Clinical Characteristics And Related Factors Of Crohn's Disease With Perianal Lesions

Objective: 1.To understand the clinical characteristics,diagnosis and treatment of perianal Crohn's disease.2.To explore the related factors of perianal lesions in Crohn's disease.Methods: From January 2013 to December 2017,90 inpatients diagnosed as Crohn's disease in the Department of Gastroenterology of the Affiliated Provincial Hospital of Anhui Medical University were eventually confirmed to meet the diagnostic criteria of Crohn's disease by excluding the cases with uncertain diagnosis,incomplete data and missing follow-up.1.Develop a questionnaire for Crohn's disease patients,and record their demographic data,past history,smoking history,drinking history,clinical data,laboratory indicators,endoscopy,imaging examination data and treatment medication.2.Take the time of first admission to our hospital in digestive medicine after 2013 as the starting point of clinical research,and death,non-CD diagnosis or disease outcomes as the end point of clinical research as of 31 December 2017.The prognosis was followed up by outpatient consultation,re-hospitalization and telephone calls.3.Patients who meet the diagnostic criteria of Crohn's disease are divided into perianal lesion group and non-perianal lesion group according to whether or not they have perianal lesion.The first symptoms,types of perianal lesion,serology,endoscopy,imaging,pathological characteristics,quality of life,mental problems and diagnosis and treatment of perianal Crohn's disease in patients with perianal lesion group are studied and analyzed with relevant scales to understand perianal Crohn's disease.Clinical characteristics.4.The indicators(sex,age,smoking history,location of disease,disease type,nutritional status,CDAI)of patients in perianal lesion group and non-perianal lesion group were included in the statistical analysis.Through univariate analysis and logistic multivariate analysis,the relevant influencing factors of Crohn's disease perianal lesion were obtained.Results: 1.There were 63 cases of Crohn's disease with perianal lesions,accounting for 70%,including 44 cases of anal fistula,20 cases of perianal abscess,5 cases of anal fissure,4 cases of hemorrhoids,5 cases of dermatitis,3 cases of ulcer,1 case of anorectal stenosis and 1 case of rectovaginal fistula.2.Among the patients with Crohn's disease,52(82.54%)underwent perianal MRI,9(14.29%)underwent color Doppler ultrasound,and 2(3.17%)underwent digital anal diagnosis.3.Among the patients with perianal Crohn's disease,the first symptom was abdominal pain discomfort in 23 cases;27 cases were abnormal stool such as diarrhea and loose stool,2 cases were low fever and 1 case was abdominal distension discomfort.The first symptom of the remaining 10 patients(15.9%)was perianal disease which was delayed repeatedly.4.Among the patients with perianal Crohn's disease,31(49.21%)had nutritional risk,17(26.98%)had anemia,and 12(70.59%)had microcytic hypochromic anemia.5.Typical longitudinal ulcers were found in 32 patients(50.79%)with perianal Crohn's disease,20 patients(31.75%)with pebble-like changes,23 patients(36.51%)with other segmental changes,and 13 patients(20.63%)with Afota ulcer.6.In this study,there were 15 anxiety patients,with an average SAS score of 56.16(+5.77),14 depression patients and an average SDS score of 59(+7.15),including 5 simple anxiety patients,4 simple depression patients and 10 anxiety and depression patients.7.Quality of life: The average IBDQ score of patients with perianal Crohn's disease was 162.5(+26.35).Compared with the IBDQ score of patients without perianal lesions,the average quality of life of patients with perianal Crohn's disease was 172.25(+31.02).The average quality of life of patients with perianal Crohn's disease decreased.8.There were no significant differences in gender,age,nutrition status and CDAI score between the two groups(P > 0.05),but there were significant differences in smoking,location of disease(L1,L2,L3,L4),disease type(B1,B2,B3)(P < 0.05).Smoking and proximity to the rectum were independent risk factors for Crohn's disease(P < 0.05).Conclusion: 1.Crohn's disease has a high incidence of perianal lesions,up to 70%,and some patients with perianal lesions as the first symptom,such patients with intestinal symptoms are not obvious and difficult to diagnose.2.Anal fistula accounts for the highest proportion of perianal lesions in Crohn's disease,and pelvic MRI plays an important role in the diagnosis of perianal lesions.3.Some patients with perianal Crohn's disease have mental and psychological problems,and their quality of life has declined.More attention should be paid to their physical and mental problems.4.Smoking and the location of the disease are important factors affecting the occurrence of Crohn's disease perianal lesions,and more active intervention should be given to smokers and patients whose location of the disease is close to the rectum.