克罗恩病52例临床诊断分析

背景:克罗恩病(CD)是一种全胃肠道节段性全壁层炎症性病变,其病因不明,临床表现多样,病理改变无特异性,误诊率高.目的:通过分析住院CD患者的临床资料,以期提高CD的早期诊断水平.方法:对仁济医院1993～2003年住院病例中52例出院诊断为CD患者的临床表现、诊断方法、确诊时间以及治疗和预后等进行总结和回顾分析.结果:腹痛(80.8%)、腹泻(57.7%)为本组住院CD患者最常见的胃肠道症状,消化道出血(44.2%)的发生率亦较高;病变常累及小肠(53.8%)和结肠(26.9%).结肠镜检查是末段回肠和结直肠病变最主要的诊断方法,其次为消化道钡剂检查,小肠病灶可通过小肠钡灌/胃肠钡餐或胶囊内镜、双气囊推进式小肠镜和磁共振小肠造影等检查方法发现.注意到微肉芽肿的特点可以提高活检组织非干酪性肉芽肿的检出率.52例CD入院时确诊40.4%,拟诊59.6%;2001年之后的误诊率和确诊时间与2000年之前相比没有下降.结论:CD临床表现多样且缺乏特异性,易延误诊断.结肠镜检查在CD的诊断中起关键作用,病变单独累及小肠时可采用小肠钡灌/胃肠钡餐或胶囊内镜、双气囊推进式小肠镜等检查方法以及早发现病灶.对拟诊患者应予相应治疗,考察疗效时对诊断进行再评估.

Clinical Diagnosis of Crohn's Disease: An Analysis of 52 Cases

Crohn's disease (CD) is a segmental transmural inflammatory disease of the gastrointestinal tract. So far the cause remains unclear, the clinical manifestations are diverse and the histological changes showed no distinctive features, which is easily misdiagnosed. Aims: To analyze the clinical data of inpatients diagnosed as CD for improving the accuracy of early diagnosis. Methods: Fifty-two inpatients of Renji Hospital diagnosed as CD from 1993 to 2003 were enrolled. Their clinical manifestation, diagnostic methods, time of final diagnosis, therapeutics and prognosis were retrospect-ively analyzed. Results: The most common gastrointestinal symptoms of these patients were abdominal pain (80.8%) and diarrhea (57.7%), gastrointestinal bleeding was also frequent (44.2%). Small bowel (53.8%) and colon (26.9%) were the major sites involved. Colonoscopy was the main diagnostic method for distal ileal and colorectal lesions, followed by bar-ium studies. Enteroclysis/gastrointestinal barium meal being always utilized for small bowel lesions, capsule endoscopy, double-balloon push enteroscopy and magnetic resonance enteroclysis could also be used. Non-caseating granulomas could be frequently observed if this "micro" lesion had been searched for. Among the 52 patients at the time of admission, only 40.4% were precisely diagnosed, the other 59.6% were presumably diagnosed. No decrement of misdiagnosis rate or time of final diagnosis was found between the years before and after 2001. Conclusions: The diversity and non-specificity of the clinical manifestations of CD may cause delayed diagnosis. Colonoscopy is the key method for diagnosis of CD. Early diagnosis of small bowel CD can be made by enteroclysis/gastrointestinal barium meal, capsule endoscopy or double-balloon push enteroscopy. For those suspicious cases, treatment should also be given and the diagnosis can be re-assessed.