本文關(guān)鍵詞： 克羅恩病 臨床特征 缺乏特異性 病理組織學(xué)　出處：《大連醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:回顧性歸納分析大連醫(yī)科大學(xué)第二附屬醫(yī)院從2002年9月13日至2014年9月6日期間所有確診克羅恩病(Crohn’S disease,CD)患者的臨床特點(diǎn),進(jìn)一步增進(jìn)對(duì)克羅恩病(CD)的認(rèn)識(shí)。方法:對(duì)48例確診的CD住院患者的臨床特點(diǎn)、實(shí)驗(yàn)室檢查、內(nèi)鏡檢查及病理學(xué)改變、X線、CT以及MRI影像學(xué)表現(xiàn)等數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:在48例住院克羅恩病(CD)患者中,男性32例,女性16例,男性多于女性(2:1),年齡分布從18到85歲之間,平均年齡(46.83±4.10)歲,其中20~40歲占37.5%,60歲以上占29.17%。病程:1 d~13年(中位病程10.4個(gè)月)。其中小腸病變12例(25%)、回-結(jié)腸多發(fā)病變26例(54.17%)、大腸病變10例(20.83%)。48例克羅恩病(CD)患者中最常見的癥狀是腹痛為44例(91.67%)、大便異常22例(45.83%)。CD并發(fā)癥較多,主要為腸梗阻、瘺管及穿孔,其中14例(29.16%)出現(xiàn)腸梗阻,12例(25%)出現(xiàn)穿孔,腸外表現(xiàn)10例(20.83%),8例(16.66%)發(fā)生瘺管形成。其中8例(12.5%)CD患者被誤診。實(shí)驗(yàn)室檢測(cè):C反應(yīng)蛋白增高(6/26,21.42%)、血沉增快(12/36,33.33%)、便常規(guī)+潛血陽(yáng)性(8/48,16.67%)低蛋白血癥(8/48,16.67%)。病變?cè)诨顒?dòng)期或合并感染時(shí)白細(xì)胞高10例(10/48,20.83%),40例患者接受腸道X線鋇餐或CT檢查,結(jié)果發(fā)現(xiàn):腸壁增厚10例(25%)、管腔狹窄18例(39.10%)、黏膜變平16例(34.78%)、腸道多發(fā)性病變8例(33.33%)、腸瘺12例(30%)。接受腸鏡檢查的患者為38例,其中克羅恩病患者中有25例(65.79%)累及大腸和回腸末端的。42例克羅恩病患者病理學(xué)檢查發(fā)現(xiàn):累積腸壁全層炎癥20例(47.61%),非干酪樣壞死、肉芽組織形成22例(52.38%),其中纖維組織增生性改變4例(4.76%)、淋巴細(xì)胞聚集2例(2.38%)、隱窩膿腫形成2例(4.76%)。結(jié)論:本院近12年來(lái)克羅恩病(CD)患者的發(fā)病率有所增加。我院CD患者中男性多于女性,多發(fā)病例在20~50歲之間,未發(fā)現(xiàn)雙峰分布現(xiàn)象�；颊叨嘁愿雇�、腹瀉就診。其中克羅恩病多好發(fā)于末端回腸和鄰近的結(jié)腸,臨床表現(xiàn)多種多樣,并且缺乏特異性表現(xiàn),診斷困難,容易延誤診治。需結(jié)合患者的臨床表現(xiàn)、影像學(xué)、消化內(nèi)鏡、病理學(xué)以及追蹤資料等綜合判斷。CD患者目前以內(nèi)科治療為主,在內(nèi)科治療無(wú)效或出現(xiàn)嚴(yán)重并發(fā)癥的情況下采取手術(shù)治療,隨著年齡的增加手術(shù)幾率也隨之增加。老年患者相對(duì)年輕患者有一個(gè)較重的病情,CD患者預(yù)后不佳。
[Abstract]:Objective: to analyze retrospectively all the confirmed Crohn's disease (Crohn's disease) disease in the second affiliated Hospital of Dalian Medical University from September 13th 2002 to September 6th 2014. Methods: the clinical features, laboratory examination, endoscopy and pathological changes of 48 patients with CD were studied. Results: among 48 patients with Crohn's disease, 32 were male and 16 were female. The age distribution ranged from 18 to 85 years old, with an average age of 46.83 鹵4.10 years, of which 20 or 40 years old accounted for 37.5%. The course of disease was from 1 day to 13 years (median course was 10.4 months). Gyneco-colonic disease occurred frequently in 26 cases (54.17). The most common symptom in 10 patients with colorectal lesions (20.83%) was abdominal pain in 44 cases (91.67%). 22 cases of abnormal stool (45.83%) had more complications, mainly intestinal obstruction, fistula and perforation, of which 14 cases (29.16) had intestinal obstruction and 12 cases (25%) perforation. Extra-intestinal manifestations were found in 10 cases (20. 83%). Fistula was found in 8 cases. Among them, 8 cases with 12.5CD were misdiagnosed. The laboratory test showed that the proportion of C-reactive protein increased by 6 / 26 / 21.42). ESR increased rapidly by 12 / 36 / 33.33, and then 8 / 8 / 4816.67% of normal occult blood was positive.) hypoproteinemia was more than 8 / 48. The leucocyte of 10 / 10 / 48 / 20.83 / 40 patients with leukocyte hypertrophy in active stage or with infection were examined by X-ray barium meal or CT. The results showed that there were 10 cases of thickening of intestinal wall, 18 cases of lumen stenosis, 16 cases of mucosal flattening, and 8 cases of multiple intestinal lesions. There were 12 cases of intestinal fistula and 38 cases of enteroscopy. Among them, 25 patients with Crohn's disease (65.79) and 42 patients with Crohn's disease involved in the ends of large intestine and ileum were found to have accumulated inflammation of the whole wall of intestine in 20 cases (47.61%). Non-cheese necrosis, granulation tissue formation in 22 cases, including fibrous tissue proliferative changes in 4 cases, lymphocyte aggregation in 2 cases (2.38). Conclusion: the incidence of CD in patients with Crohn's disease has increased in recent 12 years. The number of CD patients in our hospital is more than that in women. Most of the patients were diagnosed with abdominal pain and diarrhea. Crohn's disease was more common in the terminal ileum and adjacent colon, and the clinical manifestations were various. And lack of specific manifestations, difficult diagnosis, easy to delay the diagnosis and treatment. Need to be combined with the clinical manifestations of patients, imaging, digestive endoscopy. Comprehensive judgement of pathology and tracking data. CD patients are mainly treated by internal medicine at present. Surgical treatment is adopted in the case of ineffective medical treatment or serious complications. As the age increases, so does the chance of surgery. Older patients have a more severe condition than younger patients, and the prognosis of CD patients is poor.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R574.62

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本文編號(hào)：1477958