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 Third Xiangya Hospital, Central South University, we selected 45 patients with positive double-balloon enteroscopy (DBE) and confirmed Crohn’s disease. Two digestive internal physician observed the 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’s disease 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 the end of the ileum. Among them, 8 cases (17.78%) affected only jejunum. Thirty-two patients with longitudinal ulcers in Crohn’s disease, accounting for 71.11%. There was no correlation between SES-CD score and CDAI score (r=0.237, P=0.136). Conclusion: The ulcerative appearance in Crohn’s disease were diverse under double balloon enteroscopy. Crohn’s disease could only affect the upper gastrointestinal tract or jejunum. The unwounded ileum and ileocecal valve couldn’t be a sign to exclude Crohn’s disease. CDAI score couldn’t fully assess the prognosis of Crohn’s disease.