中国小肠克罗恩病患者诊断方法的回顾性分析

Early detection of small bowel Crohn’s disease: a retrospective analysis

目的 探讨采用先进的检查方法发现无并发症的小肠克罗恩病(small bowel Crohn’s disease, SBCD)的途径。方法收集2005年1月至2014年12月上海交通大学医学院附属仁济医院诊断为克罗恩病(Crohn’s disease,CD)的患者,根据诊断年份分为2005-2009年、2010-2014年两组。回顾性分析检查方法及临床特点。结果与2005-2009年相比,先进的检查方法未提高2010- 2014年非狭窄/非穿透性疾病的发现率。仅小肠累及患者肠腔狭窄率显著高于小肠+结肠累及者,且从症状出现到病灶发现的时间更长。SBCD胶囊内镜使用率较其他先进检查方法低。腹痛(74.4%)是最常见的症状,94.0%的SBCD表现为胃肠道出血和贫血。结论尽管使用先进的检查方法,无并发症SBCD的早期发现仍十分困难。对存在腹痛或胃肠道症状者,应行粪隐血和血常规检查,以发现胃肠出血或贫血。若胃肠镜无病灶发现,无并发症者可使用胶囊内镜发现SBCD。此假设需要大型的前瞻性临床试验证实。

Objective To investigate the approach on detection of small bowel Crohn’s disease (SBCD) in the absence of complications at diagnosis by advanced modalities. Methods Patients diagnosed with Crohn’s disease (CD) in Renji Hospital School of Medicine, Shanghai Jiao Tong University from Jan. 2005 to Dec. 2014 were divided into two groups by year of diagnosis: 2005-2009 and 2010-2014. The modalities used and the clinical characteristics of patients were retrospectively examined. Results Advanced modalities did not detect higher rate of non-stricturing/non-penetrating disease in 2010-2014 than older modalities in 2005-2009. Further analysis showed that a stricturing complication was significantly more common in patients with SBCD than in those who had CD with small bowel and colonic involvement, and the duration from symptom onset to lesion detection was significantly longer in patients with SBCD than in those who had CD with small bowel and colonic involvement.Fewer patients with SBCD underwent small bowel capsule endoscopy compared with the other advanced modalities. Abdominal pain (74.4%) was the most common presentation, and 94.0% patients with SBCD presented gastrointestinal bleeding and anemia. Conclusion Early detection of SBCD without complications remains difficult even advanced modalitiesis introduced. Our hypothesis is that the fecal occult blood test and routine blood test should be administered to patients with abdominal pain or gastrointestinal manifestations in order to detect gastrointestinal bleeding or anemia. Subsequent small bowel capsule endoscopy can reveal SBCD in the absence of complications when gastroscopy and colonoscopy are inconclusive. Our hypothesis needs a prospective, large clinical trial to confirm.