具有消化系统表现的白塞病的临床特点  

Clinical characteristics of Behcet's disease with involvement of gastrointestinal system

作　　者：田珂[1] 王晶桐[1] 朱元民[1] 何晋德[1] 刘玉兰[1] 

机构地区：[1]北京大学人民医院消化科,北京100044

出　　处：《胃肠病学和肝病学杂志》2014年第2期208-212,共5页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的总结具有消化系统表现的白塞病的临床特点。方法回顾性分析43例具有消化系统表现的白塞病患者的临床资料，辅助检查包括ANCA、ESR、CRP、胃肠镜等。选取174例白塞病患者作为对照组，发病率差异采用，检验。结果43例患者中，男女比例为1.05：1。初诊年龄为15～67岁，平均年龄（39-12.5）岁。常见的消化系统症状为腹痛（22／43，51.2％）、腹泻（24／43，55.8％）。7.0％（3／43）因肛瘘行手术治疗。27.9％（12／43）有过阑尾炎病史。30.8％（12／39）皮肤针刺试验阳性。95.2％（20／21）ANCA（包括ANCA-PR3及ANCA-MPO）阴性，4.8％（1／21）ANCA-PR3阳性，72.7％（24／33）ESR增快，82.1％（23／28）CRP升高。共12例患者行结肠镜检查，肠道病变主要表现为溃疡伴或不伴糜烂，溃疡可单发也可多发，形态为口疮样、火山口样及地网样。初诊治疗的方案包括：单独使用秋水仙碱、沙利度胺、糖皮质激素；两种或两种以上药物联合使用。65.1％（28／43）复发，18.6％（8／43）失访，16.3％（7／43）初诊至今未满5年，无死亡或2次手术者。结论本组患者未发现特异性自身抗体或炎症指标。肠白塞与克罗恩病之间可能存在某种联系，有待进一步研究。部分炎症性肠病患者、部分肠白塞患者可能被误诊，现有的白塞病诊断标准具有局限性。Objective To summarize the clinical characteristics of Behcet＇s disease （BD） with involvement of gastrointestinal system. Methods The clinical data of 43 BD patients with involvement of gastrointestinal system admitted to People＇ s Hospital of Peking University from 1991 to 2012 were analyzed retrospectively, which included the data generated by diagnostic testing, such as ANCA, ESR, CRP, and gastrointestinal endoscopy. 174 patients with BD were used as control group, frequency of appendicitis was analyzed. Statistical analyses were performed by chi square test. Results Male to female ratio was 1.05： 1. The onset was 15 - 67 years with mean age （39±12.5 ） years old. Abdominal pain was the most common gastrointestinal symptom （22/43, 51.2% ）, followed by diarrhea （24/43, 55.8% ）. Of 43 patients, 3 （7.0%） patients had surgery for anal fistula and 12 （27.9%） patients suffered from appendicitis. The pathergy test showed positive in 30.8% （12/39） patients. 21 patients received ANCA testing （including ANCA-PR3 and ANCA-MPO） with 20 （95.2%） showing negative, and 1 case （4.8%） was positive in ANCA-PR3 testing. ESR and CRP were elevated in 72.7% （24/33） patients and 82.1% （23/28） respectively. Colonoscopy was performed in 12 cases. The most common colonoscopy findings were single or multiple ulcers which shaped as volcano type, geographic and aphthous. Initial treatment consisted of single medicine （such as Colchicine, Thalidomide, and glucocorticoid） and the combination of two or more medicines. There was exacerbation of BD in 65. 1% （28/43） followed for 5 years and 18.6% （8/43） lost to follow up. There was no patient death during the analyzed time period. None of the patients required a second surgical procedure. Conclusion Of 43 patients, we did not find autoantibodies or inflammatory index specific to BD. We postulate there may be a relationship between the intestinal BD and Crohn＇s disease （ CD）. Patients with inflammatory bowel disease or intes

关 键 词：白塞病 临床特点 诊断 肠白塞 克罗恩病 

分 类 号：R574.62[医药卫生—消化系统]