Abstract
BackgroundMicrocirculatory disturbance is an important factor in the pathogenesis of Inflammatory Bowel Disease (IBD) but there have been few studies in this field. Confocal Laser Endomicroscopy (CLE) has been used over the last 10 years and has made it possible to explore the changes in microcirculation of the colonic mucosa.MethodsWe retrospectively selected patients who underwent probe-based Confocal Laser Endomicroscopy (pCLE) between 2014 and 2016. There were 7 patients with ulcerative colitis (UC) in clinical remission and 7 healthy subjects included in this study; all the UC patients’ medical data were reviewed. For each patient, three segments of the colon were examined using pCLE including the ascending, transverse/descending and sigmoid colon. In each segment, the representative pCLE images of the three sites were selected for analysis. Four indicators, including Mean Vessel Diameter (MVD), Diameter Standard Deviation (DSD), Functional Capillary Density-long (FCDL) and Functional Capillary Density-area (FCDA), were measured with a specially designed detection software algorithm. The four indicators were compared between UC patients and healthy subjects. According to the different blood flow patterns, three types of distribution were established: the Around (A), Cobweb (C) and Deficiency (D) type. The relationships between the recurrence and blood flow patterns of UC patients were analyzed.ResultsMVD, DSD, FCDL and FCDA were 10.62 ± 0.56 μm, 2.23 ± 0.26, 0.030 ± 0.019 μm and 0.289 ± 0.030 for the healthy subjects and 11.06 ± 1.10 μm, 2.68 ± 0.29, 0.026 ± 0.005 μm and 0.272 ± 0.034 for the UC patients, respectively. Compared with healthy subjects, DSD was significantly increased and FCDA was significantly decreased (P < 0.01 for both). There was no difference in MVD and FCDL between UC patients and healthy subjects. The type A and type C blood flows were observed in healthy subjects (66.67 and 33.33%, respectively) while type C appears more in UC patients (71.3%) and type D blood flow could only be found in UC patients (14.29%) P < 0.01. UC patients who showed Type D blood flow had a shorter recurrence interval.ConclusionsSome local mucosal capillary density in UC patients was decreased, particularly in the inflammation-affected segment. The three mucosal blood flow patterns can be used as an indicator of mucosal healing.
Highlights
Microcirculatory disturbance is an important factor in the pathogenesis of Inflammatory Bowel Disease (IBD) but there have been few studies in this field
A review of patients’ records From 2014 to 2018, we reviewed the 7 ulcerative colitis (UC) patients’ medical records including visit records, prescriptions and hospitalization records
The general linear model was used to test whether there was a statistical difference between UC patients of different affected statuses and healthy subjects
Summary
Microcirculatory disturbance is an important factor in the pathogenesis of Inflammatory Bowel Disease (IBD) but there have been few studies in this field. Microcirculatory disturbance and angiogenesis are considered important components for the pathogenesis of IBD [2]. Many studies have shown that there is a close connection between chronic inflammation and angiogenesis. Hypoxia is regarded as the most important stimulator of these two conditions [3]. Some studies have shown that CLE has the capability to perform a histopathological diagnosis of IBD, evaluate the disease status and predict the response to medical therapy [5]. Among the observed CLE image changes of UC patients, mucosal capillary blood flow is a factor deserving special attention and regarded as a unique advantage of CLE detection [6]
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