孤立性小肠克罗恩病与其他小肠溃疡性疾病的鉴别：临床特点和双气囊肠镜检查特点

IF 2 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterology Research and Practice Pub Date : 2022-05-30 DOI:10.1155/2022/5374780

Meng Niu, Zhenghao Chen, Meng Li, Xing-Long Zhang, C. Chen

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引用次数: 1

摘要

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）的临床特征和双球囊肠镜检查（DBE）特征。方法排除同时存在结肠和/或回肠瓣膜病变的患者（n=45）或最终诊断未确定的患者（n=29）。对经DBE发现的139例ISBCD患者和62例OSBUD患者进行回顾性分析。结果ISBCD的发病年龄低于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＜0.01），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）也更有利于诊断ISBCD。非甾体抗炎药（NSAIDs）使用两周以上可降低诊断为ISBCD的概率（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），p＜0.001），并且它们的主要形态在不同的肠段中不同。纵向溃疡（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＜001）有助于ISBCD与OSBUD的分化。我们构建了一个诊断模型，即ISBCD指数（AUROC=0.877，95%CI:0.83-0.925），使用多因素二元逻辑回归来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特征和病理学有助于区分ISBCD和OSBUD。

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Differentiation of Isolated Small Bowel Crohn's Disease from Other Small Bowel Ulcerative Diseases: Clinical Features and Double-Balloon Enteroscopy Characteristics

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 (n = 45) or whose final diagnosis was not determined (n = 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, p < 0.001). Abdominal pain was more common in ISBCD (OR 4.986, 95% CI 2.539-9.792, p < 0.001). Elevated fibrinogen levels (OR 1.431, 95% CI 1.022-2.003, p = 0.037) and lower levels of D-dimer (OR 0.999, 95% CI 0.999-1.000, p = 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, p = 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, p < 0.001). The ulcers of ISBCD were more distributed in the ileum (111 (79.9%) vs. 29 (46.8%), p < 0.001), and their main morphology differed in different intestinal segments. Longitudinal ulcers (OR 14.293, 95% CI 4.920-41.518, p < 0.001) and large ulcer (OR 0.128, 95% CI 0.044-0.374, p < 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.

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来源期刊

Gastroenterology Research and Practice GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

4.40

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： Gastroenterology Research and Practice is a peer-reviewed, Open Access journal which publishes original research articles, review articles and clinical studies based on all areas of gastroenterology, hepatology, pancreas and biliary, and related cancers. The journal welcomes submissions on the physiology, pathophysiology, etiology, diagnosis and therapy of gastrointestinal diseases. The aim of the journal is to provide cutting edge research related to the field of gastroenterology, as well as digestive diseases and disorders. Topics of interest include: Management of pancreatic diseases Third space endoscopy Endoscopic resection Therapeutic endoscopy Therapeutic endosonography.