摘要
目的比较CD与原发性肠道淋巴瘤(PIL)的临床特点,探寻对鉴别诊断有价值的相关指标。方法纳入2010年至2017年在解放军总医院第七医学中心消化内科确诊为CD和PIL的患者共91例,其中CD 76例,PIL 14例,CD继发淋巴瘤1例。回顾性分析纳入患者的病历资料,统计学方法采用t检验、非参数检验或卡方检验。结果CD患者的确诊年龄为(37.7±16.0)岁,小于PIL患者的(52.6±19.6)岁,差异有统计学意义(t=-3.085,P=0.003)。CD患者的病程中位数为36.0个月,长于PIL患者的3.5个月,差异有统计学意义(Z=-3.616,P<0.01)。腹痛、肠外表现(口腔溃疡、关节损伤、结节性红斑和肛周病变等)在CD患者中更常见,差异均有统计学意义(χ2=9.427、5.173,P均<0.05)。CD患者单凭肠镜下活组织检查未能获得确诊;14例PIL患者中,13例经肠镜下活组织检查和免疫组织化学检查确诊,1例经术后确诊;PIL组病理活组织检查确诊率高于CD组,差异有统计学意义(χ2=82.584,P<0.01)。1例患者初期临床诊断为CD,采用英夫利西单克隆抗体治疗5次后继发淋巴瘤。结论年轻、病程长、腹痛、肠外表现等更支持CD诊断,而PIL在肠镜下活组织检查的确诊率较CD高。
Objective To explore the valuable indicators for differential diagnosis by comparing the clinical features of Crohn′s disease(CD)with primary intestinal lymphoma(PIL).Methods From 2010 to 2017,at The Seventh Medical Center of PLA General Hospital,a total of 91 patients diagnosed with CD or PIL were enrolled,including 76 cases of CD,14 cases of PIL and one case of CD with secondary lymphoma.The clinical data of enrolled patients were retrospectively analyzed.T-test,non-parametric test and chi-square test were used for statistical analysis.Results The average age at diagnosis of CD patients was(37.7±16.0)years,which was younger than that of PIL patients(52.6±19.6)years,and the difference was statistically significant(t=-3.085,P=0.003).The median duration of CD was 36.0 months,which was longer than that of PIL(3.5 months),and the difference was statistically significant(Z=-3.616,P<0.01).Abdominal pain and extra-intestinal manifestations(oral ulcers,joint injuries,erythema nodosum and perianal lesions)were more common in CD patients,and the differences were all statistically significant(χ2=9.427 and 5.173,both P<0.05).CD patients were not diagnosed by colonoscopic biopsy alone.Totally 13 of 14 patients were diagnosed by colonoscopic biopsy and immunohistochemisty and one patient was diagnosed after surgery.The diagnostic rate of pathological biopsy in PIL group was significantly higher than that in CD group(χ2=82.584,P<0.01).One patient was initially clinically diagnosed as CD,and then developed secondary lymphoma after five times of infliximab treatment.Conclusions The diagnosis of CD is generally supported by young age,long course of disease,abdominal pain and extra-intestinal manifestations.The diagnostic rate of colonoscopic biospsy in PIL patients is higher than that in CD patients.
作者
贾燕
陈诚
盛剑秋
王继恒
杨善兵
李世荣
Jia Yan;Chen Cheng;Sheng Jianqiu;Wang Jiheng;Yang Shanbing;Li Shirong(Department of Gastroenterology,The Seventh Medical Center of PLA General Hospital,Beijing 100700,China;School of Basic Medical Sciences,Naval Medical University,Shanghai 200433,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2019年第10期674-677,共4页
Chinese Journal of Digestion
