消化道病理(二).ppt

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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:Crohndiseas

2、eandulcerativecolitis.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

3、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（CrohnDisease）克

4、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.Thecolon,particular

5、lytherightcolon,maybeaffected.）2021/9/19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/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.Reportsfromvariouscountriesindicatethattheincidencehasincreaseddramaticallyoverth

6、epast30years.）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).ThediseaseusuallyappearsinadolescentsoryoungadultsandismostcommonamongpersonsofEuropeanorigin,withaconsiderablyhigherfrequencyintheJewishpopulation.Thereisaslightfemalepredominance(1.6:1).2021/9/19发病机制（Pathogenes

7、is）家族性遗传性体质ConcordanceratesintwinpairsandsiblingsstronglyimplicateageneticpredispositiontoCrohndisease.AfamilyhistoryofinflammatoryboweldiseaseismorecommonforCrohndiseasethanforulcerativecolitis.AputativesusceptibilitylocusforCrohndiseasehasbeenassignedtothecentromericregi

8、onofchromosome16whereitisassociatedwiththeNOD2/CARD15locus,whichcodesforanintracellularre