克罗恩病诊断状况的调查研究

Survey on clinical diagnosis of Crohnrs disease

目的以世界卫生组织（WHO）及中国克罗恩病诊断治疗共识意见为标准，调查分析上海交通大学医学院附属瑞金医院克岁恩病的诊断情况。方法采用回顾性调查研究方式，分析1998年至2007年就诊的268例克罗恩病患者。根据WHO的克罗恩病诊断标准及我国2007年制定的克罗恩病共识意见，重新评价这些克岁恩病患者临床、内镜检查、影像学检查、病理检查的诊断符合情况；并分析临床医师对克罗恩病诊断能力是否有所提高。结果符合我国拟诊标准的有236例，符合WHO疑诊标准的有20例，完全符合两种诊断规范的分别只有5例和10例。近年来内镜诊断水平较前有所提高。确诊必需的病理诊断能力较低，与最近几年相比，2004年之前的病理确诊率更高。结论克罗恩病典型病变的病理学诊断率偏低。临床诊断克罗恩病的水平距离诊断共识意见的要求还有较大差距。

Objective To investigate the diagnosis of Crohn＇s disease（ CD） in Ruijin hospital of School of Medicine of Shanghai Jiaotong University according to the criteria made by World Health Organization （WHO） and Chinese Medical Association. Methods The consecutive patients with CD diagnosed in Ruijin hospital between 1998 and 2007 were retrospectively analyzed. The clinical manifestation, endoscopic, radiologic and pathologic findings of all patients were re-evaluated according to the diagnostic criteria of CI） proposed by WHO and Chinese Medical Association in 2007. The diagnostic level of CD was assessed. Results Only 5 and 10 patients were confirmed to be well consistent with the criteria of WHO and Chinese Medical Association, respectively. Two hundred and thirty-six patients were confirmed as suspected diagnosis to the criteria of Chinese Medical Association and 20 patients to WHO. The level of endoscopic diagnosis was raised, wherease the level of pathologic diagnosis was decreased in recent years compared with that before 2004. Conclusion The pathologic diagnosis rate of CD is still at a low level. The current diagnostic level of CD is lagging behind the demand of the guidelines.