Ben-Horin Shomron, Bardan Eytan, Barshack Iris, Zaks Nurit, Livneh Avi
Department of Medicine F, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Gastroenterol. 2003 Jul;98(7):1471-9. doi: 10.1111/j.1572-0241.2003.07532.x.
In the 1359 published patients with multiorgan cholesterol crystal embolism (CCE), the digestive system seems to be the third most frequently affected system. Yet, this system received hitherto only little attention in the medical literature. Therefore, the aim of the present study was to clinically characterize the subset of patients with CCE involving the digestive system, based on our institutional experience and a review of the literature. Cases with CCE in a 7-yr period (1995-2001) were sought in the computerized records of our medical center. Of the CCE patients, those with digestive system involvement that could be related to CCE were included in this study. The clinical features of CCE were determined and compared with those found in published series. Fourteen cases with CCE were identified, giving an annual incidence of 0.8 per 10(5). Digestive system involvement was found in five (36%) of the 14 patients. All five patients had established atherosclerosis. Precipitating factors were vascular manipulations or anticoagulation treatment in four of these five patients. Two patterns of disease appeared: acute catastrophic multiorgan disorder with poor prognosis and chronic and more indolent GI disease. Abdominal pain, GI bleeding, fever, and diarrhea were the most common manifestations, resulting from bowel infarction, mucosal ulcerations, hepatocellular liver disorder, and/or pancreatitis. CCE is a systemic disorder with a frequent involvement of the digestive system and protean clinical manifestations. It should, therefore, be considered in any gastroenterological patient with atherosclerosis and recent vascular manipulations or systemic anticoagulation.
在1359例已发表的多器官胆固醇结晶栓塞（CCE）患者中，消化系统似乎是第三大最常受累的系统。然而，该系统在医学文献中迄今受到的关注很少。因此，本研究的目的是根据我们机构的经验和文献综述，对涉及消化系统的CCE患者亚组进行临床特征描述。我们在医疗中心的计算机记录中查找了7年期间（1995 - 2001年）患有CCE的病例。在CCE患者中，那些消化系统受累且可能与CCE相关的患者被纳入本研究。确定了CCE的临床特征，并与已发表系列中的特征进行比较。共识别出14例CCE患者，年发病率为每10万人中0.8例。14例患者中有5例（36%）出现消化系统受累。所有5例患者均已确诊患有动脉粥样硬化。这5例患者中有4例的诱发因素是血管操作或抗凝治疗。出现了两种疾病模式：预后不良的急性灾难性多器官疾病和慢性且较为隐匿的胃肠道疾病。腹痛、胃肠道出血、发热和腹泻是最常见的表现，其原因是肠梗死、黏膜溃疡、肝细胞性肝病和/或胰腺炎。CCE是一种全身性疾病，常累及消化系统且临床表现多样。因此，对于任何患有动脉粥样硬化且近期有血管操作或全身抗凝的胃肠病患者，都应考虑到CCE。
