CAJ | 학술논문

目的研究老年白塞病累及消化道的临床表现、内镜与病理特征. 方法收集8例白塞病患者,入组条件:临床诊断白塞病,年龄≥60岁,累及消化道；总结入组患者临床特点、内镜下表现；患者均进行消化道活检并观察组织学表现,应用组织化学方法染色以证实血管炎改变. 结果白塞病累及食管比例为16.7％(9/54),老年患者6例(11.1％),食管病变中老年患者占66.7％(6/9)；白塞病累及回结肠比例为9.3％(5/54),老年患者4例(7.4％),回结肠病变中老年患者的比例为80.0％(4例).6例患者出现胸骨后痛,其中2例伴吞咽困难；4例伴腹痛及便血；实验室检查:4例红细胞沉降率增快,C反应蛋白升高,患者抗核抗体、抗中性粒细胞胞浆均阴性.查体6例见口腔溃疡、生殖器溃疡,2例曾有反复口腔溃疡和生殖器溃疡病史.眼炎6例,皮肤损害4例.6例见食管多发溃疡,以浅溃疡多见,溃疡表面白苔干净,溃疡周边有充血、水肿；累及回盲部及升结肠的4例.病理表现为典型小血管炎.经治疗后胸骨后痛症状消失,食管溃疡愈合. 结论白塞病患者出现消化道累及与病程有关,病程长,消化道受累可能性增加,老年患者食管受累多见,老年白塞病患者累及食管,胸骨后痛可能为其相对特异的临床症状,糖皮质激素和(或)沙利度胺治疗有效.
목적 연구노년백새병루급소화도적림상표현、내경여병리특정. 방법 수집8례백새병환자,입조조건:림상진단백새병,년령≥60세,루급소화도；총결입조환자림상특점、내경하표현；환자균진행소화도활검병관찰조직학표현,응용조직화학방법염색이증실혈관염개변. 결과 백새병루급식관비례위16.7％(9/54),노년환자6례(11.1％),식관병변중노년환자점66.7％(6/9)；백새병루급회결장비례위9.3％(5/54),노년환자4례(7.4％),회결장병변중노년환자적비례위80.0％(4례).6례환자출현흉골후통,기중2례반탄인곤난；4례반복통급편혈；실험실검사:4례홍세포침강솔증쾌,C반응단백승고,환자항핵항체、항중성립세포포장균음성.사체6례견구강궤양、생식기궤양,2례증유반복구강궤양화생식기궤양병사.안염6례,피부손해4례.6례견식관다발궤양,이천궤양다견,궤양표면백태간정,궤양주변유충혈、수종；루급회맹부급승결장적4례.병리표현위전형소혈관염.경치료후흉골후통증상소실,식관궤양유합. 결론 백새병환자출현소화도루급여병정유관,병정장,소화도수루가능성증가,노년환자식관수루다견,노년백새병환자루급식관,흉골후통가능위기상대특이적림상증상,당피질격소화(혹)사리도알치료유효.
Objective To investigate the clinical manifestations,endoscopy and pathological features of Behcet's disease (BD) in gastrointestinal systems in elderly patients.Methods Totally 8 patients aged ≥ 60 years with BD were collected.Clinical characteristics and endoscopic performances of gastrointestinal tracts in patients were summarized.All patients were received gastrointestinal biopsy and the histology change was observed.The vasculitis of gastrointestinal tracts was confirmed by histochemical staining.Results The proportion of patients with BD involving the esophagus was 16.7％ (9/54) and among whom 6 cases (11.1 ％) were elderly,so the proportion of BD patients with esophageal lesions in elderly patients was 66.7 ％ (6/9).The proportion of patients with BD involving the ileocolon was 9.3％ (5/54) and 4 cases (7.4％) were elderly patients,so the proportion of BD patients with ileocolon lesions in elderly patients was 80.0％ (4/5).6 patients had retrosternal chest pain,among whom 2 patients with dysphagia and 4 patients with abdominal pain and hematochezia.In the laboratory tests,the levels of erythrocyte sedimentation rate (ESR) and C reactive protein were elevated in 4 cases,and antinuclear antibodies (ANA) and anti-neutrophil cytoplasm antibody(ANCA)were negative in all patients.In the physical examination,oral and genital ulcers in 6 patients,and a history of recurrent oral and genital ulcers were found in the other 2 patients.6 patients had ophthalmia and 4 patients with skin lesions.6 patients had multiple esophageal ulcers,in which shallow ulcers was more common,and the surface of ulcer was clean and white with congestion and edema at the periphery of ulcers.BD involving the ileocecal and ascending colon were found in 4 cases.Typical small vessel vasculitis was the pathological performance.The retrosternal chest pain disappeared and the esophageal ulcers were healed after the treatment.Conclusions Gastrointestinal involvement in BD patients is associated with the the course of disease.Longer duration can increase the possibility of gastrointestinal involvement in BD.Elderly BD patients are more common with esophageal involvement.Rctrosternal chest pain may be a relatively specific clinical symptom in BD involving esophageal tract.Glucocorticoids and (or) thalidomide are effective for the treatment of BD with esophageal involvement.