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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (02) : 121 -127. doi: 10.3877/cma.j.issn.2095-2015.2024.02.004

论著

不同亚型上消化道克罗恩病的临床特点和预后差异研究
陈憩1, 顾于蓓2,†()   
  1. 1. 200025　上海交通大学医学院附属瑞金医院放射科
    2. 200025　上海交通大学医学院附属瑞金医院消化科
  • 收稿日期:2023-10-12 出版日期:2024-04-01
  • 通信作者: 顾于蓓
  • 基金资助:
    上海市卫生健康委员会卫生行业临床研究专项基金(202040110); 广慈创新技术启航计划(GCQH-2023-08)

Clinical features and prognosis in different subtypes of upper gastrointestinal Crohn's disease patients

Qi Chen1, Yubei Gu2,†()   

  1. 1. Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200025, China
    2. Department of Gastroenterology, Rui Jin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200025, China
  • Received:2023-10-12 Published:2024-04-01
  • Corresponding author: Yubei Gu
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引用本文：

陈憩, 顾于蓓. 不同亚型上消化道克罗恩病的临床特点和预后差异研究[J]. 中华消化病与影像杂志(电子版), 2024, 14(02): 121-127.

Qi Chen, Yubei Gu. Clinical features and prognosis in different subtypes of upper gastrointestinal Crohn's disease patients[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(02): 121-127.

目的

探究不同亚型上消化道克罗恩病（CD）患者的临床特点和预后差异。

方法

连续性纳入2017—2021年上海瑞金医院初诊CD患者，结合内镜与病理结果将患者分为上消化道累及组（UGI＋组）和非上消化道累及组（UGI－组）。分析CD患者上消化道累及率、UGI＋组内镜下特点及严重程度；采用Kaplan-Meier方法描绘生存曲线，分析UGI＋组与UGI－组3年持续无手术率与无并发症率差异性。并进一步将UGI＋组患者按是否十二指肠球部受累进行分组，比较不同亚型间预后的差异性。

结果

76例患者纳入研究，在上消化道内镜检查中发现46例（60.5%）患者存在68处阳性内镜表现。内镜特点多样，其中胃底竹节样外观是发生率最高的上消化道内镜表现形式（20.6%），其次依次为十二指肠球部溃疡（17.6%）和十二指肠球部结节样增生（14.7%）。随访后得出UGI＋组与UGI－组在3年持续无手术率和无并发症率间无明显差异（P>0.05）。进一步分组分析发现：UGI－组、CD上消化道累及非十二指肠球部组（UGI＋DB－组）与CD上消化道累及十二指肠球部组（UGI＋DB＋组）的3年持续无事件率分别为88.9%、87.9%、68.0%。其中UGI＋DB＋组的3年无事件率显著低于UGI－组和UGI＋DB－组（P<0.05）。

结论

初诊CD患者上消化道累及现象并非少见，其内镜下表现形式多样。提倡初诊CD患者无论有无上消化道症状均进行胃镜检查。当患者累及部位为十二指肠球部则在随访中表现为明显的手术率或并发症率增高，对于该部分患者应尽早给予积极治疗，以期改善预后。

关键词: 上消化道克罗恩病, 亚型, 临床特点, 预后
Objective

To analyze the clinical characteristics and prognosis in different subtypes of upper gastrointestinal Crohn's disease (CD) patients.

Methods

CD patients treated at Shanghai Ruijin Hospital from 2017 to 2021 were enrolled. They were divided into the upper gastrointestinal tract involvement (UGI+) group and non-upper gastrointestinal tract involvement (UGI-) group based on endoscopic and pathological findings. The upper gastrointestinal tract involvement rate of CD patients, the endoscopic characteristics and severity of UGI+ group were analyzed. Kaplan Meier method was used to survival curve, and the differences of 3-year continuous operation-free rate and complication free rate between UGI+ and UGI- group were analyzed. Patients in the UGI+ group were further divided according to whether duodenal bulb was involved, and the difference of prognosis among different subtypes was compared.

