克罗恩病在双腔气囊全小肠内镜下的表现

目的：观察克罗恩病(Crohn’s disease，CD)在双腔气囊小肠镜下的溃疡形态和发生部位，评价内镜下严重程度与临床表现严重程度的相关性，为医师根据内镜下表现诊断CD提供线索和依据。方法：前瞻性随访2015年7月至2016年12月中南大学湘雅三医院首次行全小肠双腔气囊小肠镜并确诊CD的45例患者，由2名经验丰富的消化内科内镜医师观察小肠镜下溃疡的形态，并进行简化CD内镜评分(simple endoscopic score for CD，SES-CD)，分析SES-CD与CD活动指数(Crohn’s disease activity index，CDAI)的相关性。结果：在45名克罗恩病患者中，24例(53.33%)溃疡位于回肠末端，5例(11.11%)位于回结肠，16例(35.56%)位于上消化道未累及回肠末端，其中8例(17.78%)仅累及空肠。在CD患者中纵行溃疡有32例(71.11%)。SES-CD与CDAI评分无相关性(r=0.237，P=0.136)。结论：双腔气囊小肠镜下CD溃疡表现具有多样性且可仅累及上消化道或空肠，因此不能以回肠末端及回盲瓣完好而排除CD。CDAI评分不能完全评估CD的预后。

Characteristics of Crohn’s disease under double balloon enteroscopy

Objective: To observe ulcer characteristics of Crohn’s disease under double balloon enteroscopy,and to evaluate the correlation between endoscopic severity and clinical manifestations.Methods: A prospective, observational study from July 2015 to December 2016 in the ThirdXiangya Hospital, Central South University, we selected 45 patients with positive double-balloonenteroscopy (DBE) and confirmed Crohn’s disease. Two digestive internal physician observedthe ulcer characteristics of Crohn’s disease under double balloon enteroscopy, and gave a simpleendoscopic score for CD (SES-CD). We analyzed the correlation between SES-CD and Crohn’sdisease activity index (CDAI).Results: DBE indicated 24 patient ulcers (53.33%) locating at the end of the ileum, 5 (11.11%)locating at ileocolon, 16 (35.56%) locating at upper gatrointestinal tract and they did not affect theend of the ileum. Among them, 8 cases (17.78%) affected only jejunum. Thirty-two patients withlongitudinal ulcers in Crohn’s disease, accounting for 71.11%. There was no correlation betweenSES-CD score and CDAI score (r=0.237, P=0.136).Conclusion: The ulcerative appearance in Crohn’s disease were diverse under double balloonenteroscopy. Crohn’s disease could only affect the upper gastrointestinal tract or jejunum. Theunwounded ileum and ileocecal valve couldn’t be a sign to exclude Crohn’s disease. CDAI scorecouldn’t fully assess the prognosis of Crohn’s disease.