Maleh Haim Cesar, Bica Blanca Elena Rios Gomes, Papi José Ângelo de Souza, de Azevedo Mário Newton Leitão, Carneiro Antônio José de Vasconcellos
Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
Rev Bras Reumatol. 2014 Sep-Oct;54(5):342-8. doi: 10.1016/j.rbr.2014.03.020. Epub 2014 Jul 6.
Patients with ankylosing spondylitis can have intestinal inflammatory lesions, thus the use of colonoscopy for such patients should be defined.
To assess the gross intestinal colonoscopic changes and microscopic histopathologic findings of patients with ankylosing spondylitis; to correlate the colonoscopic and histopathologic findings; and to study the relationship of the histopathologic findings with extra-articular manifestations of the disease, HLA-B27, BASFI and BASDAI.
This is a cross-sectional study of 22 patients with ankylosing spondylitis. The patients underwent clinical assessment, BASDAI and BASFI application, blood collection for HLA-B27 measurement, and colonoscopy with biopsy of four intestinal segments (terminal ileum, right and sigmoid colons, and rectum).
Abnormal colonoscopic results were obtained in 13 (59.1%) patients, the major abnormality being intestinal polyps. The groups of normal and abnormal colonoscopic results (n=9 and n=13, respectively) were homogeneous regarding age, BASFI, BASDAI, and categorical variables, and the P-value showed no significant difference between groups. The histopathological findings revealed abnormal biopsies in 81%, 90.9%, 90.9% and 86.4% for terminal ileum, right colon, sigmoid colon, and rectum, respectively. The histopathologic results showed no statistically significant association with the extra-articular manifestations, BASFI, BASDAI and HLA-B27 positivity.
The histological analysis of the four intestinal segments evidenced inflammatory lesions in patients with normal and abnormal colonoscopic results, independently of bowel symptomatology and therapy used in the treatment of the basal disease.
强直性脊柱炎患者可出现肠道炎性病变，因此应明确对此类患者进行结肠镜检查的应用情况。
评估强直性脊柱炎患者肠道的结肠镜大体改变及微观组织病理学表现；关联结肠镜检查结果与组织病理学表现；研究组织病理学表现与该疾病关节外表现、HLA-B27、巴斯强直性脊柱炎功能指数（BASFI）和巴斯强直性脊柱炎疾病活动指数（BASDAI）之间的关系。
这是一项针对22例强直性脊柱炎患者的横断面研究。患者接受临床评估、应用BASDAI和BASFI、采集血液检测HLA-B27，并进行结肠镜检查，同时对四个肠段（回肠末端、右半结肠、乙状结肠和直肠）进行活检。
13例（59.1%）患者结肠镜检查结果异常，主要异常为肠道息肉。结肠镜检查结果正常和异常的两组患者（分别为9例和13例）在年龄、BASFI、BASDAI及分类变量方面具有同质性，两组间P值无显著差异。组织病理学检查结果显示，回肠末端、右半结肠、乙状结肠和直肠活检异常的比例分别为81%、90.9%、90.9%和86.4%。组织病理学结果与关节外表现、BASFI、BASDAI及HLA-B27阳性之间无统计学意义上的关联。
对四个肠段的组织学分析表明，无论结肠镜检查结果正常与否，患者均存在炎性病变，且与基础疾病治疗中使用的肠道症状学及治疗方法无关。
