炎症性肠病Montreal分类的应用

The application of Montreal classification in inflammatory bowel disease

目的探讨克罗恩病（CD）和溃疡性结肠炎（UC）患者的临床表现特点。方法回顾我院110例住院CD、UC患者的临床表现，按照Montreal标准进行分类并统计分析其特点。结果110例CD患者中诊断年龄小于16岁者较少（3．6％），17～40岁者最多（65．5％），后者中回肠结肠同时累及者所占比例最高（37.3％），诊断年龄大于40岁组以回肠累及者稍多（14.5％），各年龄组的累及部位总体差异无统计学意义（P=0．054）；各组穿透者均少（5.3％），狭窄者最多（50.4％），各诊断年龄组狭窄和穿透的发生趋势相似（P=0．984）；结肠累及组狭窄者少，回肠累及组与回肠结肠同时累及组狭窄者均多，但总体差异无统计学意义（P=0.096）。110例UC患者中初发型未治疗者34例，其余为已治疗过或复发者。各累及范围组均以轻中度为主，达到重度的仅7例，均在广泛结肠组，总体差异无统计学意义（P=0．056）。结论CD患者诊断年龄在17～40岁者最多，穿透发生率低，易发生狭窄，狭窄部位主要在回肠；UC患者以轻中度为主，即使广泛结肠累及也是轻度多，重度少，临床表现的严重程度和结肠镜下所见累及范围没有一致性。

Objective To investigate the clinical features of Crohn＇s disease （CD） and ulcerative colitis （UC） according to the Montreal classification. Methods The clinical data of 110 cases of CD or UC were reviewed. The age at diagnosis, location and clinical behavior were assessed with the Montreal criteria. Results CD patients diagnosed at an age younger than 16 years were rare （3. 6% ）, the majority of the CD patients was diagnosed at 17 -40 years old （65. 5% ）. Although ileocolon lesions were most common in the patients diagnosed at 17 -40 years old （37. 3% ）, yet ileum lesions were a little more than those of other parts of digestive tract in the patients diagnosed after 40 years old （14. 5% ）, the difference was not significant（ P = 0. 054）. Stricture frequently occurred（ 50. 4% ）, especially when the lesions were located at ileum or ileocolon. Perforation rarely happened （5. 3% ）. There was no significant difference between different location groups for clinical behaviors （ P = 0. 096 ）. The incidence of stricture or perforation was almost same among different age groups （ P = 0. 984）. UC patients mostly presented with mild or moderate symptoms even in the group with extensive lesion. UC patients with severe symptoms were rare （6. 8% ）. There was no significant difference in severity between the groups with different extent of lesion （ P = 0. 056）. Conclusions The majority of CD patients was diagnosed at 17 - 40 years old. Stricture is much more than perforation, penetrating, occurring mostly at ileum. UC patients mostly present mild or moderate symptoms, no matter how extensive the lesion is. The extent of the lesion detected with coloscopic examination is not correlated to the severity of clinical manifestations.