Kitis G, Thompson H, Allan R N
Br Med J. 1979 Oct 6;2(6194):825-8. doi: 10.1136/bmj.2.6194.825.
Finger clubbing, measured objectively by using the hyponychial angle, was present in 75 out of 200 (38%) patients with Crohn's disease, 15 out of 103 (15%) with ulcerative colitis, and two out of 24 (8%) with proctitis. In Crohn's disease and ulcerative colitis the hyponychial angle was significantly correlated with both disease activity and the extent of fibrosis in the resected specimens from 47 surgically treated patients. The prevalence of finger clubbing in patients with macroscopic disease within the area of the gut innervated by the vagus nerve was significantly higher than that in patients in whom the disease was confined to the distal colon and rectum. Finger clubbing in patients with Crohn's disease tended to regress after resection of macroscopic disease. It is concluded that finger clubbing is significantly commoner in Crohn's disease than ulcerative colitis. The focal stimuli for finger clubbing include mucosal inflammatory change and fibrosis mediated by the vagus and possibly other autonomic pathways acting as the afferent arc of a finger-clubbing reflex.
采用甲床角进行客观测量，200例克罗恩病患者中有75例（38%）出现杵状指，103例溃疡性结肠炎患者中有15例（15%）出现，24例直肠炎患者中有2例（8%）出现。在47例接受手术治疗的患者中，克罗恩病和溃疡性结肠炎患者的甲床角与疾病活动度以及切除标本中的纤维化程度均显著相关。迷走神经支配区域内有肉眼可见病变的患者中杵状指的患病率显著高于病变局限于远端结肠和直肠的患者。克罗恩病患者在肉眼可见病变切除后杵状指倾向于消退。得出的结论是，杵状指在克罗恩病中比溃疡性结肠炎中更为常见。杵状指的局部刺激因素包括黏膜炎症变化以及由迷走神经介导的纤维化，可能还有其他自主神经通路作为杵状指反射的传入弧发挥作用。
