Al-Daraji Wael Ismail, Al-Mahmoud Riham M W, Ilyas Mohammed
Department of Pathology, School of Molecular Medicine, University of Nottingham, Nottingham, UK.
Dig Dis Sci. 2008 Aug;53(8):2079-82. doi: 10.1007/s10620-007-0132-7. Epub 2007 Dec 15.
Familial Mediterranean fever (FMF) is also called recurrent polyserositis. The salient features of this disease include brief recurrent episodes of peritonitis, pleuritis, and arthritis, which are usually associated with fever. Colchicine is highly effective in the treatment of FMF and in preventing the development of recurrent attacks and amyloidosis, and it is essential to make the correct diagnosis and institute daily therapy with colchicine (0.5-0.6 mg bid). Colchicine is used to treat a variety of conditions but it is known to have gastrointestinal (GI) side effects. In this study, effects of colchicines on the gastrointestinal tract were evaluated in patients with FMF treated with colchicine.
Biopsies were reviewed from 43 patients attending Ain Shams University Hospital (Egypt) who were diagnosed with FMF and treated with colchicine. One-hundred and twelve GI biopsies, obtained over a 14-year period, were reviewed. This included biopsies from stomach body (38), stomach antrum (50), and colon (24). In addition, gastric biopsies were reviewed from 17 control patients who did not have FMF and were not on colchicine.
Three patients known to have FMF and on colchicine therapy showed typical histological features of colchicine (metaphase mitoses, epithelial pseudoproliferation, mucin depletion, and frequent apoptosis). These features were seen only in gastric antral biopsies and not in colonic biopsies. None of the control group showed the characteristic morphological features of colchicine toxicity.
This is the first report of histological changes seen in the stomach following colchicine therapy. In contrast with previous reports, we did not find any definitive change in the large intestine. Our data show that gastric changes can be encountered in symptomatic patients who have recently had colchicine. If these finding are seen histologically, they merit correlation with the clinical impression and should not be interpreted as toxicity in isolation.
家族性地中海热（FMF）也被称为复发性多浆膜炎。该疾病的显著特征包括腹膜炎、胸膜炎和关节炎的短暂复发发作，通常伴有发热。秋水仙碱在治疗FMF以及预防复发发作和淀粉样变性的发展方面非常有效，正确诊断并开始每日服用秋水仙碱（0.5 - 0.6毫克，每日两次）至关重要。秋水仙碱用于治疗多种病症，但已知有胃肠道（GI）副作用。在本研究中，对接受秋水仙碱治疗的FMF患者的胃肠道秋水仙碱作用进行了评估。
回顾了艾因夏姆斯大学医院（埃及）43例被诊断为FMF并接受秋水仙碱治疗的患者的活检样本。对14年期间获取的112份胃肠道活检样本进行了回顾。这包括胃体活检（38份）、胃窦活检（50份）和结肠活检（24份）。此外，还回顾了17例未患FMF且未服用秋水仙碱的对照患者的胃活检样本。
3例已知患有FMF且接受秋水仙碱治疗的患者显示出秋水仙碱的典型组织学特征（中期有丝分裂、上皮假增殖、粘蛋白耗竭和频繁凋亡）。这些特征仅在胃窦活检中可见，而在结肠活检中未见到。对照组中无一例显示出秋水仙碱毒性的特征性形态学改变。
这是秋水仙碱治疗后胃组织学变化的首次报告。与先前的报告相反，我们在大肠中未发现任何明确变化。我们的数据表明，近期服用秋水仙碱的有症状患者可能会出现胃部变化。如果在组织学上发现这些表现，应将其与临床印象相关联，而不应孤立地解释为毒性。
