目的 研究小肠CD的临床特征.方法 纳入2009年1月至2012年9月行结肠镜及全消化道钡餐、胶囊内镜、双气囊小肠镜、CT小肠成像术等检查的138例确诊CD患者,根据CD蒙特利尔分型标准,对患者诊断年龄、病变部位及疾病行为进行分型,评估患者的临床症状、实验室检查、诊断方法及复发情况.通过与回结肠型、结肠型CD的临床特征进行对比,重点分析单纯小肠CD的临床特征.计量资料采用t检验、单因素方差分析或非参数检验,计数资料分析采用卡方检验,相关性分析采用Spearman相关分析,危险因素筛查采用多变量Logistic回归分析.结果 单纯小肠CD共62例(44.9％),小肠CD中53例(85.5％)为男性,平均诊断年龄35.3岁,67.7％(42/62)患者诊断年龄在40岁以下.小肠CD发生狭窄型行为的比例(35.5％,22/62)明显高于回结肠型(18.8％,6/32)、结肠型CD(13.9％,5/36)(x2=6.594,P=0.037).空肠受累是CD发生狭窄型行为的独立危险因素(OR=3.481,95％CI:1.250～9.693).小肠CD以梗阻症状为首诊症状者(38.7％,24/62)多于结肠型CD(16.7％,6/36)(x2 =5.210,P=0.022),而以腹泻为首诊表现者(21.0％,13/62)少于回结肠型(37.5％,12/32)、结肠型CD患者(44.4％,16/36)(x2=6.512,P=0.039),出现2种及2种以上肠外表现者(3.2％,2/62)亦少于回结肠型(15.6％,5/32)、结肠型CD患者(19.4％,7/36)(x2=7.957,P=0.019).克罗恩病活动指数(CDAI)评分普遍较低,与CRP等血清学炎性反应指标无统计学意义上的相关性.小肠CD诱导缓解后至临床复发的平均时间[(23.64±17.08)个月]明显短于回结肠型[(35.07±29.84)个月,t=-4.285,P=0.002],亦短于结肠型[(32.35±28.46)个月]患者(t=-3.700,P=0.004),但在临床复发率方面尚未观察到与回结肠型、结肠型CD存在明显差异.结论 小肠CD患者在CD中所占比例大,以男性多见.小肠CD,尤其是空肠CD更易发生狭窄型行为.小肠CD患者诱导缓解后出现临床复发的时间更短.
目的 研究小腸CD的臨床特徵.方法 納入2009年1月至2012年9月行結腸鏡及全消化道鋇餐、膠囊內鏡、雙氣囊小腸鏡、CT小腸成像術等檢查的138例確診CD患者,根據CD矇特利爾分型標準,對患者診斷年齡、病變部位及疾病行為進行分型,評估患者的臨床癥狀、實驗室檢查、診斷方法及複髮情況.通過與迴結腸型、結腸型CD的臨床特徵進行對比,重點分析單純小腸CD的臨床特徵.計量資料採用t檢驗、單因素方差分析或非參數檢驗,計數資料分析採用卡方檢驗,相關性分析採用Spearman相關分析,危險因素篩查採用多變量Logistic迴歸分析.結果 單純小腸CD共62例(44.9％),小腸CD中53例(85.5％)為男性,平均診斷年齡35.3歲,67.7％(42/62)患者診斷年齡在40歲以下.小腸CD髮生狹窄型行為的比例(35.5％,22/62)明顯高于迴結腸型(18.8％,6/32)、結腸型CD(13.9％,5/36)(x2=6.594,P=0.037).空腸受纍是CD髮生狹窄型行為的獨立危險因素(OR=3.481,95％CI:1.250～9.693).小腸CD以梗阻癥狀為首診癥狀者(38.7％,24/62)多于結腸型CD(16.7％,6/36)(x2 =5.210,P=0.022),而以腹瀉為首診錶現者(21.0％,13/62)少于迴結腸型(37.5％,12/32)、結腸型CD患者(44.4％,16/36)(x2=6.512,P=0.039),齣現2種及2種以上腸外錶現者(3.2％,2/62)亦少于迴結腸型(15.6％,5/32)、結腸型CD患者(19.4％,7/36)(x2=7.957,P=0.019).剋囉恩病活動指數(CDAI)評分普遍較低,與CRP等血清學炎性反應指標無統計學意義上的相關性.小腸CD誘導緩解後至臨床複髮的平均時間[(23.64±17.08)箇月]明顯短于迴結腸型[(35.07±29.84)箇月,t=-4.285,P=0.002],亦短于結腸型[(32.35±28.46)箇月]患者(t=-3.700,P=0.004),但在臨床複髮率方麵尚未觀察到與迴結腸型、結腸型CD存在明顯差異.結論 小腸CD患者在CD中所佔比例大,以男性多見.小腸CD,尤其是空腸CD更易髮生狹窄型行為.小腸CD患者誘導緩解後齣現臨床複髮的時間更短.
