单中心肛周克罗恩病临床特点分析

Analysis of clinical characteristics of perianal Crohn＇s disease in a single-center

目的 通过对肛周克罗恩病（PCD）患者的临床资料进行分析，探讨PCD的临床特点。方法 回顾性分析2011年6月至2014年10月南京中医药大学附属医院肛肠科收治住院的52例PCD患者的临床资料，包括Montreal分型、临床症状、肛周病变类型、既往肛周手术和药物治疗情况、疾病活动指数以及血清炎性标记物和营养指标等。结果 52例患者中，男性40例，女性12例，年龄（27.9 ± 9.1）岁。根据Montreal分型，肠道病变部位为回结肠者占51.9%（27/52），疾病行为中炎症型占75.0%（39/52）。入院时临床症状为腹痛者13例（25.0%），腹泻者15例（28.8%）；肛周病变为肛瘘者32（61.5%），肛周脓肿者16例（30.8%）。分别有75.0%（39/52）和63.5%（33/52）的患者在本次入院前曾接受过肛周手术和药物治疗。实验室检查结果提示，C反应蛋白、红细胞沉降率和血小板升高比例分别为63.5%（33/52）、61.5%（32/52）和32.7%（17/52），体质量指数过低、低蛋白血症和贫血患者的比例分别为44.2%（23/52）、26.9%（14/52）和42.3%（22/52）。结论 PCD患者的临床特点以男性为主，发病年龄较轻，回结肠受累和炎症型病变多见。伴有特征性的消化道症状、需要反复手术的肛周疾病、炎性指标和营养指标异常等均提示可能存在PCD。

Objective To discuss the clinical features of perianal Crohn disease （PCD） .Methods Clinical data of 52 PCD patients who were treated at the Department of Colorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine from June 2011 to October 2014 were analyzed retrospectively. Montreal classification, clinical symptoms, the subtype of perianal lesions, history of perianal surgery and medical treatment, disease active indexes, serum inflammation markers and nutritional indexes were included.Results Among 52 patients, there were 40 males and 12 females with a mean age of （27.9 ± 9.1） years. According to Montreal classification, 51.9% （27/52） of patients had ileocolic involvement and 75.0% （39/52） had inflammatory disease behavior. Thirteen （25.0%） and 15 （28.8%） patients had abdominal pain and diarrhea respectively at admission. With respect to the subtype of perianal lesions, there were 32 （61.5%） cases of anal fistula and 16 （30.8%） cases of perianal abscess. Thirty-nine（75.0%） and 33（63.5%） patients had a history of perianal surgery and medical treatment before admission resepectively. Laboratory findings revealed high C-reaction protein level in 63.5% （33/52） , high erythrocyte sedimentation rate in 61.5% （32/52） , elevated platelet in 32.7% （17/52） , low body weight in 44.2% （23/52） , low albumin in 26.9% （14/52） and anemia in 42.3% （22/52） of patients.Conclusions The clinical features of PCD patients include male predominant, early onset disease, high prevalence of ileocolic involvement and inflammation disease behavior. Features prompting underlying PCD diagnosis include characteristic gastrointestinal symptoms, requiring multiple perianal surgery, and abnormality of inflammation markers and nutritional indexes.