25例腸白塞病患者臨床特征分析

背景：腸白塞病是一種全身多系統血管炎性疾病的腸道受累亞型，可導致嚴重的腸道和腸外并發癥，增加住院率，降低患者生活質量。目的：分析腸白塞病患者的臨床、內鏡和病理特征。方法：選取2018年4月—2023年4月華中科技大學同濟醫學院附屬同濟醫院收治的25例腸白塞病患者，回顧性分析患者的基本資料、臨床癥狀和體征、內鏡和實驗室檢查結果以及治療方案。結果：在25例腸白塞病患者中，男性12例，女性13例；發病中位年齡為37歲。口腔潰瘍發生率為72.0%，其中60.0%的患者以口腔潰瘍為首發癥狀。確診前，60.0%的患者有腹痛癥狀，12.0%有胸骨后疼痛或不適。所有患者內鏡下均可見回盲部潰瘍，其中典型潰瘍15例，非典型潰瘍10例，兩組性別分布差異有統計學意義（P=0.041 4）。典型潰瘍患者的腸白塞病疾病活動指數（DAIBD）評分明顯高于非典型潰瘍患者（P=0.019 4），而中性粒細胞計數、血紅蛋白、超敏C反應蛋白、γ?谷氨酰轉移酶的兩組間差異均無統計學意義（Pgt;0.05）。5例患者合并食管潰瘍。5例患者在病程中升級為生物制劑治療（阿達木單抗或英夫利西單抗）。4例典型潰瘍患者因腸穿孔、消化道出血或肛瘺接受外科手術治療。結論：性別、DAIBD評分與腸白塞病患者的回盲部典型潰瘍存在一定相關性。

關鍵詞 腸白塞病； 潰瘍； 內鏡檢查； 診斷； 治療

Clinical Characteristics Analysis of 25 Patients With Intestinal Beh?et′s Disease YANG Qinglin， WAN Junchen， WANG Huagang， ZHOU Qi. Department of Gastroenterology， Tongji Hospital， Tongji Medical College of Huazhong University of Science and Technology， Wuhan （430030）

Correspondence to： ZHOU Qi， Email： zhouqi@tjh.tjmu.edu.cn

Background： Intestinal Beh?et's disease is a subtype of multisystem vasculitis that affects the intestine， leading to severe intestinal and extra?intestinal complications， increased hospitalization rate， and a decrease in the quality of life of patients. Aims： To analyze the clinical， endoscopic， and pathological characteristics of patients with intestinal Beh?et's disease. Methods： Twenty?five patients with intestinal Beh?et's disease admitted from April 2018 to April 2023 at Tongji Hospital， Tongji Medical College of Huazhong University of Science and Technology were enrolled. The demographic data， clinical symptoms and signs， endoscopic findings， laboratory results， and therapeutic strategies were retrospectively analyzed. Results： In 25 patients with intestinal Beh?et's disease enrolled in this study， 12 were males and 13 females， with a median age of onset at 37 years old. Oral ulcer was reported in 72.0% of patients， with 60.0% presenting with oral ulcer as the initial manifestation. Before diagnosis， 60.0% of patients suffered from abdominal pain， and 12.0% experienced retrosternal pain or discomfort. All patients presented with ileocecal ulcer under endoscopy， with 15 cases of typical ulcer and 10 cases of atypical ulcer. The difference in gender distribution was statistically significant between the two groups （P=0.041 4）. The disease activity index for intestinal Beh?et's disease （DAIBD） in typical ulcer group was significantly higher than that in atypical ulcer group （P=0.019 4）， while no significant differences in neutrophil count， hemoglobin， hypersensitive C?reactive protein， and γ?glutamyl transferase were found between the two groups （Pgt;0.05）. Five patients were accompanied with esophageal ulcer. During the course of the disease， 5 patients escalated to biological therapy （adalimumab or infliximab）. Four patients with typical ulcer underwent surgical treatment due to complications such as intestinal perforation， gastrointestinal bleeding， and anal fistula. Conclusions： There exists a significant association between gender， DAIBD score and typical ileocecal ulcer in patients with intestinal Beh?et's disease.

Key words Intestinal Beh?et Disease; Ulcer; Endoscopy; Diagnosis; Therapy

白塞病（Beh?et's disease）是一種以復發性口腔潰瘍、生殖器潰瘍和復發性葡萄膜炎三聯征為主要特征的系統性血管炎，于1937年由土耳其醫師Hulusi Beh?et首次發現并定義[1]。白塞病可以累及多系統，包括皮膚、黏膜、眼、關節、消化道、中樞神經系統以及各類型大中小血管等[2]。……