Goldberg H I, Caruthers S B, Nelson J A, Singleton J W
Gastroenterology. 1979 Oct;77(4 Pt 2):925-37.
On-study barium radiographs of 535 patients in the National Cooperative Crohn's Disease Study have been analyzed for the pattern of distribution of bowel disease and the individual features that characterized bowel involvement. On-study and off-study radiographs of 403 of these patients were compared under code to judge radiographic response to drug treatment and discover correlations of radiographic findings with clinical response. Patients with more clinically active disease had more colonic disease on x-ray. Duodenal abnormalities were recognized in 22% of the patients and radiographically typicaly Crohn's disease of the duodenum in 8%. Recurrent Crohn's disease and that characterized by small bowel obstruction each displayed a characteristic appearance. Overall there was little evidence of radiographic improvement during the study, and little correlation between clinical response and evidence of radiologic improvement. Only patients treated with prednisone for more than 6 mo showed statistically significant radiologic improvement. Patients with definite radiographic progression or regression were found in each treatment group. Both fistula and stricture with obstruction were associated with a poor clinical response to all therapies. In view of the evidence from this study that radiographic findings do not correlate with clinical symptoms or response, the ritual use of x-ray to follow patients with Crohn's disease is unnecessary.
对全国合作性克罗恩病研究中535例患者的研究期间钡剂造影X线片进行了分析，以了解肠道疾病的分布模式以及肠道受累的个体特征。对其中403例患者的研究期间和研究结束后的X线片进行了编码比较，以判断对药物治疗的X线反应，并发现X线表现与临床反应之间的相关性。临床疾病活动度较高的患者，其结肠疾病在X线片上表现更为明显。22%的患者存在十二指肠异常，其中8%为十二指肠典型的克罗恩病X线表现。复发性克罗恩病和以小肠梗阻为特征的克罗恩病各有其特征性表现。总体而言，研究期间几乎没有X线改善的证据，临床反应与放射学改善证据之间也几乎没有相关性。只有接受泼尼松治疗超过6个月的患者显示出有统计学意义的放射学改善。每个治疗组中均发现有明确X线进展或退行的患者。瘘管和伴有梗阻的狭窄均与所有治疗的临床反应不佳相关。鉴于本研究的证据表明X线表现与临床症状或反应无关，对克罗恩病患者例行进行X线检查并无必要。
