克罗恩病患者合并肠外表现的临床特征及相关因素分析  

Clinical characteristics and factors related to extraintestinal manifestations in patients with Crohn′s disease

作　　者：汪海潮 叶晨 吴亚玲 杨鹏宇 德吉卓玛 张蕾[1,2] 刘占举[1,2] 王晓蕾[1,2] Wang Haichao;Ye Chen;Wu Yaling;Yang Pengyu;Deji Zhuoma;Zhang Lei;Liu Zhanju;Wang Xiaolei(Department of Gastroenterology,The Tenth People′s Hospital,Tongji University,Shanghai 200072,China;Tongji University School of Medicine,Shanghai 200072,China;School of Medicine,Soochow University,Suzhou 215000,Jiangsu Province,China)

机构地区：[1]同济大学附属第十人民医院消化内科,上海200072 [2]同济大学医学院,上海200072 [3]苏州大学医学部,江苏苏州215000

出　　处：《中华炎性肠病杂志（中英文）》2020年第3期206-211,共6页Chinese Journal of Inflammatory Bowel Diseases

基　　金：国家自然科学基金面上项目(81970449)。

摘　　要：目的:探讨克罗恩病(CD)患者合并肠外表现(EIM)的临床特征和影响因素。方法:回顾性分析2008年1月至2018年1月同济大学附属第十人民医院消化内科确诊的623例住院CD患者的病例资料,根据是否合并EIM将患者分为两组。单因素分析两组患者的临床特征;多元Logistic回归分析EIM发生的影响因素;Fisher′s确切概率法分析各EIM的相关性。结果:623例CD患者中,男性422例(67.7%),女性201例(32.3%)。中位确诊年龄31.0(23.0~43.0)岁;中位随访时间53.5(29.0,84.0)个月。112例(18.0%)合并EIM的CD患者中,合并1种、2种、3种和4种EIM患者分别有86例(76.8%)、22例(19.6%)、3例(2.7%)和1例(0.9%)。EIM中累及口面部者84例(75.0%)、骨关节36例(32.1%)、皮肤17例(15.2%)和眼部7例(6.3%)。与无EIM组相比,合并EIM者女性(41.1%比30.3%)、回结肠型(L3)(52.7%比37.6%)、非狭窄非穿透型(B1)(69.6%比54.2%,)、首诊出现腹泻(43.8%比32.5%)或发热(14.3%比6.5%)、接受激素治疗的比例更高(53.6%比39.3%),但回肠末端型(L1)(19.6%比36.8%)、狭窄型(B2)(26.8%比37.0%)、穿透型(B3)(3.6%比8.8%)、接受英夫利西单克隆抗体治疗比例(46.4%比60.7%)和腹部手术率更低(14.3%比24.1%),差异均有统计学意义(P均<0.05)。Logistic多因素分析显示女性(OR=1.665,95%CI:1.067~2.600,P=0.025)、结肠型(OR=1.996,95%CI:1.072~3.718,P=0.029)、L3型(OR=2.568,95%CI:1.490~4.427,P=0.001)、B1型(B1比B3:OR=2.977,95%CI:1.015~8.726,P=0.047;B1比B2:OR=1.882,95%CI:1.168~3.302,P=0.009)和发热(OR=2.276,95%CI:1.170~4.430,P=0.015)是CD患者出现EIM的独立危险因素。口面部、骨关节和皮肤病变间两两相关,眼部与骨关节病变相关(P均<0.05)。结论:女性、结肠受累、B1型和首诊时发热是CD患者出现EIM的危险因素。各种EIM的出现具有一定的相关性。Objective To investigate the clinical characteristics and possible influencing factors of the extraintestinal manifestations(EIM)in patients with Crohn′s disease(CD).Methods Clinical data of 623 patients diagnosed as CD at Department of Gastroenterology,Shanghai Tenth People′s Hospital,from January 2008 to January 2018 were retrospectively analyzed.These patients were divided into two groups according to whether EIM was complicated.Univariate analysis was used to evaluate the clinical features,and multivariate analysis was used to reveal the risk factors of EIM.Fisher′s exact test was used to analyze the associations among various EIMs.Results Among 623 CD patients,422(67.7%)were male and 201(32.3%)were female;the median age at diagnosis was 31.0 years old(23.0 to 43.0 years old);the medium follow-up time was 53.5 months(29.0 to 84.0 months).One hundred and twelve patients(18.0%)complicated with EIM,including 86 cases with one EIM,22 case(19.6%)with two EIM,3 case(2.7%)with three EIM,and 1 case(0.9%)with four EIMs simultaneously.Oral involvement was found in 84 cases(75.0%),joints and bones in 36 cases(32.1%),skin in 17 cases(15.2%),and eye in 7 cases(6.3%).Compared to patients without EIM,those with EIM had higher ratios of female(41.1%vs.30.3%),ileocolic(L3)type(52.7%vs.37.6%),non-stenosis and non-penetration(B1)type(69.6%vs.54.2%),diarrhea or fever as the first symptom(43.8%vs.32.5%,14.3%vs 6.5%)and steroids administration(53.6%vs.39.3%),while they had lower ratios of distal ileum(L1)type(19.6%vs.36.8%),stenosis(B2)type(26.8%vs.37.0%),penetration(B3)type(3.6%vs.8.8%),infliximab treatment(46.4%vs.60.7%),and abdominal surgery(14.3%vs.24.1%)(all P<0.05).Multivariate analysis showed that female(OR=1.665,95%CI:1.067-2.600,P=0.025),colonic type(OR=1.996,95%CI:1.072-3.718,P=0.029),ileocolic type(OR=2.568,95%CI:1.490-4.427,P=0.001),B1 type(B1 vs.B3:OR=2.977,95%CI:1.015-8.726,P=0.047;B1 vs.B2:OR=1.882,95%CI:1.168-3.302,P=0.009)and fever(OR=2.276,95%CI:1.170-4.430,P=0.015)were the independent risk factors of EIM i

关 键 词：克罗恩病 肠外表现 临床特征 相关因素 

分 类 号：R574[医药卫生—消化系统]