克罗恩病患者199例次内镜下非干酪样肉芽肿检出分析  

Analysis of the detection of non-caseating granuloma under endoscopy in 199 patients with Crohn′s disease

作　　者：曹雅雯 朱兰香[1] 陈彦君[1] 赵梓乐 陈卫昌[1] Cao Yawen;Zhu Lanxiang;Chen Yanjun;Zhao Zile;Chen Weichang(Department of Gastroenterology,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院消化内科,苏州215000

出　　处：《中华消化杂志》2022年第4期253-258,共6页Chinese Journal of Digestion

摘　　要：目的初步探讨克罗恩病患者内镜下非干酪样肉芽肿的检出率及其影响因素,以提高克罗恩病的病理确诊率。方法收集2016年7月至2021年4月于苏州大学附属第一医院住院,符合克罗恩病临床诊断标准且行内镜检查并行内镜下活体组织检查(以下简称活检)的患者199例次,分析克罗恩病患者总体,以及不同发病类型(初发和复发)和活检部位是否包括结肠的克罗恩病患者的非干酪样肉芽肿检出率。根据内镜下活检是否检出非干酪样肉芽肿,将患者分为检出组和未检出组,比较2组患者的临床资料,包括性别、年龄、病程、体重指数、吸烟情况、临床表现(腹痛、腹泻、消化道出血、肛周病变、消瘦、发热、肠梗阻)、治疗药物(5-氨基水杨酸、免疫抑制剂、糖皮质激素、生物制剂、全肠内营养)、肠道手术史、实验室检查结果(血红蛋白、血小板计数、中性粒细胞计数、C反应蛋白、红细胞沉降率、白蛋白)、内镜下表现(溃疡、瘘管、狭窄)、简化克罗恩病活动指数(CDAI)、活检取材总数和活检部位。统计学方法采用卡方检验、校正卡方检验、Mann-Whitney U检验、Fisher确切概率法。采用多因素logistic回归分析克罗恩病患者内镜下检出非干酪样肉芽肿的影响因素。结果199例克罗恩病患者中检出组67例,总体检出率为33.7%;未检出组132例。克罗恩病初发患者的非干酪样肉芽肿检出率高于复发患者[39.9%(59/148)比15.7%(8/51)],活检部位包括结肠的克罗恩病患者的非干酪样肉芽肿检出率高于不包括结肠者[64.1%(25/39)比26.3%(42/160)],差异均有统计学意义(χ^(2)=9.93、20.12,P=0.002、<0.001)。检出组患者的年龄小于未检出组,病程短于未检出组,有腹痛、有生物制剂治疗史的患者比例低于未检出组,简化CDAI评分高于未检出组,活检取材总数多于未检出组[30.0岁(25.0岁,37.0岁)比32.0岁(28.0岁,41.0岁),1.0年(0.0年,3.0�Objective To explore the detection rate of non-caseating granuloma under endoscopy in patients with Crohn′s disease and its influencing factors,in order to improve the pathological diagnosis rate of Crohn′s disease.Methods From July 2016 to April 2021,at the First Affiliated Hospital of Soochow University,199 patients who met the clinical diagnostic criteria for Crohn′s disease and underwent endoscopic biopsy were collected.The detection rates of non-caseating granulomas in all patients with Crohn′s disease,in different types(primary and recurrent)and whether the biopsy site included the colon were analyzed.According to whether non-caseating granulomas were detected by endoscopic biopsy,the patients were divided into the detected group and the undetected group.The clinical data of the two groups of patients were compared,which included gender,age,course of disease,body mass index,smoking status,clinical manifestations(abdominal pain,diarrhea,gastrointestinal bleeding,perianal lesions,weight loss,fever,intestinal obstruction),therapeutic medication(5-aminosalicylic acid,immunosuppressants,glucocorticoid,biological agents,exclusive enteral nutrition),history of bowel surgery,laboratory examination results(hemoglobin,platelet count,neutrophil count,C-reactive protein,erythrocyte sedimentation rate,albumin),endoscopic manifestation(ulcer,fistula,stricture),simplified Crohn′s disease activity index(CDAI),total number of biopsy samples,and site of biopsy.Chi-square test,continuity correction chi-square test,Mann-Whitney U test and Fisher exact test were used for statistical analysis,and logistic regression analysis was used to analyzed the influencing factors of detection of non-caseating granulomas under endoscopy.Results Among the 199 patients with Crohn′s disease,67 cases were detected with non-caseating granuloma(detected group),and the overall detection rate was 33.7%(67/199);132 cases were not detected with non-caseating granuloma(undetected group).The detection rate of non-caseating granulomas in pat

关 键 词：克罗恩病 内窥镜检查 非干酪样肉芽肿 活检部位 活检取材总数 

分 类 号：R574[医药卫生—消化系统]