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ID:19276083
大小:8.89 MB
页数:55页
时间:2018-09-30
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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:Crohndiseaseandulcerativecolitis
2、.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%的溃疡性结肠炎病例(Ulcerativecolitis:60-75%)10-40%的克罗思病病例(
3、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(CrohnDisease)克罗恩病(CrohnDisease)肠炎特点(FeaturesofInflammationoftheIntestine)慢性,节
4、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.Thecolon,particularlytherightcolon,maybeaffected.)2021/6/27克罗恩病的流行病学(Epidemiology)全球发生克罗思病,每年发病率为0.5-5人
5、/每10万人群。过去30年来,来自各国的报道表明,全球的克罗思发病率急剧增加。(Crohndiseaseoccursworldwide,withanannualincidenceof0.5to5per100,000.Reportsfromvariouscountriesindicatethattheincidencehasincreaseddramaticallyoverthepast30years.)欧洲的该病病例最常见于青少年或年轻成人,犹太人群呈高发病率,女性较男性稍微多见(1.6:1).Thediseaseusuallyappearsinadolescentsoryoung
6、adultsandismostcommonamongpersonsofEuropeanorigin,withaconsiderablyhigherfrequencyintheJewishpopulation.Thereisaslightfemalepredominance(1.6:1).2021/6/27发病机制(Pathogenesis)家族性遗传性体质ConcordanceratesintwinpairsandsiblingsstronglyimplicateageneticpredispositiontoCrohndisease.Afamilyhistoryofinflamm
7、atoryboweldiseaseismorecommonforCrohndiseasethanforulcerativecolitis.AputativesusceptibilitylocusforCrohndiseasehasbeenassignedtothecentromericregionofchromosome16whereitisassociatedwiththeNOD2/CARD15locus,whichcodesforanintracellularre
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