克罗恩病的临床特征以及胶囊内镜在诊断中的价值

背景：近年我国克罗恩病（CD）的发病率和患病率呈上升趋势，然而其早期诊断率较低。目的：总结CD的临床特征，评价胶囊内镜在CD诊断中的价值。方法：回顾性分析浙江中医药大学附属第一医院2003年1月～2008年9月确诊为CD的69例住院患者的临床资料以及X线钡剂造影、结肠镜和胶囊内镜下特点。结果：69例CD患者中男35例，女34例，发病年龄17～73岁。临床表现主要有腹痛、腹泻、便血等，以及贫血、低蛋白血症、消瘦、发热，肠外表现以口腔溃疡、关节痛多见，部分出现肛门病变、肠梗阻等并发症。病变范围小肠型占47．8％，结肠型占14．5％，小肠结肠型占37．7％。X线钡剂造影诊断率为44．0％（22／50），结肠镜检查诊断率为75．8％（50／66）。胶囊内镜检查诊断率为62．5％（10／16），检出小肠病变10例，结肠病变2例，镜下主要表现为溃疡、黏膜充血水肿、糜烂、节段性病变、息肉样或鹅卵石样增生等。结论：CD病变以小肠累及率较高，其临床表现多样，常伴有多种肠外表现和并发症，可为临床诊断提供线索。胶囊内镜检查能发现CD的早期小肠黏膜病变，对CD具有较高的诊断价值。

Clinical Characteristics of Crohn's Disease and Value of Capsule Endoscopy in its Diagnosis

Background： The incidence and prevalence rates of Crohn＇s disease （CD） have been increasing rapidly in China, but its early diagnosis rate is relatively low. Aims： To analyze the clinical characteristics of CD and appraise the value of capsule endoscopy in the diagnosis of CD. Methods： The clinical data of 69 inpatients diagnosed as CD in the First Affiliated Hospital of Zhejiang Chinese Medical University from Jan. 2003 to Sep. 2008 were reviewed and the results of barium X-ray examination, colonoscopy and capsule endoscopy were analyzed retrospectively. Results： Thirty-five patients were male and 34 were female, age ranged from 17 to 73 years old. The most common manifestations were abdominal pain, diarrhea and hematoehezia, as well as anemia, hypoproteiuemia, weight loss and fever. Extraintestinal manifestations included oral ulcers, joint pain, etc. Some patients were complicated with anal lesions and intestinal obstruction. 47.8% of patients had small bowel lesions only, 14.5% colonic lesions alone, and 37.7% both small bowel and colon involvement. The diagnosis rate of barium X-ray examination, colonoscopy and capsule endoscopy was 44.0% （22/50）, 75.8% （50/66）, and 62.5% （10/16）, respectively. All 10 patients with positive capsule endoscopic findings had small bowel lesions and 2 associated with colonic lesions. The major capsule endoscopic findings were ulcers, mucosal congestion, edema, erosions, segmental distribution, polypoid or cobblestone-like mucosa, etc. Conclusions： CD mainly occurs in small bowel. The clinical manifestations are diverse and are often accompanied by a variety of extraintestinal symptoms and complications, which can provide clues for its clinical diagnosis. Capsule endoscopy can detect early mucosal lesions of small bowel, which is valuable for the diagnosis of CD.