克罗恩病合并急性下消化道大出血的临床特点及再出血危险因素分析

目的：探讨克罗恩病合并急性下消化道大出血病例的临床特点，及再出血危险因素。方法回顾性分析2002年12月至2012年12月29例克罗恩病合并急性下消化道大出血患者的临床资料。结果417例确诊克罗恩病患者中，发生急性下消化道大出血者29例（7.0％），平均发病年龄29.5岁，平均第1次出血年龄32.9岁，复发出血率60.0%（15/25），病死率24.1%（7/24）。出血好发部位依次为小肠（62.1%），结肠（37.9%）。出血部位的诊断以多层螺旋CT诊断阳性率最高（77.8%），其次为血管造影（56.3%）、结肠镜阳性率最低（20.0%）。糖皮质激素治疗使出血复发的风险增加4.567倍（P=0.0155），血小板计数增高可能有助于预测出血复发（P=0.0661，HR=3.858）。结论克罗恩病合并急性下消化道大出血复发率和病死率高，多层螺旋CT有助于明确出血部位。应用糖皮质激素治疗和血小板计数增高是预测复发出血的独立危险因素。

Clinical analysis of acute severe lower gastrointestinal bleeding and risk factors for recurrence in Crohn's disease

Objective To analyze the clinical characteristics and the recurrence factors of acute severe lower gastrointestinal bleeding (GIB) in Crohn's disease (CD). Methods The clinical data of 29 CD patients with acute severe lower GIB from Dec., 2002 to Dec., 2012 were retrospectively analyzed. Results Twenty-nine patients (7.0%) were identified as acute severe lower GIB in 417 CD patients, the average age at the time of the onset was 29.5 years old, and the average age at the time of the first bleeding episode was 32.9 years old. The mortality was 24.1% and the incidence of rebleeding was 60.0%.The propotion of localization of bleeding in the small intestine was 62.1%, in the colon was 37.9%. The positive rate of diagnosis was 20.0% in colonscopy, 56.3% in angiography, and 77.8% in MDCT. Steroid alone might increase 4.567 folds for the risk of rebleeding (P = 0.0155). Platelet count increased could predict the recurrence of bleeding (P=0.0661, HR=3.858). Conclusion The incidence of rebleeding and mortality is high in the patients with CD and acute severe lower GIB. MDCT may be helpful for the diagnosis of the location.The use of glucocorticoid and the promotion of platelet count are the independent risk factors for recurrence of bleeding.