小肠型克罗恩病临床特征分析

Clinical features of small bowel Crohn's disease

[目的]研究小肠型克罗恩病(CD)的临床特征,提高早期诊断水平,减少漏诊及误诊。[方法]纳入CD患者131例,比较小肠型CD与结肠型CD的临床特征,并进行统计学处理。[结果]小肠型CD患者共45例,病程较长(平均病史33.8个月)。小肠型CD的胃肠道症状以腹痛多见(77.8%),其次为腹泻(48.9%)、消化道出血(37.8%)、腹胀(31.1%)等;全身表现为贫血、体质量下降、发热、乏力、纳差等;肠道外症状表现为口腔溃疡、肛周病变、皮疹、关节痛等。小肠型CD患者梗阻症状明显多于结肠型CD患者(P<0.05)。7例有非干酪性肉芽肿等特征性病理改变。[结论]小肠型CD临床表现多样化,需结合实验室检查、影像学、内镜及病理表现综合判断,小肠镜和小肠造影检查是诊断首选方法。

[Objective]Through the investigation of the clinical features of small bowel Crohn＇s disease（CD）to improve early diagnostic ability,reduce missed diagnosis and misdiagnosis.[Methods]From January2004 to December 2014,a total of 131 hospitalized patients diagnosed as CD in Peking University Third Hospital were enrolled.The clinical features of small bowel CD and colon CD were compared.[Results]A total of 45 cases were single small bowel CD,with apparent predilection for young patients and longer course with a mean medical history of 33.8 months.The main digestive symptoms were abdominal pain（77.8%）,diarrhea（48.9%）,bleeding（37.8%）,and abdominal distension（31.1%）.The general symptoms included anemia,weight-loss,fever and debility.Extra-intestinal tract symptoms included dental ulcer,crissum affection,rash and arthralgia.The ratio of obstruction in small bowel CD group was significantly higher than that in colonic CD group（P〈0.05）.Non-caseating granulomatous were found in 7cases.[Conclusion]Small bowel CD may cause diversity of clinical manifestations.Diagnosis of small bowel CD needs a combined course with all clinical evidences and clues for clinical manifestations,laboratory examinations,radiography,endoscopy and pathology together.Endoscopy and enteroclysis are the preferred means for diagnosing small bowel CD.