克罗恩病临床特征以及诊断和治疗选择

目的 分析克罗恩病的临床表现、误诊原因和诊疗方法,以促进与提高对本病的认识及诊治效果。方法 对近期诊治31例患者的发病情况、临床表现、内镜及实验室检查结果,结合文献报道,分析本病的临床特征与诊治方案。结果 患者以表中年为主,女略多于男。病变侵犯胃肠道任一部位,呈节段性分布,常同时侵犯多个部位,以结肠及小肠为主;腹痛与腹泻为主要的肠道症状;但尚有低热、消瘦、贫血及皮肤、关节与肛周疾病等多系统症状。内镜可见跳跃式分布的黏膜充血、水肿、溃疡、息肉、狭窄或铺路石征等破坏与增殖病变并存的特点,诊断正确率为62.9%。活检肉芽肿检出率为30.8%。B超可探查出肠道并发症。误衣原因：对本病认识不足;肠道病变多部位性,致使临床症状多样化;过于强调病理学检查及肉芽肿的诊断意义。口服泼尼松对轻－中型患者诱导缓解较氨基水杨酸盐类更迅速;免疫制剂为二线药物,个体间疗效不一;20例接受强化性营养支持治疗,具有辅助治疗作用。16例手术治疗收到较好疗效。结论 本病发病数明显增多,临床表现缺乏特异性;内镜联合活检,加强临床与病理医师沟通是及时和正确诊断的关键。治疗宜个体化选择方案,手术具有积极意义。

Clinical features of Crohn's disease: its diagnosis and treatment

OBJECTIVE: To enhance our understanding of Crohn's disease and improve its early diagnostic accuracy and therapeutic efficacy. METHODS: Thirty-one patients with active Crohn's disease were studied. All their diagnostic and therapeutic results were analyzed. RESULTS: Most patients were young adults, with a 1.14:1 female predominance in prevalence. The disease affects any segment or a combination of segments of the alimentary tract from the mouth to the anus. However, the colon and the small bowel were the major sites involved. Recurrent episodes of abdominal pain and watery diarrhea were the most common symptoms. In addition, low grade fever, emaciation, anemia, and symptoms with skin, joints or perianal complications could be discovered if attention was paid. An endoscopy combined with histologic examination in biopsy specimens provided characteristic features with a diagnostic accuracy of 62.9%. Granulomas were identifiable in 30.8% of all biopsy specimens. Transabdominal bowel sonography (TABS) accurately detected intestinal complications. Factors causing misdiagnosis were: insufficient attention of the disease, diverse clinical presentations, or over emphasis of the diagnostic value of granulomas. Oral prednisone therapy for mild to moderate disease was more rapid to receive clinical remission when compared to oral aminosalicylates (SASP or 5-ASA). Nutrition support therapy was given in 20 cases with active disease and received beneficial effects on host nutritional status. Immunosuppressives were used on an individual basis, and showed variable effects with limited experience. Sixteen patients had operations due to intestinal obstruction or failure to respond to drug therapies. Rapid improvement after operations was achieved. CONCLUSIONS: Crohn's diseases not uncommon in China. Abdominal pain and watery diarrhea are two hallmark symptoms. Endoscopy (with biopsy), and TABS were both valuable procedures for diagnosis. Prednisone and SASP/5-ASA were effective as inductive therapies. Surgery, as an alternative and effective treatment, provided another choice in well selected patients.