消化道病理(二)ppt课件

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1、炎症性肠病的临床病理THECLINICO-PATHOLOGYOFINFLAMMATORYBOWELDISEASE(IBD)王军臣2015-11-24溃疡性结肠炎（Ulcerativecolitis）克罗思病（Crohn’sdisease）未定型结肠炎（Indeterminatecolitis）IBM一词主要是指两种肠病：克罗思病和溃疡性结肠炎。两者临床病程与病史不同，病变有别，但某些特点相同，而治疗原则不同。Inflammatoryboweldiseaseisatermthatdescribestwodiseases:Crohndi

2、seaseandulcerativecolitis.Althoughthesetwodisordershavedifferentclinicalcoursesaswellasnaturalhistoriesandareusuallyclearlydistinguishable,theyhavecertaincommonfeatures.IBD的类型无特异性实验室检测指标（Nospecificlaboratorytests）抗中性粒细胞胞质抗体pANCA(anti-neutrophilcytoplasmicantibody)60-75

3、%的溃疡性结肠炎病例（Ulcerativecolitis:60-75%）10-40%的克罗思病病例（Crohn’sdisease:10-40%）抗酿酒酵母菌抗体ASCA(anti-Saccharomycescerevisiaeantibody)40-80%的溃疡性结肠炎病例（Crohn’sdisease:40-80%）<10%的克罗思病病例（Ulcerativecolitis:<10%）基因检测：NOD2和其他的IBD基因（GenetictestingforNOD2andotherIBDgenes）IBD的实验室检测克罗恩病（Cr

4、ohnDisease）克罗恩病（CrohnDisease）肠炎特点（FeaturesofInflammationoftheIntestine）慢性，节段性，透壁性（Chronic,Segmental,Transmural）病变以小肠远端为主，右半结肠可受累，可有消化道甚至肠外组织受累（Crohndiseaseoccursprincipallyinthedistalsmallintestinebutmayinvolveanypartofthedigestivetractandevenextraintestinaltissues.The

5、colon,particularlytherightcolon,maybeaffected.）2021/10/5肠道粪便流的作用ThefecalstreamappearstobeofprimeimportanceinthepathogenesisofCrohndisease,asevidencedby：(1)thebeneficialeffectsofsurgicalbypass（肠旁路吻合的好处）(2)thepatternofpreanastomoticrecurrenceinpatientswithside-to-endanas

6、tomoticsites（侧-端吻合处前段复发）,and(3)thefrequencyofearlyinflammatorylesions(aphthoiderosions)intheepitheliuminassociationwithmucosallymphoidtissue（淋巴组织增生之上皮处早期炎症-口疮样糜烂）.2021/10/5病理变化（Pathology）克罗思病有两大病变特征，以此与其他的炎症性肠病相鉴别：TwomajorcharacteristicsofCrohndiseasedifferentiateitfro

7、motherGIinflammatorydiseases.第一，严重通常累及肠壁全层，故称之为透壁性炎症。First,theinflammationusuallyinvolvesalllayersofthebowelwallandis,therefore,referredtoastransmuralinflammatorydisease.第二，肠壁病变是间断性的，即节段性肠炎病变，间有未受累及的正常肠组织Second,theinvolvementoftheintestineisdiscontinuous;thatis,segment

8、sofinflamedtissueareseparatedbyapparentlynormalintestine.2021/10/5克罗恩病病变分布的四大部位特征回盲部病变为主，占50%mainlytheileumandcecumin