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Received:March 20, 2021 Published Online:November 20, 2021
Received:March 20, 2021 Published Online:November 20, 2021
中文摘要: 目的 总结分析原发性硬化性胆管炎（PSC）伴溃疡性结肠炎（UC）患者的临床特点和转归。方法 回顾性分析南京大学医学院附属鼓楼医院2014年1月至2021年1月收治的5例PSC-UC患者的相关资料，包括临床症状、实验室检查、影像学检查和病理、药物治疗和内镜治疗、有无行肝移植治疗以及随访转归等方面的数据。结果 5例患者均于UC起病后出现PSC相关表现，UC方面临床表现独特，结肠炎症状均较轻但范围广泛、右侧结肠炎症较重、直肠豁免、倒灌性回肠炎以及结直肠瘤变/癌变风险增高，经治疗后结肠炎较易控制。PSC方面，合并UC常提示预后较差，即使给予中等剂量熊去氧胆酸，未必能改变预后，已出现黄疸的患者，如不行肝移植，不可避免进展至肝衰竭甚至死亡。结论 对于PSC-UC，尽量做到早期识别和诊断，在病程早期通过优化治疗或结肠切除以尽早控制结肠炎症，探索能否逆转PSC疾病自然进程。
Abstract:Objective To summarize and analyze the clinical characteristics and prognosis of patients with primary sclerosing cholangitis (PSC) combined with ulcerative colitis (UC). Methods The clinical data of 5 patients with PSC-UC treated between January 2014 and January 2020 were reviewed retrospectively, including clinical symptoms, laboratory tests, imaging examination and pathology, drug treatment, endoscopic treatment, liver transplantation and follow-up outcome. Results Five patients presented with symptoms of PSC after onset of UC. UC was mainly characterized by pancolitis, more severe inflammation in the right colon, rectal sparing and backwash ileitis, as well as the increased risk of colorectal neoplasia/cancer and was easily controlled after treatment. It indicated a poor prognosis that the patients suffered from PSC complicated with UC, even medium-dose ursodeoxycholic acid for the treatment. The patients with jaundice would inevitably progress to liver failure or even death if liver transplantation was not conducted. Conclusions For the patients with PSC-UC, it is necessary to early identify, diagnose and control colitis as soon as possible by optimizing inflammatory bowel disease therapy or colectomy in the early stage of the disease to determine whether the natural process of PSC disease could be reversed.
文章编号： 中图分类号：R575.7 R574.62 文献标志码：B
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