克罗恩病36例临床特征分析

目的回顾性分析克罗恩病（CD）的临床特点和诊治情况。方法收集郑州市第七人民医院1996-2006年的CD住院病例，按照维也纳分类标准进行临床，按照中华医学会消化病学分会的建议进行临床严重度分度。结果共纳入36例CD患者，男女比例为1．25：1，诊断时年龄15～68岁。根据维也纳分类标准，诊断时年龄〈40岁（A1）者25例（69．4％）≥40岁（A2）者11例（30．6％）；病变部位位于末端回肠（L1）者14例（38．9％），结肠（也）10例（27．8％），回结肠（L3）11例（27．8％），上消化道（L4）2例（5．6％）；无狭窄、穿孔（B1）15例（41．7％），发生狭窄（B2）10例（27．8％），发生穿孔（B3）11例（30．1％）。A1型中病变位于末端回肠者占44．0％，A2型中病变位于结肠者占45．5％。活检标本的非干酪样肉芽肿检出率为44．4％，手术标本为66．7％。共18例患者接受手术诊治，手术率为50．0％。内科治疗轻度患者以口服柳氮磺胺吡啶（SASP）／5-氨基水杨酸（5-ASA）为主；中度患者小肠受累者以激素治疗为主，结肠受累者以口服SASP／5-ASA为主；重度患者以激素治疗为主，2例使用免疫抑制剂治疗。结论维也纳分类标准简单、易行，适用于我国CD人群的分类。本组CD患者手术率高。应根据临床严重度和病变部位选择药物治疗方案。

Analysis of clinical characteristics of 36 patients with crohn's disease

Objective To analyze the clinical characteristics, diagnosis and treatment of CD patients retrospectively. Methods Inpatients with CD were collected At Zheng Zhou Seven People＇ s Hospital from 1996 to 2006. The clinical categorization was made according to Vienna classification. The disease severity was estimated according to the method recommended by Chinese Society of Gastroenterology. Results 36 CD patients were enrolled in this study The ratio of males to females wasl. 25 ： 1. Age at diagnosis ranged from 15 to 68years Based on Vienna classification ,25 patients （69.4%）were classified as A1 （diagnosed at the age below 40 years） and 11（30. 6% ）as A2（diagnosed at the age equal to or above 40 years）. There were 14（38.9% ）patients with lesions involving the terminal ileum（ L1 ）, 10 （ 27. 8% ） Colon （ 12 ）, 10 （ 27. 8% ） ileocolon （ L3 ） and 2 （ 5.6% ） upper gastrointestinal tract（L4）. There were no stricture or penetration（ B1 ） in 15 （41.7%） patients, stricture （B2） were seen in 10（27. 8% ）and penetration（ B3 ）in 11 （30. 1% ）patients. In 44. 0% of A1 patients the lesion was located at ileum, and in 45.5 % of A2 patients the lesion was located at colon. Non-caseous granulomas were identified in 44. 4% of biopsy specimens and 66.7% of surgical specimens. Surgical therapy was carried out in 18 （ 50. 5% ） patients. In mild patients, oral salicylasosulfapyridine （ SASP ） or 5-aminosalicylic acid （ 5-ASA ） was given as the primary medical therapy. Patients with moderate small intestinal lesions and colonic lesions received oral prednisone and/or SASP/5-ASA. Most severe patients were treated with prednisone, but 2 received immunosuppressant. Conclusion Vienna classification is simple for clinical use, and it is suitable for the classification of CD patients in China. The rate of surgical therapy was high in this study. The medical therapeutic regimen should be chosen according to the activity and location of the disease.