48例克罗恩病住院患者临床特点分析

发布时间：2018-01-31 02:40

本文关键词： 克罗恩病临床特征缺乏特异性病理组织学　出处：《大连医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:回顾性归纳分析大连医科大学第二附属医院从2002年9月13日至2014年9月6日期间所有确诊克罗恩病(Crohn’S disease,CD)患者的临床特点,进一步增进对克罗恩病(CD)的认识。方法:对48例确诊的CD住院患者的临床特点、实验室检查、内镜检查及病理学改变、X线、CT以及MRI影像学表现等数据进行统计学分析。结果:在48例住院克罗恩病(CD)患者中,男性32例,女性16例,男性多于女性(2:1),年龄分布从18到85岁之间,平均年龄(46.83±4.10)岁,其中20~40岁占37.5%,60岁以上占29.17%。病程:1 d~13年(中位病程10.4个月)。其中小肠病变12例(25%)、回-结肠多发病变26例(54.17%)、大肠病变10例(20.83%)。48例克罗恩病(CD)患者中最常见的症状是腹痛为44例(91.67%)、大便异常22例(45.83%)。CD并发症较多,主要为肠梗阻、瘘管及穿孔,其中14例(29.16%)出现肠梗阻,12例(25%)出现穿孔,肠外表现10例(20.83%),8例(16.66%)发生瘘管形成。其中8例(12.5%)CD患者被误诊。实验室检测:C反应蛋白增高(6/26,21.42%)、血沉增快(12/36,33.33%)、便常规+潜血阳性(8/48,16.67%)低蛋白血症(8/48,16.67%)。病变在活动期或合并感染时白细胞高10例(10/48,20.83%),40例患者接受肠道X线钡餐或CT检查,结果发现:肠壁增厚10例(25%)、管腔狭窄18例(39.10%)、黏膜变平16例(34.78%)、肠道多发性病变8例(33.33%)、肠瘘12例(30%)。接受肠镜检查的患者为38例,其中克罗恩病患者中有25例(65.79%)累及大肠和回肠末端的。42例克罗恩病患者病理学检查发现:累积肠壁全层炎症20例(47.61%),非干酪样坏死、肉芽组织形成22例(52.38%),其中纤维组织增生性改变4例(4.76%)、淋巴细胞聚集2例(2.38%)、隐窝脓肿形成2例(4.76%)。结论:本院近12年来克罗恩病(CD)患者的发病率有所增加。我院CD患者中男性多于女性,多发病例在20~50岁之间,未发现双峰分布现象。患者多以腹痛、腹泻就诊。其中克罗恩病多好发于末端回肠和邻近的结肠,临床表现多种多样,并且缺乏特异性表现,诊断困难,容易延误诊治。需结合患者的临床表现、影像学、消化内镜、病理学以及追踪资料等综合判断。CD患者目前以内科治疗为主,在内科治疗无效或出现严重并发症的情况下采取手术治疗,随着年龄的增加手术几率也随之增加。老年患者相对年轻患者有一个较重的病情,CD患者预后不佳。
[Abstract]:Objective: to analyze retrospectively all the confirmed Crohn's disease (Crohn's disease) disease in the second affiliated Hospital of Dalian Medical University from September 13th 2002 to September 6th 2014. Methods: the clinical features, laboratory examination, endoscopy and pathological changes of 48 patients with CD were studied. Results: among 48 patients with Crohn's disease, 32 were male and 16 were female. The age distribution ranged from 18 to 85 years old, with an average age of 46.83 卤4.10 years, of which 20 or 40 years old accounted for 37.5%. The course of disease was from 1 day to 13 years (median course was 10.4 months). Gyneco-colonic disease occurred frequently in 26 cases (54.17). The most common symptom in 10 patients with colorectal lesions (20.83%) was abdominal pain in 44 cases (91.67%). 22 cases of abnormal stool (45.83%) had more complications, mainly intestinal obstruction, fistula and perforation, of which 14 cases (29.16) had intestinal obstruction and 12 cases (25%) perforation. Extra-intestinal manifestations were found in 10 cases (20. 83%). Fistula was found in 8 cases. Among them, 8 cases with 12.5CD were misdiagnosed. The laboratory test showed that the proportion of C-reactive protein increased by 6 / 26 / 21.42). ESR increased rapidly by 12 / 36 / 33.33, and then 8 / 8 / 4816.67% of normal occult blood was positive.) hypoproteinemia was more than 8 / 48. The leucocyte of 10 / 10 / 48 / 20.83 / 40 patients with leukocyte hypertrophy in active stage or with infection were examined by X-ray barium meal or CT. The results showed that there were 10 cases of thickening of intestinal wall, 18 cases of lumen stenosis, 16 cases of mucosal flattening, and 8 cases of multiple intestinal lesions. There were 12 cases of intestinal fistula and 38 cases of enteroscopy. Among them, 25 patients with Crohn's disease (65.79) and 42 patients with Crohn's disease involved in the ends of large intestine and ileum were found to have accumulated inflammation of the whole wall of intestine in 20 cases (47.61%). Non-cheese necrosis, granulation tissue formation in 22 cases, including fibrous tissue proliferative changes in 4 cases, lymphocyte aggregation in 2 cases (2.38). Conclusion: the incidence of CD in patients with Crohn's disease has increased in recent 12 years. The number of CD patients in our hospital is more than that in women. Most of the patients were diagnosed with abdominal pain and diarrhea. Crohn's disease was more common in the terminal ileum and adjacent colon, and the clinical manifestations were various. And lack of specific manifestations, difficult diagnosis, easy to delay the diagnosis and treatment. Need to be combined with the clinical manifestations of patients, imaging, digestive endoscopy. Comprehensive judgement of pathology and tracking data. CD patients are mainly treated by internal medicine at present. Surgical treatment is adopted in the case of ineffective medical treatment or serious complications. As the age increases, so does the chance of surgery. Older patients have a more severe condition than younger patients, and the prognosis of CD patients is poor.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R574.62

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