45例小肠克罗恩病临床特点分析  

Clinical characteristics of 45 patients with small bowel Crohn’s disease

作　　者：陈丹[1] 吴东[1] 李骥[1] 杨红[1] 刘炜[2] 周炜洵[3] 钱家鸣[1] CHEN Dan;WU Dong;LI Ji;YANG Hong;LIU Wei;ZHOU Weixun;QIAN Jiaming(Department of Gastroenterology,Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;Department of Radiology,Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化内科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院放射科,北京100730 [3]中国医学科学院北京协和医学院北京协和医院病理科,北京100730

出　　处：《胃肠病学和肝病学杂志》2019年第8期865-870,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：卫生行业科研专项项目(201002020)

摘　　要：目的通过分析小肠克罗恩病(small bowel Crohn’s disease, SBCD)特点,以提高临床医师对SBCD的认识和对该病的管理。方法回顾性分析1994年8月至2017年12月在北京协和医院住院并经病理确诊或临床确诊为SBCD的45例患者的临床资料,总结其临床特征;选取完成结肠镜检查且进镜至末段回肠的35例SBCD患者,比较结肠镜下末段回肠黏膜正常组( n =12)与末段回肠黏膜异常组( n =23)SBCD患者临床特点。结果 45例SBCD患者中男26例(57.8%),首发症状至确诊历时25.0(9.5, 84.0 )个月,诊断年龄以>40岁为主(23,51.1%),疾病行为以狭窄型为主(33,73.3%),肛周病变4例(8.9%)。腹痛最常见(43,95.6%),肠梗阻24例(53.3%),手术治疗27例(60.0%)。结肠镜下末段回肠黏膜异常组较末段回肠黏膜正常组首发症状至确诊历时短[13.0(9.0, 36.0 )个月 vs 72.0(27.0,121.8)个月,P=0.023),排便、排气减少(87.0% vs 50.0%,P=0.038),体质量下降(69.6% vs 33.3%, P= 0.040 ),肠外表现(95.7% vs 66.7%,P=0.038),回盲部受累(95.7% vs 41.7%,P =0.001)比例高。12例末段回肠黏膜正常的患者通过CT小肠重建(computed tomography enterography,CTE)、小肠镜、胶囊内镜或肠道超声中1种或多种检查可检出小肠病变。结论 SBCD患者特点为男性比例略高,合并肛周病变少,肠狭窄、肠梗阻及手术率均较高,SBCD通常发现较晚,诊断历时长。结肠镜下末段回肠黏膜正常组较末段回肠黏膜异常组SBCD患者临床症状轻,但诊断更困难,联合影像学及内镜检查可提高小肠病变检出率。Objective To investigate the clinical characteristics of patients with small bowel Crohn’s disease( SBCD ) and to improve the management of this disease. Methods The data of 45 patients diagnosed with SBCD in Peking Union Medical College Hospital from Aug. 1994 to Dec. 2017 were retrospectively analyzed. Thirty-five patients with SBCD who successfully received colonoscopy were divided into colonoscopy negative group ( n =12) and colonoscopy positive group ( n =23) according to the result of colonoscopy. Results SBCD was more prevalent in male patients with a proportion of 57.8%. The median time from initial symptom of the disease to a definite diagnosis was 25.0 ( 9.5 , 84.0 ) months. 51.1% patients were diagnosed after 40 years old.Intestinal stenosis was developed in 73.3% patients. 8.9%patients had perianal disease. Abdominal pain was the most common manifestation with a proportion of 95.6%. Intestinal obstruction occurred in 53.3% patients. 60.0%patients underwent at least one surgery. The patients with SBCD in colonoscopy positive group had a shorter time duration from initial symptom of the disease to a definite diagnosis than the patients in colonoscopy negative group [13.0(9.0,36.0)months vs 72.0(27.0,121.8)months, P = 0.023 ]. Reduced defecation and exhaust (87.0% vs 50.0%,P =0.038), weight loss (69.6% vs 33.3%, P = 0.040 ), extra-intestinal manifestations (95.7% vs 66.7%,P =0.038) and ileocecal involvement (95.7% vs 41.7%,P =0.001) were more frequent in patients in colonoscopy positive group than those in colonoscopy negative group. Small bowel lesions were detected in 12 patients in colonoscopy negative group by taking at least one of the following examinations including computed tomography enterography (CTE), double-balloon enteroscopy, capsule endoscopy and intestinal ultrasonography. Conclusion SBCD is more prevalent in male patients. Perianal disease was less common, while intestinal stenosis, intestinal obstruction and surgery rates were high in patients with SBCD. Diagnosis of SBCD is very diff

关 键 词：克罗恩病 小肠 炎症性肠病 

分 类 号：R574.62[医药卫生—消化系统]