中国Crohn病患者85例与美国Crohn病患者68例临床特征及治疗手段:1985～2004年回顾性分析(英文)

Clinical and therapeutic features of 85 Chinese patients and 68 American patients with Crohn's disease:Retrospective analysis from 1985 to 2004

背景:Crohn病症状复杂多变,缺乏特异性,与肠内病变的部位,范围,严重程度,有无并发症等有关,诊断多困难。因该病病因不甚清楚,尚缺乏根治性治疗。国内外报道Crohn病患者在临床表现和治疗措施方面亦有所不同。目的:探讨中国与美国Crohn病患者的临床特征及治疗的不同。设计:回顾性病例分析。单位:解放军总医院消化内科。对象:收集解放军总医院1985/2004期间住院的Crohn病患者85例和美国佛罗里达克利夫兰医院(Cleveland Clinic Florida,CCF)1985/2004 Crohn病患者68例的病例资料。Crohn病的诊断依据WHO标准,根据患者内镜或X射线平片表现及病理特征做出诊断。方法:比较两医院患者的临床资料包括:年龄,性别,家族史,肠外表现,病变部位,病变特征,药物治疗及手术治疗。组间计数资料差异比较采用χ2检验。主要观察指标:Crohn病发病年龄、家族史、肠外表现、病变部位、病变特征、药物治疗及手术治疗。结果:①一般情况及肠外表现:解放军总医院男性患者与女性患者比例1.74∶1,CCF为男∶女=1∶1.43。CCF患者家族史阳性率和肠外表现发生率分别为7%,34%,均高于解放军总医院(1%,14%,χ2=4.6312,8.3150,P<0.05)。②病变部位与病理特征:解放军总医院患者病变部位累及回肠末端(69%)较多,无一例累及肛周,病变以溃疡(66%)多见,溃疡、肠腔梗阻发生率分别为66%和14%,高于CCF患者(25%和4%,χ2=25.3092,4.0246,P<0.05)。CCF患者累及结肠及直肠较多,肛周瘘管或直肠阴道瘘(51%)较多,肛周病变、腹腔内瘘发生率分别为51%和9%,显著高于解放军总医院(0和6%,χ2=38.4290,0.1482,P<0.05)。③治疗:解放军总医院治疗药物以SASP(54%),5-ASA(19%)及甲硝唑(21%)为主,CCF患者以激素(60%),硫唑嘌呤(34%),infliximab(46%)为主。CCF患者接受手术治疗率明显高于301医院(96%,49%,χ2=36.1459,P<0.01)。结论:301医院与CCF的Crohn病患者临床特征和治疗手段有明显差异,临床特征的不同是两者在治疗方法上采取不同措施的原因之一。

BACKGROUND： Crohn＇s disease is complex and lack of specificity; meanwhile, it is related to diseased regions, areas, severity and complications in intestine. Otherwise, it is difficult to diagnose. The etiological factors are still unclear and radical therapy is lack recently. Therefore, clinical manifestations and therapeutic measures of Crohn＇ disease at home are different from those abroad. OBJECTIVE： To compare the clinical characteristics and therapeutic differences between the Chinese and American patients with Crohn＇s disease. DESIGN ： Retrospective case analysis SETTING： Department of Digestion, General Hospital of Chinese PLA PARTICIPANTS： A total of 85 Chinese patients with Crohn＇s disease were selected from General Hospital （the 301 Hospital） of Chinese PLA from 1985 to 2004; meanwhile, a total of 68 American patients with Corhn＇s disease were selected from Cleveland Clinic Florida （CCF） from 1985 to 2004. Diagnostic criteria were based on WHO standards and all patients were diagnosed according to endoscope, X-ray manifestations and pathological characteristics. METHODS： Clinical data, including age, sex, family history, external manifestations of intestine, diseased regions and characteristics, drug treatment and surgical therapy, were compared between Chinese and American patients. Otherwise, enumeration data were compared with Chi-square test. MAIN OUTCOME MEASURES： Age, sex, family history, extra intestinal manifestations, diseased regions and characteristics, drug treatment and surgical therapy of Crohn＇s disease. RESULTS： （1） General status and extra intestinal manifestations of intestine： The ratio of male and female patients in the 301 hospital was 1.74：1 and in CCF was 1：1.43. The incidences of positive family history and extra intestinal manifestations were 7% and 34%, which were higher in CCF than those in the 301 hospital （1%, 14%, Х^2=4.631 2, 8.315 0, P 〈 0.05）. （2） Diseased regions and pathological characteristics： The terminal ileum was involved at most （69%） and no patients had perianal diseases in the 301 hospital and the main pathological characteristics were ulcer （66%） and obstruction （14%）. Those were higher than those of patients in CCF （25%, 4%, Х^2=25.309 2, 4.024 6, P 〈 0.05）. Compared with the 301 hospital, the patients in CCF had more pathological changes in colon and rectum and more perianal diseases and intra-abdominal fistulas were involved （51%）. The incidences of perianal diseases and intra-abdominal fistulas were 51% and 9%, which were higher than those of patients in the 301 hospital （0, 6%, Х^2= 38.429 0, 0.148 2, P〈 0.05）. （3） Therapy： The main selections of medicine were sulfasalazine salicylazosulfapyridine （SASP, 54%）, 5-aminosalicvlic acid （5-ASA, 19%） and metronidazole （21%） in 301 hospital, but in CCF, steroids （60%）, azathioprine （34%） and infliximab （46%） were the main selections of medicine. Rates of surgical therapy were higher in CCF than those in the 301 hospital （96%, 49%, Х^2=36.145 9, P〈 0.01）. CONCLUSION： There are significant differences in clinical characteristics and therapeutic measures between Chinese and American patients with Crohn＇s disease, which is one of the reasons for the two hospitals to take different treatments.