【摘要】 目的通过分析住院患者的临床资料,以期提高克罗恩病(CD)的早期诊断水平。方法对该医院1996年1月～2005年5月58例出院诊断为CD患者的临床表现、确诊时间、诊断方法、不同时期血沉、CRP的变化、误诊情况以及治疗和预后等进行总结和回顾分析。结果腹痛(86.9%)、腹泻(69.6%)为本组患者最常见的胃肠道症状,消化道出血(32.7%)、肛周病变(18.9%)的发生率亦较高。病变在回盲部者35例(60.3%)。56例活动期CD和18例复发期CD的血沉和CRP比其缓解期明显增高。结肠镜、消化道X线、胶囊内镜及双气囊推进式小肠镜检查的阳性率分别为77.1%,63.2%,75%及100%。内镜活检病理发现非干酪性肉芽肿10例(27.8%)。初诊误诊24例(41.4%)。糖皮质激素联合5-氨基水杨酸治疗活动期CD缓解47例(81%)。结论CD临床表现复杂多样,误诊率高,血沉及CRP在CD随访中有一定价值。CD好发于回盲部。结肠镜检查是末段回肠和结直肠病变最主要的诊断方法,双气囊推进式小肠镜对早期诊断小肠CD有重要价值。确诊CD不依赖于病理发现非干酪性肉芽肿,需结合病史、临床表现、X线钡餐、内镜及病理综合判断。更多还原

【Abstract】 [Objective] To find valuable diagnostic methods and indexes that can reflect the state of the illness and be easily done for improving the accuracy of early diagnosis by analyzing the clinical data of inpatients diagnosed as CD. [Methods] Fifty-eight inpatients of Nan-fang hospital diagnosed as CD from January 1996 to May 2005 were enrolled. Their clinical manifestations, time of final diagnosis, diagnostic methods, the changes of ESR and CRP, state of misdiagnosis, therapeutics and prognosis were retrospectively analyzed. [Results] The most common gastrointestinal symptoms of these patients were abdominal pain(86.9%)and diarrhea(69.6%). Gastrointestinal bleeding(32.7%)and lesions of crissum(18.9%) are also frequent. The sites of terminal ileum and cecum are 35(60.8%). The average number of ESR and CRP in 56 cases of active CD is abviously higher than silent CD ,and 18 cases of relapse is also abviously higher than silent CD. The positive rate of colonoscopy, X-ray of gastrointestinal tract, capsule endoscopy and double-balloon enteroscopy is 77.1%,63.2%,75% and 100% respectively. Non-caseating granulomas was found by biopsy in 10 patients(27.8%).24 patients(41.4%) were misdiagnosed at the first time of admission.47 patients(81%) of active CD treated by cortex hormone and 5-ASA were improved. [Conclusion] The diversity and non-specificity of the clinical manifestations of CD may cause delayed diagnosis. ESR and CRP are valuable methods to judge the state of illness. Most sites of CD are in terminal ileum and cecum. Coloscopy is a key method for diagnosis of colorectal CD. Double-balloon enteroscopy is a valuable method for early diagnosis of small bowel CD. Non-caseating granulomas is not a necessary index to diagnose CD, which should be judged by the history, X-ray, endoscope and pathology.更多还原