40例克罗恩病分析

A Retrospective Study of 40 Patients with Crohn’s Disease

背景:近年我国克罗恩病(CD)的发病率逐年上升,但对CD临床特点的认识尚有限。目的:回顾性分析CD的临床特点和诊治情况。方法:收集安徽医科大学第一附属医院1995～2005年的CD住院病例,按照维也纳分类标准进行临床分类,按照中华医学会消化病学分会的建议进行临床严重度分度。结果:共纳入40例CD患者,男女比例为1.22:1,诊断时年龄16～65岁。根据维也纳分类标准,诊断时年龄<40岁(A1)者28例(70.0%),≥40岁(A2)者12例(30.0%);病变部位位于末端回肠(L1)者15例(37.5%),结肠(L2)11例(27.5%),回结肠(L3)11例(27.5%),上消化道(L4)3例(7.5%);无狭窄、穿孔(B1)16例(40.0%),发生狭窄(B2)10例(25.0%),发生穿孔(B3)14例(35.0%)。A1型中病变位于末端回肠者占42.9%,A2型中病变位于结肠者占41.7%。L1型狭窄发生率明显高于L2型(40.0%对18.2%),穿孔发生率明显低于L2型(26.7%对45.4%)。参考简化CD活动指数(CDAI)评分,轻度6例(15.0%),中度20例(50.0%),重度14例(35.0%),回结肠受累者重度患者占63.6%。结肠镜表现为黏膜充血水肿、糜烂、溃疡以及结节状增生、假息肉、肠腔狭窄等。活检标本的非干酪样肉芽肿检出率为42.1%,手术标本为61.9%。共21例患者接受手术诊治,手术率为52.5%。内科治疗轻度患者以口服柳氮磺胺吡啶(SASP)/5-氨基水杨酸(5-ASA)为主;中度患者小肠受累者以激素治疗为主,结肠受累者以口服SASP/5-ASA为主;重度患者以激素治疗为主,2例使用免疫抑制剂治疗。结论:维也纳分类标准简单、易行,适用于我国CD人群的分类。本组CD患者手术率高。应根据临床严重度和病变部位选择药物治疗方案。

Background： Recently the incidence of Crohn＇s disease （CD） has been increasing year by year in China. However, the clinical characteristics of CD are not well-known yet. Aims： To analyze the clinical characteristics, diagnosis and treatment of CD patients retrospectively. Methods： Inpatients with CD were collected at the First Affiliated Hospital of Anhui Medical University from 1995 to 2005. The clinical categorization was made according to Vienna classification. The disease severity was estimated according to the method recommended by Chinese Society of Gastroenterology. Results： Forty CD patients were enrolled in this study. The ratio of males to females was 1.22：1. Age at diagnosis ranged from 16 to 65 years. Based on Vienna classification, 28 patients （70.0%） were classified as A1 （diagnosed at the age below 40 years） and 12 （30.0%） as A2 （diagnosed at the age equal to or above 40 years）. There were 15 （37.5%） patients with lesions involving the terminal ileum （L1）, 11 （27.5%） colon （L2）, 11 （27.5%） ileocolon （L3） and 3 （7.5%） upper gastrointestinal tract （L4）. There were no stricture or penetration （B1） in 16 （40.0%） patients, stricture （B2） were seen in 10 （25.0%） and penetration （B3） in 14 （35.0%） patients. In 42.9% of A1 patients the lesion was located at ileum, and in 41.7% of A2 patients the lesion was located at colon. The prevalence of stricture was higher in L1 patients than that in L2 patients （40.0% vs. 18.2%）, however, penetration lesion was more common in L2 than that in L1 （45.4% vs. 26.7%）. Referring to simplified CD activity index （CDAI）, the degree of severity was mild in 6 （15.0%） patients, moderate in 20 （50.0%） and severe in 14 （35.0%） patients. 63.6% of patients with ileocolonic disease were at severe stage. The colonoscopic findings showed mucosal hyperemia, edema, erosions, ulcerations, nodular hyperplasia, pseudopelyps and stricture. Non-caseous granulomas were identified in 42.1% of biopsy specimens and 61.9% of surgical specimens. Surgical therapy was carried out in 21 （52.5%） patients. In mild patients, oral salicylazosulfapyridine （SASP） or 5- aminosalicylic acid （5-ASA） was given as the primary medical therapy. Patients with moderate small intestinal lesions and colonic lesions received oral prednisone and/or SASP/5-ASA. Most severe patients were treated with prednisone, but 2 received immunosuppressant. Conclusions： Vienna classification is simple for clinical use, and it is suitable for the classification of CD patients in China. The rate of surgical therapy was high in this study. The medical therapeutic regimen should be chosen according to the activity and location of the disease.