孤立性小肠克罗恩病与其他小肠溃疡性疾病的鉴别：临床特征与双气囊小肠镜特征
Differentiation of Isolated Small Bowel Crohn's Disease from Other Small Bowel Ulcerative Diseases: Clinical Features and Double-Balloon Enteroscopy Characteristics.
作者信息
Niu Meng, Chen Zheng-Hao, Li Meng, Zhang Xing, Chen Chun-Xiao
机构信息
Department of Gastroenterology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China.
Department of Gastroenterology, Yiwu Fuyuan No. 1 Hospital, Yiwu, Zhejiang Province 322000, China.
出版信息
Gastroenterol Res Pract. 2022 May 30;2022:5374780. doi: 10.1155/2022/5374780. eCollection 2022.
BACKGROUND
The diagnosis of isolated small bowel Crohn's disease (ISBCD) has always been challenging.
AIMS
This study is aimed at comparing the clinical features and double-balloon enteroscopy (DBE) characteristics of ISBCD with those of other small bowel ulcerative diseases (OSBUD).
METHODS
Patients with coexisting colonic and/or ileal valve lesions ( = 45) or whose final diagnosis was not determined ( = 29) were excluded. One hundred thirty-nine patients with ISBCD and 62 patients with OSBUD found by DBE were retrospectively analyzed.
RESULTS
The age of ISBCD onset was lower than that of OSBUD (OR 0.957, 95% CI 0.938-0.977, < 0.001). Abdominal pain was more common in ISBCD (OR 4.986, 95% CI 2.539-9.792, < 0.001). Elevated fibrinogen levels (OR 1.431, 95% CI 1.022-2.003, = 0.037) and lower levels of D-dimer (OR 0.999, 95% CI 0.999-1.000, = 0.017) were also more supportive of the diagnosis of ISBCD. Nonsteroidal anti-inflammatory drugs (NSAIDs) used for more than two weeks decreased the probability of a diagnosis of ISBCD (OR 0.173, 95% CI 0.043-0.695, = 0.013). Abdominal computed tomography revealed a higher proportion of skip lesions in ISBCD than in OSBUD (OR 9.728, 95% CI 3.676-25.742, < 0.001). The ulcers of ISBCD were more distributed in the ileum (111 (79.9%) vs. 29 (46.8%), < 0.001), and their main morphology differed in different intestinal segments. Longitudinal ulcers (OR 14.293, 95% CI 4.920-41.518, < 0.001) and large ulcer (OR 0.128, 95% CI 0.044-0.374, < 0.001) contributed to the differentiation of ISBCD from OSBUD. We constructed a diagnostic model, ISBCD index (AUROC = 0.877, 95% CI: 0.830-0.925), using multifactorial binary logistic regression to help distinguish between these two groups of diseases.
CONCLUSION
Clinical features, laboratory tests, abdominal computed tomography, DBE characteristics, and pathology help to distinguish ISBCD from OSBUD.
背景
孤立性小肠克罗恩病（ISBCD）的诊断一直具有挑战性。
目的
本研究旨在比较ISBCD与其他小肠溃疡性疾病（OSBUD）的临床特征及双气囊小肠镜（DBE）特征。
方法
排除合并结肠和/或回肠瓣膜病变的患者（n = 45）或最终诊断未明确的患者（n = 29）。对139例经DBE发现的ISBCD患者和62例OSBUD患者进行回顾性分析。
结果
ISBCD发病年龄低于OSBUD（OR 0.957，95%CI 0.938 - 0.977，P < 0.001）。腹痛在ISBCD中更常见（OR 4.986，95%CI 2.539 - 9.792，P < 0.001）。纤维蛋白原水平升高（OR 1.431，95%CI 1.022 - 2.003，P = 0.037）和D - 二聚体水平降低（OR 0.999，95%CI 0.999 - 1.000，P = 0.017）也更支持ISBCD的诊断。使用超过两周的非甾体抗炎药（NSAIDs）降低了ISBCD的诊断概率（OR 0.173，95%CI 0.043 - 0.695，P = 0.013）。腹部计算机断层扫描显示，ISBCD中跳跃性病变的比例高于OSBUD（OR 9.728，95%CI 3.676 - 25.742，P < 0.001）。ISBCD的溃疡更常见于回肠（111例（79.9%）对29例（46.8%），P < 0.001），且其主要形态在不同肠段有所不同。纵行溃疡（OR 14.293，95%CI 4.920 - 41.518，P < 0.001）和大溃疡（OR 0.128，95%CI 0.044 - 0.374，P < 0.001）有助于ISBCD与OSBUD的鉴别。我们使用多因素二元逻辑回归构建了一个诊断模型，即ISBCD指数（AUROC = 0.877，95%CI：从0.830至0.925），以帮助区分这两组疾病。
结论
临床特征、实验室检查、腹部计算机断层扫描、DBE特征及病理有助于ISBCD与OSBUD的鉴别。
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