病例介绍
患者男性,34岁。一年前无明显诱因出现右下腹阵发性钝痛,伴有腹泻,每天2-3次,无明显脓血粘液。
于当地医院行肠镜:结肠肝曲可见环周多发息肉增生,黏膜桥形成,局部粘膜纠集,浅溃疡形成,周围肿胀充血,管腔狭窄,内镜无法通过。
病理:结肠黏膜慢性炎伴糜烂,浅溃疡,局部区域呈肉芽肿性炎,间质见大量淋巴细胞呈片状聚集,并见多个淋巴滤泡,未见隐窝脓肿。
腹部增强CT提示升结肠、盲肠及回肠末端管壁增厚伴周围渗出性改变,考虑克罗恩病。口服美沙拉嗪、蒙脱石散、益生菌后效果不佳。为进一步治疗来我院就诊。
入院血常规:血红蛋白:103g/L,红细胞压积:33.2%,提示存在贫血。
此外,对于小肠病变/切除的患者,应至少每年测量一次血清维生素B12和叶酸,广泛小肠切除、回肠贮袋手术或广泛回肠受累的患者应进一步增加频率。
血清铁蛋白(SF)在IDA时降低,但炎症反应时可能增加。SF<30µg/L通常提示IDA。但是,如果存在炎症(CRP、红细胞沉降率或白细胞计数升高;腹泻;便血或内镜下炎症)时上限为100µg/L。
TfS诊断铁缺乏的临界值为<16%,但AI也可表现为TfS降低。炎性细胞因子如白细胞介素-6也可检测到炎症的存在。
铁缺乏时铁调素下降,但AI时铁调素升高。
可溶性转铁蛋白受体(sTfR)是铁缺乏时增加的另一个参数,sTfR浓度大多不受炎症的影响,sTfR或sTfR/log(SF) 指数升高>2表示存在IDA。
▎口服铁剂
贫血是IBD最常见的肠外表现,其主要原因是铁缺乏。虽然强化原发病的管理能防止铁进一步丢失,但仍需铁替代治疗以满足生理功能,疗程结束后必须定时监测贫血复发情况。补铁治疗不仅能纠正贫血,还可能影响IBD的病程。
参考文献:
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