| Objective : To analyze and discuss the clinical features of patients with inflammatory bowel disease in the Second Hospital of Lanzhou University in the past 5 years.Methods:The clinical data of patients with inflammatory bowel disease(IBD)admitted to the Second Hospital of Lanzhou University from June 2013 to June 2018 were collected.The clinical characteristics of the disease,such as patient characteristics,clinical symptoms,main laboratory indicators,imaging,endoscopy,pathology,therapeutic drugs and the distribution of clinical subtypes were analyzed and summarized.Result:1.A total of 211 patients with IBD were admitted in the past 5 years,including 167 patients with ulcerative colitis(UC)and 44 patients with Crohn's disease(CD).2.Characteristics of population:The ratio of male to female in UC was 1:1.04,and CD was 2.14:1;The onset age of IBD ranged from 8-83 years old,the average age of onset of UC and CD was 42.68±14.54 years old and 33.75±13.84 years old,respectively,the difference in age of onset between the two groups was statistically significant(p<0.001);The proportion of Han nationality in all IBD patients was the highest(91.47%),followed by Hui nationality(4.26%),Dongxiang nationality(2.84%),and Tibetan nationality(1.42%);Family history was no found;The proportion of patients undergoing intestinal surgery for CD in the course of disease was higher than that for UC,the difference was statistically significant(p < 0.001).3.Clinical type and severity of UC:44.31% UC patients belonged to the initial onset type,55.69% belonged to the chronic recurrence type;In all patients with UC,mild 40.12%,moderate 50.30%,and severe 9.58%.4.Clinical manifestations:The main manifestations of UC patients in digestive system were abdominal pain(71.86%),diarrhea(78.44%),mucopurulent bloody stool(69.46%),rectal tenesmus(33.53%);The systemic symptoms were anemia(28.14%),fever(10.18%)and weight loss(19.76%);About 5.99% of UC patients showed extraintestinal manifestations,including 7 cases of arthritis,1 case of iritis,and 2 cases of oral ulcers.and no serious complications were found.The main manifestations of CD patients in digestive system were abdominal pain(93.18%),diarrhea(31.82%);The systemic symptoms were anemia(40.91%)and weight loss(34.09%);6.82% of the patients had extraintestinal manifestations,including 2 cases of arthritis and 1 case of oral ulcers,38.64% of patients had related complications,and the incidence of intestinal obstruction was the highest(11.36%)..5.Laboratory indicators:Inflammatory indicators ESR and CRP in CD patients were higher than those in UC patients,and the difference was statistically significant(p<0.05),the remaining laboratory indicators(WBC,HGB,PLT,ALB)were not statistically significant(p>0.05).There was a statistically significant difference in platelet count between UC patients with different severity(p<0.001).6.Imaging:MRE or CTE examination was performed in 25 patients with UC,the main manifestations were edema and thickening of the intestinal wall,some perienteral effusion changes,narrowing and stiffening of the lumen,and the lesion was basically confined to the colorectum.33 patients with CD underwent MRE or CTE examination,all showed uneven thickening and abnormal enhancement of the intestinal wall in the lesion,some showed stenosis and upstream intestinal dilatation(30.30%),mesenteric lymphadenopathy(27.27%),intestine obstruction(9.09%),intestinal wall ulcer(9.09%),irregular wall plaque abnormal signal(6.82%),"Comb sign"(4.55%).7.Endoscopy and pathology:The endoscopic features of UC patients mainly showed fine granules,congestion and edema of the mucosa,multiple erosions and ulcers covered with white moss were observed in severely affected areas,and polypoid hyperplasia can also be found.In severe UC,mainly presented as bowel stif / narrow;the pathology of UC were characterized by acute and chronic inflammatory cell infiltration,glandular reduction,granulation tissue hyperplasia and crypt abscess.CD endoscopy mainly manifests as longitudinal ulcers,and some patients can also see a variety of ulcers with different sizes,pseudopolyps and intestinal stenosis in the lesions,and rarely showed typical paving stone changes caused by excessive tissue hyperplasia.The lesion can involve multiple parts of the digestive tract at the same time and represent discontinuous and jumping;The pathology of CD mainly showed granulation tissue hyperplasia,ulcer changes,inflammatory cell infiltration,of which 6 cases showed typical noncaseous granuloma and 3 cases of mild dysplasia.8.IBD drugs:80.24% of UC patients received 5-Aminosalicylic acid(5-ASA)preparations,17.36% received glucocorticoids,and 2.40% received immunosuppressants.45.45% of CD patients treated with 5-ASA preparations,36.36% with glucocorticoids,70.45% with immunosuppressants,and 20.45% with infliximab.9.IBD clinical phenotypes distribution:In patients with UC,type A1 2.99%,type A2 38.32%,type A3 58.68%;type E1 25.15%,type E2 41.92%,and type E3 31.74%;There was no statistic difference in the age of diagnosis,lesion location and disease severity of UC between different genders(p>0.05).Also,there was no statistic difference in the severity of patients at different age of diagnosis(p>0.05).While,there were statistic differences in lesions sites of UC at different age of diagnosis(p<0.05),and the lesion sites of UC with different severity were also statistically different(p < 0.01).In patients with CD,type A1 13.63%,type A2 59.09%,type A3 27.27%;type L1 and type L2 accounted for 18.18% respectively,type L3 54.55%,type L4 9.09%;type B1 45.45%,type B2 and type B3 accounted for 34.09 % and 20.45% respectively;there was no statistic difference in the age of diagnosis,lesions location and disease behavior of CD between different genders(p>0.05).Also,there were no statistic differences in lesions location and disease behavior between CD patients with different ages of diagnosis(p>0.05).While,the difference of disease behaviors in different lesions location was statistically significant(p<0.05).Conclusion:UC accounts for the majority of IBD patients in our hospital in the past 5 years.The clinical symptoms,endoscopic and pathological manifestations of IBD are various.Platelet count can be used as an indicator to assess the severity of UC.The therapeutic drugs for UC were mainly 5-ASA and glucocorticoids,while CD were more treated with immunosuppressants and biological agents.The clinical phenotypic distribution of IBD is inconsistent with the domestic and foreign studies,which is considered to be related to a variety of factors(sample size,regional differences),and need to be further confirmed by studies. |
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