我国克罗恩病患者临床表现分型的初步探讨

The phenotype and clinical patterns of Crohn's disease in the Chinese

目的探讨维也纳分类标准是否适用于我国克罗恩病的临床分型,以及抗啤酒酵母抗体(anti-saccharomyces cerevisiae antibodies,ASCAs)的临床意义。方法按诊断时年龄(A1和A2)、病变累及部位(L1、L2、L3和L4)和疾病行为(B1、B2和B3)对71例克罗恩病患者进行分型,并记录病程、手术及药物治疗情况和ASCAs结果,并比较各亚型间的临床特征。结果A1与A2的病变部位略有不同(P=0．085),前者以回结肠和回肠末段为主,后者以回肠末段和单纯结肠为主。L亚型中,并发症(狭窄和穿孔)的发生率差异具有统计学意义(P=0．012),以回肠末段最高(90．5%)。与单纯炎症型相比,有并发症者(B2和B3)的病程长(P=0．023),手术率高(P=0．003)。与阴性者相比,ASCAs阳性者的病程略短(P=0．052),但手术率高(P=0．037)。结论克罗恩病患者诊断时年龄大小与病变部位分布有关；累及部位与疾病行为尤其是并发症的发生有关；疾病行为与病程长短有关,有可能随病程的迁延而变化；ASCAs的阳性表达可能与疾病的早期发生和进展程度有关。

Objective To investigate the possibility to classified Chinese patients with Crohn＇s disease by the Vienna criteria and clinical features between subtypes. To investigate the clinical significance of anti-saccharomyces cerevisiae antibodies （ASCAs） in Crohn＇s disease. Methods We identified 71 cases of Crohn＇s disease in our hospital during the past five years by searching the electronic medical recording system of the hospital. Clinical data were retrieved. All subjects were classified into subtypes by the Vienna classification, which was established on three criteria： the age at diagnosis, the lesion location and the disease behavior. The disease course, medical and surgical treatment, the detection of serum ASCAs were also abstracted for each subject. The clinical features, disease course and management were compared between subgroups. Results The lesion location in patients diagnosed at the age of less than 40 years old was different from that in patients diagnosed after 40, although the difference was not significant （P = 0. 085 ）. The ileocolon and terminal ileum were the most common lesions in those early-diagnosed patients, while the lesions in terminal ileum and colon dominated in the late-diagnosed ones. The complications （structuring or perforation ） were significantly different in subgroups with different lesion locations （L1 90. 5% ,L2 50. 0% ,L3 50. 0% ,L4 85.7% ,P = 0. 012）, among which the terminal ileum involvement had the highest incidence of complications. The subjects with complications had significantly longer courses[ B1 （35.39±37.11）ms,B2 （87.12±116.66）ms,B3（ 90. 65 ±93.50）ms, B1 vs non B1, P=0.023] and more surgical treatments （ B1 39. 1% , B2 54. 6%, B3 70. 1% ） （ B1 vs non B1, P = 0. 003 ） than those pure inflammatory ones. No association was found between the disease course and the age at diagnosis or the lesion location. We did not find difference in medical treatments between subgroups either. ASCAs positive subjects had shorter disease course[ （54. 12 ± 74. 36） ms vs （84. 15 ± 89. 72） ms, P = 0. 052] but more surgeries （64. 7% vs 30. 0%, P = 0. 037 ） than those negative ones. Conclusions The age at diagnosis is associated with the lesion location, and the lesion location is associated with the disease behavior. The behavior may change during the disease course. ASCAs expression may be related to early onset and severity of Crohn＇s disease.