Pazenco E V, Karev V E, Raikhelson K L, Shchukina O B, Botina A V, Kharitonov A G, Semenov N V
Eksp Klin Gastroenterol. 2016(7):18-24.
To compare the clinical, endoscopic picture and morphological changes of the intestinal mucosa in patients with primary sclerosing cholangitis (PSC).
31 patients with PSC (women - 15 men - 16) were included in study group. The diagnosis of ulcerative colitis (UC) was established in 8 patients, Crohn’s disease (CD) - in 5, unclassified colitis (UCC) - in 7, and 11 patients had no clinical and endoscopic signs of IBD. The control group consisted of 30 patients with IBD: UC - 20 patients, CD - 10 persons. All the patients performed ileocolonoscopy (ICS) with multiple biopsy and histological examination of material.
The prevalence of IBD in patients with PSC was 64.5%. IBD with PSC was characterized by extensive colitis with mild clinical activity. Morphological activity of IBD associated with PSC was usually moderate and severe. Morphological activity of disease in IBD/PSC group was lower than in UC alone (p < 0.05). IBD onset came before PSC symptoms (p < 0.05). Distal gradient of inflammation in colon predominated in IBD/PSC group when disease starts with IBD symptoms, in case of PSC symptoms - proximal gradient was more frequent. In IBD/PSC group affected ileum were detected in a third of cases, including CD ileitis - 60%, backwash ileitis in UC (NCC) in 26.7%, that was significantly frequently than in UC alone (p = 0.02). Within the IBD/PSC group 30% of patients with colitis were without damaging of rectum. In all the patients with PSC without clinical, endoscopic signs of colitis polymorphocellular infiltration of mucosa were founded. Eosinophilic infiltration of mucosa in group of PSC met significantly more frequently than in other study groups. Fibrosis of intestinal mucosa was founded significantly more frequently in group of PSC without IBD compared with UC/PSC and UC patients, but not with CD group.
For IBD in PSC extensive colitis without lesions of the rectum, backwash ileitis are common. There are some morphological differences in the intestinal lesions within the IBD/PSC patients depending on the type of disease onset. There is a dissociation between low clinical activity and intensive morphological inflammation. When PSC had no clinical features of IBD, a microscopic ileocolitis (characterized by eosinophilic infiltration and fibrosis of the intestinal mucosa) without nosological classification was founded in all patients.
比较原发性硬化性胆管炎（PSC）患者的临床、内镜表现及肠黏膜形态学变化。
研究组纳入31例PSC患者（女性15例，男性16例）。其中8例确诊为溃疡性结肠炎（UC），5例为克罗恩病（CD），7例为未分类结肠炎（UCC），11例患者无炎症性肠病（IBD）的临床及内镜表现。对照组由30例IBD患者组成：20例UC患者，10例CD患者。所有患者均接受了全结肠及回肠末端结肠镜检查（ICS），并进行了多次活检及材料的组织学检查。
PSC患者中IBD的患病率为64.5%。PSC合并IBD的特点是广泛结肠炎且临床活动度较轻。PSC相关IBD的形态学活动通常为中度和重度。IBD/PSC组疾病的形态学活动低于单纯UC组（p<0.05）。IBD发病早于PSC症状出现（p<0.05）。当疾病以IBD症状起病时，IBD/PSC组结肠炎症的远端梯度占主导，若以PSC症状起病，则近端梯度更为常见。IBD/PSC组三分之一的病例检测到回肠受累，其中CD性回肠炎占60%，UC（NCC）的反流性回肠炎占26.7%，明显高于单纯UC组（p = 0.02）。IBD/PSC组中30%的结肠炎患者直肠未受累。在所有无IBD临床及内镜表现的PSC患者中均发现黏膜多形核细胞浸润。PSC组黏膜嗜酸性粒细胞浸润明显多于其他研究组。与UC/PSC组和UC患者相比，无IBD的PSC组肠黏膜纤维化明显更常见，但与CD组相比无差异。
对于PSC合并IBD患者，广泛结肠炎且直肠无病变、反流性回肠炎较为常见。IBD/PSC患者的肠道病变根据疾病起病类型存在一些形态学差异。临床活动度低与形态学炎症强烈之间存在分离。当PSC无IBD临床特征时，所有患者均发现一种无明确分类的微观性全结肠及回肠炎（以肠黏膜嗜酸性粒细胞浸润和纤维化为特征）。
