Verdier D, Mallet L, Terris G, Petite J P
Service de Gastroentérologie, Hôpital Saint-Joseph, Paris.
Presse Med. 1992 May 23;21(19):891-4.
The diagnosis of non-gangrenous ischaemic colitis is difficult to assert when histological findings are not specific and when no precipitating cardiovascular event can be found. The constant absence of relapse after the initial episode suggests that an extraneous triggering event is involved. We have studied retrospectively 25 cases of spontaneous ischaemic colitis, looking for a non-haemodynamic triggering event. At the onset of colitis 9 patients had been taking non-steroidal anti-inflammatory drugs or antibiotics for 2 weeks or less. In 3 other patients colitis was associated with Escherichia coli O157:H7 infection. Striking clinical, endoscopic and histological similarities exist between ischaemic colitis on the one hand and colitis caused by absorption of non-steroidal anti-inflammatory drugs or ampicillin and the colitis reported in E. coli O157:H7 infection on the other hand. Non-steroidal anti-inflammatory drugs and E. coli O157:H7 intestinal infection, possibly facilitated by an antibiotic treatment with e.g. ampicillin, could be either non-haemodynamic triggering factors for ischaemic colitis, or responsible per se for a transient acute colitis with the same characteristics as ischaemic colitis.
当组织学检查结果不具有特异性且未发现促发心血管事件时，非坏疽性缺血性结肠炎的诊断很难确定。初次发作后持续无复发提示存在外部触发事件。我们回顾性研究了25例自发性缺血性结肠炎病例，寻找非血流动力学触发事件。在结肠炎发作时，9例患者服用非甾体抗炎药或抗生素2周或更短时间。另外3例患者的结肠炎与大肠杆菌O157:H7感染有关。一方面，缺血性结肠炎与另一方面由非甾体抗炎药或氨苄西林吸收引起的结肠炎以及大肠杆菌O157:H7感染中报道的结肠炎之间存在显著的临床、内镜和组织学相似性。非甾体抗炎药和大肠杆菌O157:H7肠道感染，可能因例如氨苄西林的抗生素治疗而加剧，可能是缺血性结肠炎的非血流动力学触发因素，或者本身就是导致具有与缺血性结肠炎相同特征的短暂急性结肠炎的原因。
