 103 colonoscopies during clinical remission; 55 colonoscopies revealed complete endoscopic healing and 48 showed active disease. Flares within 6, 12, and 24 months of colonoscopy were not more common in patients with endoscopic activity than those with complete endoscopic healing. In contrast, patients with any of 5 histologic features of active inflammation (erosions, cryptitis, crypt abscess, increased neutrophils, or increased eosinophils in the lamina propria) had more flares than patients without those changes (P<0.05). Among the individual histologic features, an increase in  osinophils or neutrophils in the lamina propria and cryptitis were associated with higher flare rates (P<0.05).

译者简介

丁健华，医学博士，主任医师，硕士研究生导师，火箭军总医院结直肠肛门外科、全军肛肠专病中心副主任，美国克利夫兰医学中心访问学者。现任中国医师协会肛肠医师分会委员、中国医师协会大肠癌专业委员会委员、全军结直肠病学专业委员会委员、全军结直肠病学专业大肠癌学组委员，《国际肿瘤学杂志》、《世界华人消化杂志》编委，北京市科委、北京市自然科学基金评审专家。在《Disease of colon and rectum》、《Colorectal Disease》等国际及国内核心期刊发表论文60余篇，获国家实用新型专利2项，5项临床研究被美国及英国结直肠外科医师年会录用。主持或作为主要完成人获国家卫计委、全军、北京市科委课题6项，获全军医疗成果二等奖1项。

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