摘要
目的探讨CD患者发生消化道狭窄的危险因素,并总结分析其治疗情况。方法选择2010年1月至2018年12月在解放军总医院第七医学中心住院治疗的CD确诊患者122例,其中消化道狭窄组72例,无消化道狭窄组50例。比较两组患者的性别构成比、发病年龄、病程、病变累及部位(蒙特利尔分型)、疾病活动程度、肠外表现、药物治疗和并发症发生情况,分析发生消化道狭窄CD患者的治疗情况,采用多因素logistic回归分析CD患者发生消化道狭窄的危险因素。统计学方法采用独立样本t检验、Mann-WhitneyU检验和卡方检验。结果消化道狭窄组患者的发病年龄高于无消化道狭窄组[(37.6±15.1)岁比(30.8±14.7)岁],病程长于无消化道狭窄组[72个月(11~492个月)比45个月(3~240个月)],差异均有统计学意义(t=-2.044,Z=-2.770;P=0.018、0.006)。消化道狭窄组病变累及回肠患者比例低于无消化道狭窄组[69.4%(50/72)比86.0%(43/50)],重度患者比例高于无消化道狭窄组[15.3%(11/72)比4.0%(2/50)],差异均有统计学意义(χ2=4.463、3.942,P=0.035、0.047)。两组患者性别构成比、药物使用情况、肠外表现、药物治疗和并发症发生率差异均无统计学意义(P均>0.05)。多因素logistic回归分析结果显示,发病年龄、病程是CD患者发生消化道狭窄的危险因素(β=0.028,OR=1.028,95%CI 1.000~1.056,P=0.046;β=0.008,OR=1.008,95%CI 1.002~1.015,P=0.013)。进一步分层分析结果显示,发病年龄>40岁、病程>5年的CD患者消化道狭窄发生率分别高于发病年龄≤40岁、病程≤5年的患者[分别为76.3%(29/38)比51.2%(43/84)、68.4%(39/57)比50.8%(33/65)],差异均有统计学意义(OR=3.072,95%CI 1.298~7.272,P=0.009;OR=2.101,95%CI 1.002~4.406,P=0.048)。72例发生消化道狭窄的CD患者中,15例(20.8%)予内科药物和营养治疗,均未行内镜下和外科手术治疗。52例(72.2%)行外科手术治疗,6例(11.5%)行2次手术,2次手术中位间隔时间(范围)为46个月(1~204个月),8例(15.4%)患者术后发生并发症。21例(29.2%)患者予内镜下扩张治疗,术后均未发生并发症,术后随访期5例(23.8%)再行外科手术治疗。结论发病年龄>40岁、病程>5年是CD患者发生消化道狭窄的危险因素。个体化内科治疗是CD相关消化道狭窄治疗的基础,外科手术仍是主要的治疗方式,内镜下治疗安全性较高,可一定程度延缓或避免外科手术。
Objective To investigate the risk factors of Crohn′s disease(CD)-related gastrointestinal stenosis,and to summarize and analyze the corresponding treatments.Methods From January 2010 to December 2018,122 patients diagnosed with CD and hospitalized in the Seventh Medical Center,PLA General Hospital were selected including 72 patients in gastrointestinal stenosis group and 50 patients in non-gastrointestinal stenosis group.The gender,age of onset,course of disease,location of lesions involved(Montreal classification),disease activity,extraintestinal manifestations,application of therapeutic drugs,and complications were compared between the two groups.The treatment of CD patients with gastrointestinal stenosis was analyzed.Multivariate logistic regression was used to analyze the risk factors of CD patients with gastrointestinal stenosis.The independent sample t test,Mann-Whitney U test and chi-square test were used for statistical analysis.Results The age of onset of patients in gastrointestinal stenosis group was older than that in non-gastrointestinal stenosis group((37.6±15.1)years old vs.(30.8±14.7)years old),and course of disease was longer than that of non-gastrointestinal stenosis group(72 months,11 to 492 months vs.45 months,3 to 240 months);and the differences were statistically significant(t=-2.044,Z=-2.770;P=0.018,0.006).The proportion of patients with ileum involvement of the gastrointestinal stenosis group was lower than that of the non-gastrointestinal stenosis group(69.4%,50/72 vs.86.0%,43/50),and the proportion of severe patients was higher than that of the non-gastrointestinal stenosis group(15.3%,11/72 vs.4.0%,2/50);and the differences were statistically significant(χ2=4.463 and 3.942,P=0.035 and 0.047).There were no significant differences in gender,use of therapeutic drugs,extraintestinal manifestations,application of therapeutic drugs or the incidence of complications between the patients of two groups(all P>0.05).The results of multivariate logistic regression showed that the age of onset and course of disease were risk factors of CD-related gastrointestinal stenosis(β=0.028,odds ratio(OR)=1.028,95%confidence interval(CI)1.000 to 1.056,P=0.046;β=0.008,OR=1.008,95%CI 1.002 to 1.015,P=0.013).Further stratified analysis revealed that the incidence rates of CD-related gastrointestinal stenosis in patients with age of onset over 40 years old and course of disease more than five years were higher than those of patients with age of onset less than 40 years old and course of disease less than five years(76.3%,29/38 vs.51.2%,43/84;68.4%,39/57 vs.50.8%,33/65),and the differences were statistically significant(OR=3.072,95%CI 1.298 to 7.272,P=0.009;OR=2.101,95%CI 1.002 to 4.406,P=0.048).Among the 72 CD patients with gastrointestinal stenosis,15 cases(20.8%)were treated with medicine and nutrition,without endoscopic or surgical treatment.Fifty-two patients(72.2%)underwent surgical treatment,among them six patients(11.5%)received twice surgery,the interval between the two operations was 46 months(1 to 204 months),and eight patients(15.4%)had postoperative complications.Twenty-one patients(29.2%)were treated with endoscopic dilatation,and no complications occurred after surgery.Five patients(23.8%)underwent surgical treatment during the follow-up period.Conclusions The age of onset over 40 years old and the course of disease more than five years are the risk factors of CD-related gastrointestinal stenosis.Individualized medical treatment is the basis for the treatment of CD-related gastrointestinal stenosis.Surgery is still the main treatment.The endoscopic treatment is safety and can delay or avoid surgery to a certain extent.
作者
杨善兵
杜树文
张丽敏
贾康妹
陆晓娟
李舒
范鑫
贾燕
金鹏
杨欣艳
王继恒
Yang Shanbing;Du Shuwen;Zhang Limin;Jia Kangmei;Lu Xiaojuan;Li Shu;Fan Xin;Jia Yan;Jin Peng;Yang Xinyan;Wang Jiheng(Department of Gastroenterology,The Seventh Medical Center,PLA General Hospital,Beijing 100700,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2020年第9期601-605,共5页
Chinese Journal of Digestion
基金
首都卫生发展科研专项项目(2018-1-5091)
国家科技部重点研发计划(2017YFC0112304)。
