南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (06): 842-.

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局限性非特异性回盲部炎症66例的回顾与随访

张萃,欧阳钦   

  • 出版日期:2016-06-20 发布日期:2016-06-20

Focal nonspecific ileocecum inflammation: a follow-up study of 66 cases

  • Online:2016-06-20 Published:2016-06-20

摘要: 目的总结局限性非特异性回盲部炎症(FNICI)的特征与自然病程,探讨早期诊断克罗恩病的可能性。方法回顾性纳入 我院近4年诊断为FNICI病人,分析患者临床、内镜、病理学、影像学、实验室检查的特点,定期随访病情发展,追踪病变最终结 局。结果共纳入66例FNICI患者,男女比例为1.06∶1,平均年龄39岁。平均随访10.5月后,8例发展为克罗恩病,其初诊肠镜 为累及末段回肠及回盲瓣的纵形、不规则溃疡,活检病理为粘膜局灶性淋巴细胞增生为主的活动性炎症,随访中多次活检病理 后可发现典型的克罗恩病病理改变,其初诊时的血沉、C-反应蛋白明显高于最终恢复正常的患者(P=0.013,P<0.01)。结论 FNICI由多种病因造成,早期内镜、活检组织病理表现不典型,诊治困难,需长期随访。本研究发现12.1%的FNICI发展为克罗 恩病。对溃疡持续存在、扩大并伴ESR、CRP升高的病例需密切随访,认真识别以早期诊断克罗恩病。

Abstract: Objective To investigate the natural disease course of nonspecific ileocecum inflammation (FNICI) and the possibility of early diagnosis of Crohn’s disease (CD). Methods The patients with an established diagnosis of FNICI at our hospital in the past 4 years were retrospectively analyzed for clinical manifestations, endoscopical, readigraphic and histopathological findings and laboratory data. The patients were followed up regularly for their outcomes. Results Our analysis included 66 patients with FNICI (with a male-to-female ratio of 34∶32 and a mean age of 39 years old). The patients were followed up for 10.5 months on average, and 8 (12.1%) patients developed CD. Among these 8 patients, the initial endoscopic examination upon admission revealed ulcers involving the ileocecum valve, and biopsy results showed focal active chronic mucosal inflammation. Laboratory tests showed that the patients who finally developed CD had significantly higher erythrocyte sedimentation rate (P=0.013) and C reaction protein (P<0.01) than the patients who eventually had full recovery. Conclusion FNICI is a common lesion caused by multiple factors and has not specific endoscopic or histopathological features, which makes its definite diagnosis difficult. The patients with persistent ulcer and elevated erythrocyte sedimentation rate and C reactive protein should be closely followed up for early diagnosis of CD.