Osada Taro, Ohkusa Toshifumi, Okayasu Isao, Yoshida Tsutomu, Hirai Shu, Beppu Kazuko, Shibuya Tomoyoshi, Sakamoto Naoto, Kobayashi Osamu, Nagahara Akihito, Terai Takeshi, Watanabe Sumio
Department of Gastroenterology, Jutendo University School of Medicine, Bunkyo-ku, Tokyo, Japan.
J Gastroenterol Hepatol. 2008 Dec;23 Suppl 2:S262-7. doi: 10.1111/j.1440-1746.2008.05413.x.
Colonoscopy plays an integral role in the diagnosis, management and surveillance of ulcerative colitis (UC). In the present study we assessed the relationship between endoscopic and histological findings, clinical symptoms, and laboratory data.
We performed total colonoscopy examinations in 54 consecutive patients with UC. Seven segments (appendiceal region, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum) were scored for endoscopic and histological activity. The patients were also evaluated using a symptom-activity index and laboratory markers: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) and platelet (plt) counts.
There was a significant positive correlation between endoscopic and histological scores (r(s)=0.738), and between symptom activity score, endoscopic score (r(s)=0.444), and histological score (r(s)=0.557). Although the endoscopic and histological scores of distal colonic lesions (rectum-sigmoid, endoscopic: r(s)=0.515, histological: r(s)=0.624) correlated with clinical symptoms, there was no similar correlation for the proximal colon (appendiceal region-descending; endoscopic, r(s)=0.268, histological, r(s)=0.329). CRP, ESR, and WBC count also correlated with the sum of endoscopic and histological scores (CRP, r(s)=0.447, r(s)=0.369; ESR, r(s)=0.483, r(s)=0.589; WBC, r(s)=0.338, r(s)=0.330), whereas platelet count did not (r(s)=0.171, r(s)=0.210). In particular, CRP and ESR were well correlated with the activity of proximal colonic lesions (CRP, r(s) = 0.474, r(s)=0.480; ESR, r(s) = 0.423, r(s)=0.529) rather than with that of distal lesions (CRP, r(s)=0.236, r(s)=0.212; ESR, r(s)=0.368, r(s)=0.497).
In this study, clinical symptoms reflected the activity of distal colonic lesions, whereas CRP and ESR reflected the activity of proximal lesions. Therefore, total colonoscopy may be indicated when CRP or ESR is elevated in UC patients in clinical remission.
结肠镜检查在溃疡性结肠炎（UC）的诊断、治疗及监测中发挥着不可或缺的作用。在本研究中，我们评估了内镜检查结果与组织学检查结果、临床症状及实验室数据之间的关系。
我们对54例连续性UC患者进行了全结肠镜检查。对七个节段（阑尾区、盲肠、升结肠、横结肠、降结肠、乙状结肠和直肠）的内镜及组织学活动情况进行评分。还使用症状活动指数和实验室指标对患者进行评估：C反应蛋白（CRP）、红细胞沉降率（ESR）、白细胞（WBC）计数及血小板（plt）计数。
内镜评分与组织学评分之间存在显著正相关（r(s)=0.738），症状活动评分与内镜评分（r(s)=0.444）及组织学评分（r(s)=0.557）之间也存在显著正相关。虽然远端结肠病变（直肠-乙状结肠）的内镜及组织学评分与临床症状相关（内镜：r(s)=0.515，组织学：r(s)=0.624），但近端结肠（阑尾区-降结肠）不存在类似的相关性（内镜，r(s)=0.268，组织学，r(s)=0.329）。CRP、ESR及WBC计数也与内镜和组织学评分总和相关（CRP，r(s)=0.447，r(s)=0.369；ESR，r(s)=0.483，r(s)=0.589；WBC，r(s)=0.338，r(s)=0.330），而血小板计数则不然（r(s)=0.171，r(s)=0.210）。特别是，CRP和ESR与近端结肠病变的活动情况相关性良好（CRP，r(s)=0.474，r(s)=0.480；ESR，r(s)=0.423，r(s)=0.529），而与远端病变的相关性较差（CRP，r(s)=0.236，r(s)=0.212；ESR，r(s)=0.368，r(s)=0.497）。
在本研究中，临床症状反映了远端结肠病变的活动情况，而CRP和ESR反映了近端病变的活动情况。因此，对于临床缓解期的UC患者，若CRP或ESR升高，可能需要进行全结肠镜检查。
