成人乳糜泻的临床与内镜特征分析

Clinical and endoscopic characteristics of adult celiac disease

目的分析成人乳糜泻(CD)的临床与内镜特征, 为更有效地诊治CD提供科学依据。方法横断面研究。收集2016年3月至2021年12月在新疆维吾尔自治区人民医院消化科收治的96例CD患者的临床和内镜资料进行回顾性分析。计量资料组间比较采用t检验或非参数检验, 计数资料组间比较采用χ2检验。结果共确诊96例CD患者, 男性33例、女性63例, 男女比例为1∶1.9, 年龄18~81(47±14)岁, 31~60岁年龄段发病为主, 中位病程为2.0 (0.2, 40.0)年。经典型CD患者41例(42.7%), 非经典型CD患者55例(57.3%)。经典型CD患者均表现为慢性腹泻, 常伴有慢性腹痛(46.3%, 19/41)、腹胀(17.1%, 7/41)、贫血(65.9%, 27/41)和慢性疲劳(48.8%, 20/41)。非经典型CD主要表现为慢性腹痛(58.2%, 32/55)、腹胀(32.7%, 18/55), 常伴有贫血(40.0%, 22/55)和骨量减少/骨质疏松(38.2%, 21/55)。与非经典型CD相比, 经典型CD更容易出现贫血, 差异有统计学意义(P=0.012)。CD患者合并症的发生频率为36.5%(35/96), 主要合并症为甲状腺疾病(19.8%, 19/96)、结缔组织病(6.2%, 6/96)和肾脏疾病(6.2%, 6/96)。CD合并疾病在经典型CD与非经典型CD两组间比较差异无统计学意义(P>0.05)。CD患者有内镜下表现的频率为84.4%(81/96)。十二指肠球部内镜下主要表现为结节样改变(72.9%, 70/96), 沟槽样改变(10.4%, 10/96)和局灶性绒毛萎缩(9.4%, 9/96);降部内镜下主要表现为十二指肠皱襞减少、变平或消失(43.8%, 42/96), 扇贝样改变(38.5%, 37/96)和结节样改变(34.4%, 33/96)。结论成人CD患者女性居多, 31~60岁年龄段发病为主。临床表现以非经典型CD临床表现为主, 部分患者常合并其他自身免疫性疾病, 对于有特征性内镜表现的患者应警惕CD的可能。临床医师应加强对CD的认识, 减少漏诊。

Objective The study aimed to analyze the clinical and endoscopic characteristics of adult celiac disease(CD)to provide a scientific basis for more effective CD diagnosis and treatment.Methods In this cross-sectional study,the clinical and endoscopic data of 96 adult CD patients treated in the Department of Gastroenterology of the People′s Hospital of Xinjiang Uygur Autonomous Region from March 2016 to December 2021 were retrospectively collected and analyzed.Results A total of 96 CD patients were diagnosed,including 33 men and 63 women.The average age was 47±14 years(range,18-81 years).The disease occurred mainly in the age group of 31-60 years.The median course of the disease was 2.0(0.2-40.0)years.There were 41(42.7%)classical and 55(57.3%)non-classical CD patients.All patients with classical CD showed chronic diarrhea,often accompanied by abdominal pain(46.3%,19/41),abdominal distension(17.1%,7/41),anemia(65.9%,27/41),and chronic fatigue(48.8%,20/41).The main manifestations of non-classical CD were chronic abdominal pain(58.2%,32/55),abdominal distension(32.7%,18/55),anemia(40.0%,22/55),and osteopenia/osteoporosis(38.2%,21/55).Compared with non-classical CD,anemia developed more frequently in classical CD,and the difference was statistically significant(P=0.012).The incidence of complications in CD patients was 36.5%(35/96),and the main complications were thyroid disease(19.8%,19/96),connective tissue disease(6.2%,6/96),and kidney disease(6.2%,6/96).There was no significant difference between classical and non-classical CD(P>0.05).The frequency of endoscopic manifestations in CD patients was 84.4%(81/96).Duodenal bulb endoscopy showed nodular changes(72.9%,70/96),grooved changes(10.4%,10/96),and focal villous atrophy(9.4%,9/96).The main manifestations of descending endoscopy were the decrease,flattening,or disappearance of duodenal folds(43.8%,42/96),scallop-like changes(38.5%,37/96),and nodular changes(34.4%,33/96).Conclusions Adult CD patients are mostly female.CD occurred mainly in the age group of 31-60 years.The clinical manifestations were mainly those of non-classical CD.Some patients often had other autoimmune diseases.Patients with characteristic endoscopic manifestations should be warned about the possibility of developing CD.Clinicians should strengthen the understanding of CD and reduce the related rates of missed diagnosis.