肠白塞病64例临床分析

Clinical analysis of gastrointestinal involvement in Behcet＇s disease： a study of 64 patients

目的探讨肠白塞病的临床特点。方法回顾性分析北京协和医院1994年1月至2013年8月肠白塞病住院患者临床资料，分析临床、实验室及内镜特点，并探讨性别对病情的影响。采用t检验或，检验进行统计学分析。结果肠白塞病患者64例，占同期白塞病住院患者10．5％（64／611），其中男性31例，女性33例。肠白塞病消化系统症状中位发病年龄34岁（5～71岁），91％（58例）患者消化系统症状出现在白塞病其他系统首发表现之后。临床以腹痛最常见（88％，56／64），部分患者可出现消化道出血（31％，20／64）、肠梗阻（22％，14／64）、肠穿孔（11％，7／64）、肠瘘（16％，10／64）等严重并发症。内镜下病变主要累及回盲部，以深大溃疡为主。女性肠白塞病患者CRP较男性高[（52±46）和（27±36）mg/L，t=2．287，P=0．026]，血清白蛋白水平较低[（34±6）和（37±5）mg／L]（t=2．237，P=0．029）。糖皮质激素联合免疫抑制剂及TNF-α拮抗剂治疗后；62例有效，共有21例次患者病程中有手术史。结论肠白塞病以青壮年患者多见，消化道症状多晚于白塞病系统病变出现，临床以腹痛最常见，病变主要累及回盲部，以深大溃疡为主，女性病情相对较重。激素联合免疫抑制剂治疗多有效，部分需要手术治疗。

Objective To investigate the clinic manifestations of intestinal involvement of Behqet＇s disease （BD）. Methods Medical data of patients with intestinal involvement of BD admitted to Peking Union Medical College Hospital （PUMCH） from January 1994 to August 2013 were retrospectively reviewed. Clinic manifestations, laboratory tests and endoscopic characteristics were analyzed, and the influence of sex on the clinic manifestations was investigated. Numerical data and categorical data comparisons were analyzed using t-test, X^2test respectively. Results Sixty-four patients with intestinal involvement accounted for 10.5 percent （64/611） of total hospitalized BD patients during the same period. Among these 64 patients, 31 were male and 33 were female. The median age at the onset of intestinal involvement was 34 years old. Gastrointestinal symptoms were presented after other systemic symptoms of BD in 91% patients （58/64）. Abdominal pain （88%, 56/64） was the most common clinical manifestations of intestinal involvement, and severe complications such as gastrointestinal bleeding （31%, 20/64）, intestinal obstruction （22%, 14/64）, intestinal perforation （11%, 7/64） and intestinal fistula （16%, 10/64） could also occur in some patients. Lesions usually located at ileocecum portion of the gastrointestinal tract. The common endoscopic manifestation was deep ulcers. Female sex was associated with higher C reactive protein level and lower serum albumin level [ （52±46） vs （27±36） rag/L, t=2.287, P=0.026; Serum albumin： （34±6） vs （37±5） mg/L, t=2.237, P=0.029 ]. After treated with glucocorticoid, im-munosuppressant and TNF-ct blockers, 62 patients achieved clinical remission while 21 cases were＇operated. Conclusion Most of intestinal involvement of BD patients are young adults, and the gastrointestinal syrup-toms usually present after the presence of other systemic symptoms.Abdominal pain is the most common manifestations, while severe complications such as gastrointestinal bleeding and intestinal obstruction can also occur. The most common endoscopic findings are deep ulcers, which often located in the ileocecal region. Female patients are more likely to have severe clinical course. Glucocorticoid, immunosup-pressant and TNF-ct antagonist therapy are effective, but some patients still need surgical intervention.