本文選題：探頭式共聚焦激光顯微內(nèi)鏡 + 潰瘍性結(jié)腸炎　； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：研究背景及目的： 近幾年潰瘍性結(jié)腸炎在我國的發(fā)病率呈上升趨勢,疾病過程以緩解和復(fù)發(fā)交替進(jìn)行為主要特點(diǎn)。目前對潰瘍性結(jié)腸炎的診斷仍以臨床表現(xiàn)結(jié)合內(nèi)鏡表現(xiàn)、組織病理學(xué)的綜合診斷為標(biāo)準(zhǔn)。其粘膜炎癥發(fā)生的病理生理機(jī)制尚不十分明確,以往的研究主要集中于病理組織學(xué)對上皮細(xì)胞、免疫細(xì)胞等形態(tài)學(xué)觀察。有研究表明,潰瘍性結(jié)腸炎患者血栓形成的風(fēng)險較高,且處于長期炎癥狀態(tài)的腸道微血管內(nèi)皮細(xì)胞出現(xiàn)由NO介導(dǎo)的舒張功能異常,提示潰瘍性結(jié)腸炎患者腸粘膜微循環(huán)血流動力學(xué)可能存在異常。探頭式共聚焦激光顯微內(nèi)鏡在內(nèi)鏡檢查的同時可以獲得活體粘膜及粘膜下組織學(xué)動態(tài)圖像,可實(shí)時動態(tài)觀察腸粘膜血流動力學(xué)的改變。目前對潰瘍性結(jié)腸炎腸粘膜微循環(huán)血流動力學(xué)的在體研究尚屬空白。本研究的目的旨在利用探頭式共聚焦激光顯微內(nèi)鏡實(shí)時動態(tài)觀察潰瘍性結(jié)腸炎腸粘膜微循環(huán)血流動力學(xué)改變,并探討其血流動力學(xué)改變與炎癥程度的關(guān)系,為研究潰瘍性結(jié)腸炎病理生理機(jī)制提供臨床理論依據(jù)。 研究方法： 自2013年3月至2014年3月就診于山東大學(xué)齊魯醫(yī)院行共聚焦顯微內(nèi)鏡檢查為潰瘍性結(jié)腸炎的42例患者作為實(shí)驗(yàn)組,高清內(nèi)鏡檢查未見明顯異常的39例患者作為對照組納入本研究。每位患者均由四名經(jīng)驗(yàn)豐富的共聚焦內(nèi)鏡醫(yī)師之一按照常規(guī)操作進(jìn)行內(nèi)鏡檢查,高清內(nèi)鏡檢查前靜脈注謝1mL2%的熒光素鈉1作為皮試,進(jìn)境至回腸末端后,靜脈注射3mL10%的熒光素鈉,以適宜力度將共聚焦探頭接觸患者腸粘膜獲取共聚焦圖像；實(shí)驗(yàn)組選取回腸末端及病變部位圖像、對照組選取回腸末端及直乙交界處圖像進(jìn)行數(shù)據(jù)分析。每個圖像記錄微血管直徑及面積兩個靜態(tài)指標(biāo)及血細(xì)胞流動是否出現(xiàn)停滯、往返、聚集、緡錢樣改變四個動態(tài)指標(biāo),并對實(shí)驗(yàn)組的每個患者進(jìn)行臨床評分(Mayo Clinical Score)、內(nèi)鏡評分(UCEIS)及共聚焦內(nèi)鏡炎癥程度分級,觀察潰瘍性結(jié)腸炎患者微循環(huán)血流動力學(xué)特點(diǎn)的改變,并探究微血管血流動態(tài)學(xué)指標(biāo)評分與微血管直徑和面積、臨床評分、內(nèi)鏡評分及共聚焦內(nèi)鏡下炎癥程度之間的相關(guān)性。 研究結(jié)果： 實(shí)驗(yàn)組與對照組回腸末端血流動態(tài)學(xué)總分無明顯差異,而實(shí)驗(yàn)組病變處血流動態(tài)學(xué)總分、微血管直徑、微血管面積與對照組直乙交界處均有明顯差異,p0.01。實(shí)驗(yàn)組Mayo I臨床評分與內(nèi)鏡UCEIS評分有明顯相關(guān)性(r=0.402,p0.01),且內(nèi)鏡UCEIS評分與共聚焦內(nèi)鏡炎癥程度分級有明顯相關(guān)性(r=0.444,p0.01)。病變部位血流動態(tài)學(xué)總分與內(nèi)鏡UCEIS評分呈正相關(guān)(r=0.395,p0.05),“停滯、往返、聚集、緡錢樣改變”四項(xiàng)血流動態(tài)學(xué)指標(biāo)與UCEIS評分的相關(guān)系數(shù)分別為：0.039、0.445、0.187、0.121。 結(jié)論： 探頭式共聚焦激光顯微內(nèi)鏡可實(shí)時觀察潰瘍性結(jié)腸炎患者腸粘膜微循環(huán)血流動力學(xué)的改變,潰瘍性結(jié)腸炎患者病變處微血管管徑、面積均較正常者增大,且存在明顯血流瘀滯趨勢,并與其炎癥程度存在相關(guān)性,炎癥程度愈重,其血流瘀滯程度愈大,微血栓形成的風(fēng)險愈高。
[Abstract]:Background and purpose of the study :

In recent years , the incidence of ulcerative colitis has been increasing in our country , and the course of disease is characterized by the alternation of remission and recurrence . The pathological and physiological mechanism of mucosal inflammation is not very clear .

Study method :

Forty - two patients with ulcerative colitis were examined by confocal microscopy from March 2013 to March 2014 as experimental group . 39 patients with no obvious abnormality were examined by high - definition endoscopy as control group . One of the four experienced co - focus endoscopes was used as control group .
To study the changes of microcirculation hemodynamics in patients with ulcerative colitis , and to explore the correlation between the score of vascular hemodynamics and the degree of microvessels ' diameter and area , clinical score , endoscopic scoring and the degree of inflammation in confocal endoscope .

Results of the study :

There was no significant difference between the experimental group and the control group . There was no significant difference between the experimental group and the control group ( r = 0.402 , p0.01 ) , and the endoscopic UCEIS score was significantly correlated with the endoscopic UCEIS score ( r = 0.444 , p0.01 ) . There was positive correlation between the total score of blood flow dynamics and endoscopic UCEIS score ( r = 0.395 , p0.05 ) , and the correlation coefficients of four blood flow dynamic indexes and UCEIS scores were 0.039 , 0.445 , 0.187 and 0.121 , respectively .

Conclusion :

The probe - type confocal laser micro - endoscope can observe the changes of microcirculation in the intestinal mucosa of patients with ulcerative colitis in real time , and the diameter and area of the microvessels in the lesions of ulcerative colitis are higher than those of the normal ones , and there is a clear tendency of blood stasis and stagnation , and there is a correlation between the degree of inflammation and the degree of inflammation , the more the blood stasis is , the higher the risk of microthrombus formation .

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R574.62

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本文編號：1812844