炎症性肠病诊断和预后的随访

Re-evaluation of the diagnosis and outcome in patients with inflammatory bowel disease

目的 采用统一的诊断标准 ,通过随访来评价我院就诊的炎症性肠病 (IBD)患者的诊断及预后。方法 采用 1993年全国慢性非感染性肠道疾病研讨会 (太原会议 )制定的标准 ,对 1980～ 1999年在我院就诊的 10 0例溃疡性结肠炎 (UC)和 15例克罗恩病 (CD)在诊断 1～ 16年后 ,通过采用调查表、电话、见面等方式随访患者病情和预后 ,并对原始诊断进行评价。结果 在 115例原诊断IBD患者中 ,40例失访 ,能供评价的患者仅有 75例 (6 5 % )。在 6 4例原诊断UC患者中 ,46例与随访诊断相同 ,9例诊断可能相同 ,诊断基本符合率为 86 % ;9例改变原诊断 ,误诊率为 14%。 11例原诊断CD的患者中 ,7例与随访诊断相同 ,2例诊断可能相同 ,诊断基本符合率为 82 %。在诊断符合的 5 5例UC中 ,3例 (5 % )死亡 ,其中 1例的并发症可能与IBD有关。余 5 2例在随访中 37例 (71% )复发。随访诊断的 10例CD患者中 ,1例 (10 % )因并发症死亡。余 9例CD在随访中 7例 (78% )复发。对疾病预后的判断结果显示 ,UC的症状缓解和改善率为 88% ,CD为 6 7%。UC患者的生活质量明显较CD好 (P =0 .0 2 5 )。结论 大多数UC(86 % )和CD(82 % )的原诊断确立 ,仍有 14%UC和 18%CD患者误诊。UC复发率为71% ,CD为 78%。UC的症状缓解和改善率 (88% )高于CD(6 7%

Objective To re evaluate the diagnosis and outcome in patients with inflammatory bowel disease (IBD) by long term follow up at Wuhan University Zhongnan Hospital in Wuhan, China. Methods One hundred patients with ulcerative colitis (UC) and 15 with Crohn's disease (CD) treated in this hospital from 1980 to 1999 were re evaluated with the uniform diagnostic criteria proposed by National Workshop of Chronic Non infectious Intestinal Diseases, 1993. All patients were followed up by questionnaire, telephone and face to face interview 1～16 years after the initial diagnosis. Results Of 115 patients with IBD, 75(65%) were available for follow up study. Of 64 cases of UC, 46 had their diagnosis confirmed, 9 diagnosed as possible UC, and 9 cases were reclassified as other diseases. Of 11 cases with CD, 7 were diagnosed correctly, 2 were possible CD, and 1 were intestinal tuberculosis. In the remaining 55 UC, 3 died and 1 due to complication of UC. Other 52 UC, 37 had relapse. In the 10 patients with CD, 1 died due to complication. In other 9 cases 7 had relapse. In 46 patients with UC and 6 patients with CD there were symptom free or symptoms improved. Conclusions At follow up 1 to 16 years after the diagnosis of IBD, the initial diagnosis of UC and CD was confirmed in 86% and 82% respectively. Relapse rates of UC and CD were 71% and 78% respectively. The prognosis of patients with UC is better with 88% symptom free and improvement, while only 67% of patients with CD were symptom free and symptoms improved.