목적 연구소장CD적림상특정.방법 납입2009년1월지2012년9월행결장경급전소화도패찬、효낭내경、쌍기낭소장경、CT소장성상술등검사적138례학진CD환자,근거CD몽특리이분형표준,대환자진단년령、병변부위급질병행위진행분형,평고환자적림상증상、실험실검사、진단방법급복발정황.통과여회결장형、결장형CD적림상특정진행대비,중점분석단순소장CD적림상특정.계량자료채용t검험、단인소방차분석혹비삼수검험,계수자료분석채용잡방검험,상관성분석채용Spearman상관분석,위험인소사사채용다변량Logistic회귀분석.결과 단순소장CD공62례(44.9％),소장CD중53례(85.5％)위남성,평균진단년령35.3세,67.7％(42/62)환자진단년령재40세이하.소장CD발생협착형행위적비례(35.5％,22/62)명현고우회결장형(18.8％,6/32)、결장형CD(13.9％,5/36)(x2=6.594,P=0.037).공장수루시CD발생협착형행위적독립위험인소(OR=3.481,95％CI:1.250～9.693).소장CD이경조증상위수진증상자(38.7％,24/62)다우결장형CD(16.7％,6/36)(x2 =5.210,P=0.022),이이복사위수진표현자(21.0％,13/62)소우회결장형(37.5％,12/32)、결장형CD환자(44.4％,16/36)(x2=6.512,P=0.039),출현2충급2충이상장외표현자(3.2％,2/62)역소우회결장형(15.6％,5/32)、결장형CD환자(19.4％,7/36)(x2=7.957,P=0.019).극라은병활동지수(CDAI)평분보편교저,여CRP등혈청학염성반응지표무통계학의의상적상관성.소장CD유도완해후지림상복발적평균시간[(23.64±17.08)개월]명현단우회결장형[(35.07±29.84)개월,t=-4.285,P=0.002],역단우결장형[(32.35±28.46)개월]환자(t=-3.700,P=0.004),단재림상복발솔방면상미관찰도여회결장형、결장형CD존재명현차이.결론 소장CD환자재CD중소점비례대,이남성다견.소장CD,우기시공장CD경역발생협착형행위.소장CD환자유도완해후출현림상복발적시간경단.
Objective To investigate the clinical features of small bowel Crohn's disease(CD).Methods From January 2009 to September 2012,a total of 138 patients diagnosed as CD who underwent examinations of colonoscopy,digestive tract radiography,capsule endoscopy,double-balloon enteroscopy and computed tomography (CT) enterography were enrolled.According to the Montreal Classification criteria,the disease was typed by the age at diagnosis,location of the lesions and behavior of the disease.The clinical symptoms,laboratory examinations,diagnostic methods and recurrence condition were also evaluated.Through the comparison of the clinical features of ileocolonic and colonic CD,the clinical features of small bowel CD were analyzed.Measurement data were analyzed with t-test,analysis of variance or non parametric test.Chi square test was performed for count data.Spearman's correlation analysis was used for correlation analysis and multivariate Logistic regression analysis was used for risk factors screening.Results A total of 62 (44.9％) cases were simple small bowel CD.Fifty-three patients (85.5％) were male,and the mean age at diagnosis was 35.3 years old.The age of 67.7％(42/62) of small bowel CD patients were less than 40 years old when diagnosed.The ratio of stricture in small bowel CD group (35.5％,22/62) was significantly higher than that of ileocolonic (18.8％,6/32) and colonic CD group (13.9％,5/36) (x2=6.594,P=0.037).Jejunal involvement was an independent risk factor for structure in CD (OR=3.481,95％ CI:1.250 to 9.693).The patients with obstructive symptoms as primary symptom in small bowel CD (38.7％,24/62) were more than those with colonic CD (16.7％,6/36) (x2 =5.210,P=0.022).However,patients with diarrhea as primary symptom in small bowel CD (21.0％,13/62) were less than those with ileocolonic (37.5％,12/32) and colonic CD (44.4％,16/36) (x2=6.512,P=0.039).Patients with two or more extraintestinal manifestations in small bowel CD (3.2％,2/62) were also significantly less than those with ileocolonic (15.6％,5/32) and colonic CD (19.4％,7/36) (x2=7.957,P=0.019).The score of CD activity index was generally low,and with no statistical correlation to serum inflammation markers such as C reaction protein.The average time duration between induction of remission and clinical recurrence of small bowel CD ((23.64 ± 17.08) months) was shorter than that of ileocolonic type ((35.07±29.84) months,t=-4.285,P=0.002) and colonic CD ((32.35 ± 28.46) months,t =-3.700,P =0.004).However,there was no significant difference in the rate of clinical recurrence between small bowel CD and ileocolonic,colonic CD.Conclusions Patients with small bowel CD account for a large proportion in patients with CD,especially in males.Stricture is more common in jejunum CD.The time duration between induction of remission and clinical recurrence of small bowel CD is short.
