炎症性肠病中的杵状指：与克罗恩病的上小肠病变和手术需求相关。
Finger clubbing in inflammatory bowel disease: association with upper small bowel lesions and need of surgery in Crohn's disease.
机构信息
Department of Systems Medicine, GI Unit, University "Tor Vergata" of Rome.
GI Unit, ASST, Hospital Maggiore of Crema, Crema.
出版信息
Eur J Gastroenterol Hepatol. 2021 Jun 1;33(6):844-851. doi: 10.1097/MEG.0000000000001966.
OBJECTIVE
Finger clubbing has been associated with inflammatory bowel disease (IBD).
AIMS
In a prospective single-center study, we aimed to assess the frequency of finger clubbing in a cohort of IBD patients. Whether finger clubbing is associated with clinical characteristics of IBD was also investigated.
METHODS
IBD patients with a detailed clinical history were enrolled. Finger clubbing was assessed by visual inspection. Data were expressed as median (range), chi-square, t-test. Multivariate logistic regression analysis was used to assess risk factors for finger clubbing, when considering demographic and clinical characteristics, smoking habits and chronic pulmonary diseases (CPD).
RESULTS
Finger clubbing was searched in 470 IBD patients: 267 Crohn's disease and 203 ulcerative colitis. Finger clubbing was more frequent in Crohn's disease than in ulcerative colitis: 45/267 (16.8%) vs. 15/203 (7.3%) [odds ratio (OR), 2.54 (1.37-4.70); P = 0.003]. Crohn's disease involved the ileum (59.9%), colon (4.5%), ileum-colon (25.8%) and upper gastrointestinal (GI) (9.8%). Ulcerative colitis extent included proctitis (E1) (13.4%), left-sided (E2) (43.3%) and pancolitis (E3) (43.3%). Upper GI lesions, but not other Crohn's disease localizations, were more frequent in patients with finger clubbing [9/45 (20%) vs. 17/222 (7.7%); P = 0.032]. Crohn's disease-related surgery was more frequent in patients with finger clubbing [36/45 (80%) vs. 107/222 (48.1%); P < 0.001]. In Crohn's disease, the only risk factors for finger clubbing were upper GI lesions and Crohn's disease-related surgery [OR, 2.58 (1.03-6.46), P = 0.04; OR, 4.07 (1.86-8.91), P = 0.006]. Ulcerative colitis extent was not associated with finger clubbing [E1: OR, 0.27 (0.02-3.44), P = 0.33; E2: OR, 0.93 (0.24-3.60), P = 0.92; E3:OR, 0.64 (0.22-1.86), P = 0.59]. In ulcerative colitis, but not in Crohn's disease, finger clubbing was more frequent in smokers [13/15 (86.6%) vs. 99/188 (52.6%); P = 0.01] and in patients with CPD [5/15 (33.3%) vs. 16/188 (8.5%); P = 0.002]. Smoking and CPD were the only risk factors for finger clubbing in ulcerative colitis [OR, 7.18 (1.44-35.78), P = 0.01; OR, 10.93 (2.51-47.45), P = 0.001].
CONCLUSION
In the tested IBD population, finger clubbing was more frequent in Crohn's disease than in ulcerative colitis. In Crohn's disease, upper GI lesions and history of Crohn's disease-related surgery were risk factors for finger clubbing, suggesting the possible role of finger clubbing as a subclinical marker of Crohn's disease severity.
目的
杵状指与炎症性肠病（IBD）有关。
目的
在一项前瞻性单中心研究中，我们旨在评估 IBD 患者队列中杵状指的频率。还研究了杵状指是否与 IBD 的临床特征有关。
方法
纳入有详细病史的 IBD 患者。通过视觉检查评估杵状指。数据表示为中位数（范围），卡方检验，t 检验。多变量逻辑回归分析用于评估考虑人口统计学和临床特征、吸烟习惯和慢性肺部疾病（CPD）时杵状指的危险因素。
结果
在 470 名 IBD 患者中搜索到杵状指：267 名克罗恩病和 203 名溃疡性结肠炎。克罗恩病中杵状指比溃疡性结肠炎更常见：45/267（16.8%）比 15/203（7.3%）[比值比（OR），2.54（1.37-4.70）；P=0.003]。克罗恩病累及回肠（59.9%）、结肠（4.5%）、回肠-结肠（25.8%）和上胃肠道（GI）（9.8%）。溃疡性结肠炎的范围包括直肠炎（E1）（13.4%）、左侧结肠炎（E2）（43.3%）和全结肠炎（E3）（43.3%）。上胃肠道病变，但不是其他克罗恩病的定位，在有杵状指的患者中更常见[9/45（20%）比 17/222（7.7%）；P=0.032]。克罗恩病相关手术在有杵状指的患者中更常见[36/45（80%）比 107/222（48.1%）；P<0.001]。在克罗恩病中，杵状指的唯一危险因素是上胃肠道病变和克罗恩病相关手术[OR，2.58（1.03-6.46），P=0.04；OR，4.07（1.86-8.91），P=0.006]。溃疡性结肠炎的范围与杵状指无关[E1：OR，0.27（0.02-3.44），P=0.33；E2：OR，0.93（0.24-3.60），P=0.92；E3：OR，0.64（0.22-1.86），P=0.59]。在溃疡性结肠炎中，但不在克罗恩病中，吸烟者[13/15（86.6%）比 188/188（52.6%）；P=0.01]和有 CPD 的患者[5/15（33.3%）比 188/188（8.5%）；P=0.002]中杵状指更常见。吸烟和 CPD 是溃疡性结肠炎中杵状指的唯一危险因素[OR，7.18（1.44-35.78），P=0.01；OR，10.93（2.51-47.45），P=0.001]。
结论
在测试的 IBD 人群中，克罗恩病中杵状指比溃疡性结肠炎更常见。在克罗恩病中，上胃肠道病变和克罗恩病相关手术史是杵状指的危险因素，提示杵状指可能是克罗恩病严重程度的亚临床标志物。
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