中国药物警戒 ›› 2010, Vol. 7 ›› Issue (5): 269-271.

• 临床研究 • 上一篇    下一篇

克罗恩病临床特点、治疗方法选择与合理用药建议

张茹1,2, 吕红1, 钱家鸣1*, 沈冰冰1, 杨晓鸥1, 陈蔷1   

  1. 1中国医学科学院北京协和医学院 北京协和医院消化科,北京 100730;
    2中国人民解放军总医院 军医进修学院南楼消化科,北京 100853
  • 收稿日期:2016-02-19 修回日期:2016-02-19 出版日期:2010-05-08 发布日期:2016-02-19
  • 通讯作者: 钱家鸣,女,博士生导师,教授,消化系统疾病诊治。Email：yuanjiah@gmail.com
  • 作者简介:张茹,女,博士,老年病诊治及消化系统疾病诊治。

The Significance of Clinical Features of Crohn's Disease in Treatment Modalities

ZHANG Ru1,2, LV Hong1, QIAN Jia-ming1,*, SHEN Bing-bing1, YANG Xiao-ou1, CHEN Qiang1   

  1. 1Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;
    2Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2016-02-19 Revised:2016-02-19 Online:2010-05-08 Published:2016-02-19

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摘要： 目的 分析克罗恩病（CD）患者的临床资料,探讨其治疗方法及其与临床特点的关系,提出合理用药建议。方法 回顾性分析1983~2007年北京协和医院收治的158例克罗恩病患者,计数资料作χ2检验,计量资料作t检验。结果 ①一般情况;158例CD 患者中男：女为1.98 1,发病年龄平均33.8±15.6（7~78）岁,其中轻度15.8%、中度30.4%、重度53.8%;患者发病年龄高峰为20~29岁（29.1%）。②内科治疗与临床特点及用药情况：轻度CD患者（96.0%）选择氨基水杨酸制剂者明显多于中（87.5%）、重度（76.5%）（P =0.028）;重度CD患者（70.6%）需营养支持治疗者明显多于轻（28.0%）、中度患者（43.8%）（P =0.000）;患者病变部位与药物的选择及是否选择手术无明显相关性。③内科治疗的变迁：2000年后CD患者（52.4%）肠外表现发生率较2000年前（38.2%）显著升高（P =0.048）,使用氨基水杨酸和糖皮质激素、营养支持、免疫抑制剂者明显增多（P<0.05）。④外科治疗与临床特点59 例（37.3%）CD患者需手术治疗,其中53例（89.8%）因患CD并发症而需手术治疗,主要为肠梗阻、肠瘘、肠穿孔等。中性粒细胞百分比（N%）高,血清总蛋白、白蛋白低者手术风险增大。结论 CD发病年龄高峰为20~29岁,免疫抑制剂和营养支持治疗在CD患者中应用逐年增多,内科治疗方案的制定与病情严重程度相关,而病变部位与治疗方式的选择无关,N%高和血浆蛋白低者的CD患者手术风险增大。使用硫嘌呤应注意其骨髓毒性,硫唑嘌呤甲基转移酶（TPMT）活性测定或TPMT基因型分析也许能预测,治疗前8周内,应每周查血常规,以后至少每3个月查1次。

关键词: 克罗恩病, 治疗, 临床特点, 合理用药

Abstract: Objective To evaluate the relationship between clinical features of Crohn's disease(CD) and medical treatment modalities in a historical chort. Methods A total of 158 patients with CD in Peking Union Medical College Hospital from 1983 to 2007 were included. Demographic and clinical features as well as medical treatment regimens were studied. Results of the158 patients with CD, male:female ratio was 1.98:1. The mean age at disease onset was 33.8±15.6(range 7~78) years. Mild, moderate, and severe CD comprised 15.8%, 30.4%, and 53.8% of the patient population, respectively. The peak onset age was 20~29 years old, with 29.1% of patients being in the age group. Patients with mild CD(96.0%) were more frequently treated with aminosalicylic acid than those with moderate(87.5%) and severe(76.5%) disease(P=0.028). Patients with severe CD(70.6%) more often required nutritional support than those with mild(28.0%) and moderate(43.8%)(P =0.000). It appears that medical treatment regimens and the requirement for surgical intervention were independent of the disease location of CD. More patients presented with extraintestinal manifestations after Year 2000(52.4%) thanbefore Year 2000(38.2%)(P=0.048). In addition, aminosalicylic acids, corticosteroids, immunomo-dulators, and nutritional support have been more widely used since Year 2000. A higher polymorphic neutrophil per-centage count in peripheral blood and lower serum total protein and albumin were associated with an increased risk for surgical intervention. 59 patients(37.3%) required surgical therapy, of whom 53(89.8%) underwent surgery for CD-associated complications, including intestinal obstruction, perforation, or fistula. Conclusion s The peak onset age of CD was 20~29 years. There was a trend of more frequent use of aminosalicylates, corticosteroids, immunomodulators, and nutritional support since Year 2000. Choice among medical treatment regimens and the requirement of surgical intervention appeared to be associated with disease severity, but not disease location. Poor nutritional status was associated with an increased risk for surgical intervention.

Key words: Crohn's disease, therapeutic, clinical features, rational use of drug

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