Results

A total of 76 patients were included in this study, among which 46 cases had 68 positive endoscopic findings. Endoscopic features were diverse and the bamboo joint-like appearance of the gastric fundus had the highest incidence (20.6%), followed by duodenal ulcers (17.6%) and protruding lesions of the duodenal bulb (14.7%). After follow-up, there was no significant difference between the UGI+ group and the UGI- group in the 3-year continuous operation-free rate (P>0.05). Further subgroup analysis showed that the 3-year event-free rate in the UGI- group, CD upper digestive tract involving non-duodenal bulb group (UGI+DB- group) and CD upper digestive tract involving duodenal bulb group (UGI+DB+ group) were 88.9%, 87.9% and 68.0%, respectively. The 3-year event-free rate of the UGI+DB+ group was significantly lower than that in the UGI- group and UGI+DB- group (P<0.05).

Conclusion

Upper gastrointestinal involvement is not uncommon in newly diagnosed CD patients, and its endoscopic manifestations are varied. Endoscopy should be recommended to newly diagnosed CD patients regardless of asymptomatic gastrointestinal symptoms. UGI+ patients with duodenal bulb involvement have significantly higher rates of surgery or complications. Therefore, active treatment should be promptly provided to this subgroup of patients to improve their prognosis.

Key words: Upper gastrointestinal Crohn's disease, Subtypes, Clinical characteristics, Prognosis
图1 研究流程图
表1 克罗恩病患者一般情况和临床特点（例）
组别 例数 性别 初诊年龄≤25岁 病程≥5年 身高≥170 cm 体重指数≤18 kg/m2 吸烟
男性 女性
UGI+组 46 34 12 23 17 29 24 15
UGI-组 30 16 14 11 13 12 16 10
总体[例(%)] 76 50 (65.8) 26 (34.2) 34(44.7) 30(39.5) 41(53.9) 40(52.6) 25(32.9)
组别 例数 临床表现
腹痛 腹泻 便血 黑便 贫血 发热 上消化道症状 瘘管
UGI+组 46 36 32 16 4 28 7 11 17
UGI-组 30 28 18 13 3 22 7 7 9
总体[例(%)] 76 64 (84.2) 50 (65.8) 29 (38.2) 7 (9.2) 50 (65.8) 14(18.4) 18 (23.7) 26 (34.2)
组别 例数 疾病受累部位 肛周病变 疾病行为 克罗恩病活动评分
L1 (回肠型CD) L2 (结肠型CD) L3 (回结肠型CD) B1 (非穿透非狭窄型) B2 (狭窄型) B3 (穿透型) <150 150-450 >450
UGI+组 46 7 0 39 13 32 12 2 2 43 1
UGI-组 30 9 1 20 8 18 7 5 2 27 1
总体[例(%)] 76 16(21.1) 1 (1.3) 59(77.6) 21 (27.6) 50(65.8) 19 (25.0) 7 (9.2) 4 (5.3) 70 (92.1) 2 (2.6)
图2 上消化道克罗恩病内镜表现注：2A食管中段可见阿弗他溃疡；2B胃窦线状溃疡；2C幽门处深大溃疡；2D胃窦结节样增生；2E十二指肠球部结节样增生；2F十二指肠球部结节样增生导致肠腔狭窄；2G胃底可见竹节样。
表2 上消化道克罗恩病内镜特点（例）
受累部位 溃疡 结节样增生 竹节样改变 狭窄 瘘管
食管 4 0 0 0 1
胃底 0 0 14 0 0
胃体 1 1 0 0 0
胃角 1 0 0 0 0
胃窦 5 6 0 0 1
幽门 4 0 0 2 0
十二指肠球部 12 10 0 2 0
十二指肠降段 4 0 0 0 0
总数[例(%)] 31(45.6) 17(25.0) 14(20.6) 4(5.9) 2(2.9)
图3 Kaplan-Meier曲线图
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