Wu Xi, Lu Xing-hua
Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Nei Ke Za Zhi. 2006 Aug;45(8):661-3.
To investigate the possibility to classified Chinese patients with Crohn's disease by the Vienna criteria and clinical features between subtypes. To investigate the clinical significance of anti-saccharomyces cerevisiae antibodies (ASCAs) in Crohn's disease.
We identified 71 cases of Crohn's disease in our hospital during the past five years by searching the electronic medical recording system of the hospital. Clinical data were retrieved. All subjects were classified into subtypes by the Vienna classification, which was established on three criteria: the age at diagnosis, the lesion location and the disease behavior. The disease course, medical and surgical treatment, the detection of serum ASCAs were also abstracted for each subject. The clinical features, disease course and management were compared between subgroups.
The lesion location in patients diagnosed at the age of less than 40 years old was different from that in patients diagnosed after 40, although the difference was not significant (P = 0.085). The ileocolon and terminal ileum were the most common lesions in those early-diagnosed patients, while the lesions in terminal ileum and colon dominated in the late-diagnosed ones. The complications (structuring or perforation) were significantly different in subgroups with different lesion locations (L1 90.5%, L2 50.0%, L3 50.0%, L4 85.7%, P = 0.012), among which the terminal ileum involvement had the highest incidence of complications. The subjects with complications had significantly longer courses [B1 (35.39 +/- 37.11) ms, B2 (87.12 +/- 116.66) ms, B3 (90.65 +/- 93.50) ms, B1 vs non B1, P = 0.023] and more surgical treatments (B1 39.1%, B2 54.6%, B3 70.1%) (B1 vs non B1, P = 0.003) than those pure inflammatory ones. No association was found between the disease course and the age at diagnosis or the lesion location. We did not find difference in medical treatments between subgroups either. ASCAs positive subjects had shorter disease course [(54.12 +/- 74.36) ms vs (84.15 +/- 89.72) ms, P = 0.052] but more surgeries (64.7% vs 30.0%, P = 0.037) than those negative ones.
The age at diagnosis is associated with the lesion location, and the lesion location is associated with the disease behavior. The behavior may change during the disease course. ASCAs expression may be related to early onset and severity of Crohn's disease.
探讨依据维也纳标准及临床特征对中国克罗恩病患者进行亚型分类的可能性。研究抗酿酒酵母抗体（ASCA）在克罗恩病中的临床意义。
通过检索我院电子病历系统，确定过去五年中71例克罗恩病患者。收集临床资料。所有受试者根据维也纳分类法进行亚型分类，该分类基于三个标准：诊断年龄、病变部位和疾病行为。还提取了每位受试者的病程、药物及手术治疗情况、血清ASCA检测结果。比较各亚组间的临床特征、病程及治疗情况。
年龄小于40岁诊断的患者与40岁后诊断的患者病变部位不同，尽管差异无统计学意义（P = 0.085）。早期诊断患者中，回结肠和末端回肠是最常见的病变部位，而晚期诊断患者中，末端回肠和结肠病变为主。不同病变部位亚组的并发症（狭窄或穿孔）有显著差异（L1 90.5%，L2 50.0%，L3 50.0%，L4 85.7%，P = 0.012），其中末端回肠受累并发症发生率最高。有并发症的受试者病程显著更长[B1（35.39±37.11）个月，B2（87.12±116.66）个月，B3（90.65±93.50）个月，B1与非B1比较，P = 0.023]，手术治疗更多（B1 39.1%，B2 54.6%，B3 70.1%）（B1与非B1比较，P = 0.003），高于单纯炎症患者。未发现病程与诊断年龄或病变部位之间存在关联。各亚组间药物治疗也未发现差异。ASCA阳性受试者病程短于阴性受试者[（54.12±74.36）个月对（84.15±89.72）个月，P = 0.052]，但手术更多（64.7%对30.0%，P = 0.037）。
诊断年龄与病变部位相关，病变部位与疾病行为相关。疾病行为可能在病程中发生变化。ASCA表达可能与克罗恩病的早发及严重程度有关。
