不同部位克罗恩病的临床特点分析

Clinical features of Crohn＇s disease at different location

目的 探讨不同部位（小肠、结肠、回结肠）克罗恩病的临床特点，以期提高对该病的认识。方法回顾性分析2000年至2008年1月住院诊断的103例患者，根据其发病部位的不同，对其一般资料、病程、临床表现、实验室检查、病理学改变等进行分析。结果103例患者中男性70例，女性33例，诊断时年龄12～70岁。以20～29岁为高峰期，30～39岁次之。病变部位位于小肠（L1）的39例（38％），结肠（L2）的16例（16％），回结肠（L3）的48例（46％），发病年龄的性别差异无统计学意义，但L1型临床诊断年龄明显高于12型（P〈0．05）和L3型（P〈0．01），且肠梗阻发生率远远高于L3（P〈0．05）。L1型中通过胶囊内镜协助诊断的占L1型的30．8％，结肠镜协助诊断的占44％；L2、L3临床表现结合结肠镜及病理检查明确诊断的分别占87．5％、83．3％，通过手术确诊的L1患者（9例）占手术确诊病例的47．3％，但与12、L3相比差异无统计学意义。参考简化CD活动指数（CDAI）评分，轻度23例（22．3％），中度58例（56．3％），重度22例（21．4％），回结肠受累者（L3）重度患者13例，占59．0％，与L1比较差异有统计学意义（P〈0．05）。结论在克罗恩病患者中L1型较多以诊断延迟、急诊需手术治疗为特点；L3型则因病变范围较广，并发症及全身表现严重，重型多见。需重视发病早期胶囊内镜和回结肠镜检查的重要作用，减少手术发生率，延缓患者首次手术的时间。

Objective To study the clinical features of Crohn＇s disease （CD） at different location, i. e. small intestine, colon and ileocolon, to facilitate the knowledge of the disease. Methods Data of 103 patients, hospitalized to our department from 2000 to January 2008, were retrospectively analyzed, including general status, clinical manifestations, laboratory findings and pathological changes . Results The cohort included 70 males and 33 females, with the age when the diagnosis was confirmed ranging from 12 to 70, with a peak at 20-29 yr. The location of the main lesion was at small bowel （L1） in 39 （38%）, at colon （L2） in 16 （16%） and at ileum-colon （L3） 48 （46%）. There was no significant difference between each group, regarding the age of onset or the when the diagnosis was confirmed. The incidence of intestinal obstruction was higher in L1 patients than that in L3 （P 〈0.05）. In group L1, 12 （30. 8% ） were diagnosed by capsule endoscopy, and 17 （44%） were confirmed by eolonoscopy. Diagnostic rates of L2 and L3 with reference to clinical manifestations, combined with colonoseopy and pathology were 87.5% and 83.3% , respectively. In this cohort, there were 23 （22. 3% ） mild cases, 58 （56. 3% ） moderate eases and 22 （21.4%） severe cases, according to simplified CD activity index （CDAI）. The rate of severe ease in L3 was 59. 0% （ 13/48 ）, which was significantly higher than that in L1 （ P 〈 0. 05 ）. Conclusion In patients with CD, L1 is characterized by delayed diagnosis and need of emergent surgery, while L3 is featured with extensive involvement, severe complications and systemic manifestations. Severe case is common in L3 patient, capsule endoscopy and colonoseopy are important in early detection of the disease to decrease operation rate and delay the time of first operation.