【摘要】 目的　分析克罗恩病临床表现的多样性及误诊的主要原因。方法　对最近 5年收治的 30例患者的临床表现、内镜及实验室检查结果 ,结合文献报道 ,分析克罗恩病临床特点与误诊原因。结果患者以青中年为主 ,女略多于男。病变侵犯胃肠道任一部位 ,呈节段性分布 ,常同时侵犯多个部位 ,结肠及小肠最多 ;腹痛与腹泻为主要的肠道症状 ,但尚有低热、消瘦、贫血及皮肤、关节与肛周等多系统症状。内镜有跳跃式分布的溃疡、息肉、狭窄或卵石样改变等破坏与增殖病变并存的特点。活检肉芽肿检出率为 30 .8%。B超可探查出肠道并发症。误诊原因包括对本病认识不足 ;肠道病变多部位性 ,致使临床症状多样化 ;过于强调病理学检查及肉芽肿的诊断意义等。药物与手术治疗 (16例 )均收到积极疗效。结论　本病发病数明显增多 ,临床表现缺乏特异性 ;内镜联合活检 ,加强临床与病理医师沟通是及时、正确诊断的关键更多还原

【Abstract】 Objective To evaluate the diversity of clinical manifestation and factors causing misdiagnosis of Crohn’s disease. Methods Thirty patients of active Crohn’s disease were studied. All their diagnostic and therapeutic data were analysed. Results Most patients were young adults, with a 1.14∶1 female predominance in prevalence. The disease affects any segment or a combination of segments of the alimentary tract from mouth to anus. In particular, the colon and small bowel were the major sites involved. Recurrent episodes of abdominal pain and watery diarrhea were the most common symptoms. Low grade fever, emaciation, anemia, and skin, joint and perianal symptoms could be found. Endoscopy combined with histologic examination of biopsy specimens provided characteristic features with a diagnostic accuracy of 52.9%. Granulomas were identifiable in 30.8% of all biopsy specimens. Transabdominal bowel sonography (TABS) can be used to detect intestinal complications. Factors causing misdiagnosis were: ① insufficient understanding of the disease; ② diverse clinical presentations; ③ over emphasis on the diagnostic value of granulomas in Crohn’s disease.Conclusions Crohn’s disease is not uncommon in China. Abdominal pain and watery diarrhea are two major symptoms. Endoscopy (with biopsy), and transabdominal bowel sonography were both valuable procedures for diagnosis.更多还原