| Objective: To analyze the clinical characteristics of 78 cases of crohn’s disease(CD) in the Fujian Provincial Hospital, in order to improve the level of the diagnosis of CD.Methods: Analyze retrospectively the clinical data of the 78 CD patients from 2002 to 2010 in Fujian Provincial Hospital and Analyze their relationship by Montreal classification.Results:1. General data: 78 cases of CD patients, male 48 cases and femal 30 cases,the ratio of male and female patients was 16:1. Patient age was 8 to 78 years and average age was 34.19±15.95 years. Male was 34.60±15.75 years and female 33.53±16.52 years. There was no statistical significance between male and female(P = 0.775). The course before diagnosis was 4 days to 18 years.2. Clinical manifestation: adominal pain in 70 cases(89.74%), diarrhea in 55 cases(70.51%), bloody stool in 20 cases(25.64%); weight lose in 33 cases(42.31%), fever in 20 cases(26.92%), anemia in 40 cases(51.28%); oral ulcer in 10 cases(12.82%), arthropathy in 2 cases(2.56%), dermopathy in 2 cases(2.56%), ocular pathological in 0 cases(0%), liver and gallbladder diseases in 6 cases(7.69%); Complication: ileus in 29 cases(37.18%), intestinal perforation in 15 cases(19.23%), perianal diseases in 18 cases(23.08%), fistula in 4 cases(5.13%).3. Auxiliary examination: 33 cases of CD patients underwent CT examination, segmental bowel wall thickening in 27 cases(81.82%), intestinal tract with stenosion in 9 cases(27.27%), retroperitoneal lymph nodes in 7(21.21%), intestinal wall with lump in 3 cases(9.09%), intestinal mucosa with potentialization in 4 cases(12.12%), normal appearance in 3 cases(9.09%); 25 cases of CD patients underwent Barium meal X-ray, segmental bowel with stricture in 18 cases(72.00%), gastrointestinal mucosa with ulcer in 5 cases(20.00%), no obvious abnormal in 2 cases(8.00%). A patient can exist different lesions at the same time.4. Endoscopic biopsy specimens: 33 cases of CD patients underwent endoscopy, intestinal wall with multiple ulcers in 54 cases(72.97%), lumen with stricture in 10 cases(13.51%), intestinal mucosa with hyperemia and edema in 12 cases(16.22%), intestinal mucosa with stone-like change in 8 cases(10.81%), duodenal stenosis in 1 cases(1.35%) and esophagus with multiple ulcers in 4 cases(5.41%). The endoscopic biopsy of mucosa showed inflammatory cellular infiltration in 60 cases(81.08%), granulomas in 22 cases(29.73%), lymphoid follicular formation in 6 cases(8.10%), crypt abscess in 7 cases(9.46%). A patient can exist the above two or more than two different lesions at the same time.5. Operation and pathology: 26 cases took operation, and pathology showed segmental inflammatory in 16 cases(61.54%), inflammatory granuloma in 7 cases(26.92%), fissuring ulcers in 3 cases(11.54%). A patient can exist the above two or more than two different lesions at the same time.6. Montreal classification for CD: classification by age,A1 8 cases(10.26%), A2 45 cases(57.69%), A3 25 cases(32.05%); classification by diseased region, L1 31 cases(39.74%), L2 12 cases(15.39%), L3 35cases(44.87%), no L4 cases(0%), L1+L4 2 cases(2.56%), L2+L4 1 cases(1.28%), L3+L4 4 cases(5.13%); clasification by diseased behavior, B1 34 cases(43.59%), B2 29 cases(37.18%), B3 15 cases(19.23), B1 p 3 cases(3.85%), B2 p 3 cases(3.85%), B3 p 12 cases(15.38%). All the distribution of subtype had no statistical significance by age classification(P>0.05); but perianal diseases and apenteric manifestation had significant statistical significance(P<0.05 and P<0.01); All the distribution of subtype had no statistical significance by diseased region classification(P>0.05); There was no statistically significant difference between male and female(P<0.05).7. Lab examination: HGB decreased in 40 cases(51.28%), HCT decreased in 43 cases(55.13%), WBC increased in 21 cases(26.92%), PLT increased in 43 cases(55.13%), ESR increased in 50 cases(64.10%), CRP increased in 61 cases(78.21%), ALB decreased in 58 cases(74.36%).8. The disease activity score of HBI:the HBI score of 78 CD’s patients was 2 to 14 points, average HBI score was 7.24±3.03 points. Activity period in 12 cases(15.38%) and remission stage in 66 cases(84.62%). In the terms of age and WBC, the differences between the two period had no statistical significance(P>0.05); In the terms of HGB, HCT, PLT, ESR, CRP and ALB, the differences between the two period had statistical significance(P<0.05 or P<0.01);Conclusion: 1.The onset age group data show unimodal distribution, and the peak ages of CD was between 21 and 30 years.2.The ileocolon and the non-narrow and non-penetrating lesions were involved commonly.3.The clinical manifestations is various. Abdominal pain and diarrhea were the more common symptoms.4.The score of HBI have a certain correlation with disease activity. Confirmative diagnosis depends on clinical manifestations, auxiliary examination, endoscopic examination and pathological findings. |
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