小肠克罗恩病62例临床特征分析

Clinical features of 62 cases of small＇s bowel Crohn s disease

目的研究小肠CD的临床特征。方法纳入2009年1月至2012年9月行结肠镜及全消化道钡餐、胶囊内镜、双气囊小肠镜、CT小肠成像术等检查的138例确诊CD患者，根据CD蒙特利尔分型标准，对患者诊断年龄、病变部位及疾病行为进行分型，评估患者的临床症状、实验室检查、诊断方法及复发情况。通过与回结肠型、结肠型CD的临床特征进行对比，重点分析单纯小肠CD的临床特征。计量资料采用t检验、单因素方差分析或非参数检验，计数资料分析采用卡方检验，相关性分析采用Spearman相关分析，危险因素筛查采用多变量Logistic回归分析。结果单纯小肠CD共62例（44．9％），小肠CD中53例（85．5％）为男性，平均诊断年龄35．3岁，67．7％（42／62）患者诊断年龄在40岁以下。小肠CD发生狭窄型行为的比例（35．5％，22／62）明显高于回结肠型（18．8％，6／32）、结肠型CD（13．9％，5／36）（X^2=6．594，P=0．037）。空肠受累是CD发生狭窄型行为的独立危险因素（OR=3．481，95％CI：1．250～9．693）。小肠CD以梗阻症状为首诊症状者（38．7％，24／62）多于结肠型CD（16．7％，6／36）（X^2=5．210，P=0．022），而以腹泻为首诊表现者（21．0％，13／62）少于回结肠型（37．5％，12／32）、结肠型CD患者（44．4％，16／36）（X^2=6．512，P=0．039），出现2种及2种以上肠外表现者（3．2％，2／62）亦少于回结肠型（15．6％，5／32）、结肠型CD患者（19．4％，7／36）（X^2=7．957，P=0．019）。克罗恩病活动指数（CDAI）评分普遍较低，与CRP等血清学炎性反应指标无统计学意义上的相关性。小肠CD诱导缓解后至临床复发的平均时间[（23．64±17．08）个月]明显短于回结肠型[（35．07±29．84）个月，t=-4．285，P=0．0023，亦短于结肠型[（32．35±28．46）个月]患者（t=-3．700，P=0．004），但在临床复发率方面尚未观察到与回结肠型、结肠型CD存在明显差异。结论小肠CD患者在CD中所占比例大，以男性多见。小肠CD，尤其是空肠CD更易发生狭窄型行为。小肠CD患者诱导缓解后出现临床复发的时间更短。

Objective To investigate the clinical features of small bowel Crohn＇s disease（CD）. Methods From January 2009 to September 2012, a total of 138 patients diagnosed as CD who underwent examinations of colonoscopy, digestive tract radiography, capsule endoscopy, double-balloon enteroscopy and computed tomography （CT） enterography were enrolled. According to the Montreal Classification criteria, the disease was typed by the age at diagnosis, location of the lesions and behavior of the disease. The clinical symptoms, laboratory examinations, diagnostic methods and recurrence condition were alsoevaluated. Through the comparison of the clinical features of ileocolonic and colonic CD, the clinical features of small bowel CD were analyzed. Measurement data were analyzed with t-test, analysis of variance or non-parametric test. Chi-square test was performed for count data. Spearman＇s correlation analysis was used for correlation analysis and multivariate Logistic regression analysis was used for risk factors screening. Results A total of 62 （44.9%） cases were simple small bowel CD. Fifty-three patients （85.5%） were male, and the mean age at diagnosis was 35.3 years old. The age of 67. 7% （42/62） of small bowel CD patients were less than 40 years old when diagnosed. The ratio of stricture in small bowel CD group （ 35.5 %, 22 / 62 ） was significantly higher than t hat of ileocolonic （ 18.8 %, 6/32） and colonic CD group （13.9% , 5/36） （X^2 =6. 594, P=0. 037）. Jejunal involvement was an independent risk factor for structure in CD （OR= 3. 481, 95%CI： 1. 250 to 9. 693）. The patients with obstructive symptoms as primary symptom in small bowel CD （38.7%, 24/62） were more than those with colonic CD （16. 7%, 6/36） （X^2 = 5.210, P = 0. 022）. However, patients with diarrhea as primary symptom in small bowel CD （21.0K, 13/62） were less than those with ileocolonic （37.5%, 12/32） and colonic CD （44.4%, 16/36） （X^2= 6. 512, P= 0. 039）. Patients with two or more extraintestinal manifestations in small bowel CD （3.2%, 2/62） were also significantly less than those with ileocolonic （15. 6%, 5/32） and colonic CD （19.4%, 7/36） （X^2=7. 957, P=0. 019）. The score of CD activity index was generally low, and with no statistical correlation to serum inflammation markers such as C-reaction protein. The average time duration between induction of remission and clinical recurrence of small bowel CD （（23. 64 ± 17. 08） months） was shorter than that of ileocolonic type （（35.07±29.84） months, t=-4. 285, P=0. 002） and colonic CD （（32.35±28. 46） months, t = - 3. 700, P = 0. 004）. However, there was no significant difference in the rate of clinical recurrence between small bowel CD and ileocolonic, colonic CD. Conclusions Patients with small bowel CD account for a large proportion in patients with CD, especially in males. Stricture is more common in jejunum CD. The time duration between induction of remission and clinical recurrence of small bowel CD is short.