基于蒙特利尔病变部位分型的克罗恩病患者临床特征分析

Analysis of clinical characteristics of Crohn's disease based on disease locations according to the montreal classification

摘要:

目的 探讨回肠末段型（L1）、结肠型（L2）及回结肠型（L3）克罗恩病（CD）患者的临床特征、实验室检查、疾病行为等方面的差异。方法 回顾性研究2021年1月—2022年6月武汉大学人民医院181例CD患者的临床资料，其中L1型CD患者66例，L2型CD患者20例，L3型CD患者95例。收集患者临床资料和实验室检查结果等，分析3组患者在临床特征和实验室检查结果等方面的差异。多因素二元Logistic回归分析L1、L2和L3型CD患者临床特征。绘制受试者工作特征（ROC）曲线，分析部分临床特征预测CD病变部位的效能。结果 L1组患者平均年龄大于L3组患者（P <0.05）。L1组患者黏液脓血便构成比低于L2和L3组患者（P <0.05）。L1组患者平均血小板计数低于L3组患者（P <0.05）。L1组患者肛周病变构成比低于L2和L3组患者（P <0.05）。多因素二元Logistic回归分析结果显示，L2型CD［O^R =1.017（95% CI：1.004，1.031）］和L3型CD［O^R =1.026（95% CI：1.016，1.037）］与CD疾病活动指数（CDAI）相关（P <0.05），L3型CD［O^R =7.088（95% CI：2.390，21.018）］与肛周病变风险增加相关（P <0.05）。ROC曲线分析结果显示，与L1型CD比较，当血沉为29.50 mm/h时，L2型CD的ROC曲线下面积（AUC）为0.724（95% CI：0.579，0.868），此时预测L2型CD敏感性为77.8%（95% CI：0.519，0.926），特异性为64.1%（95% CI：0.510，0.754）；当血小板计数取临界值307×10⁹/L时，L3型CD的AUC为0.702（95% CI：0.618，0.785），此时预测L3型CD敏感性为72.3%（95% CI：0.602，0.826），特异性为65.2%（95% CI：0.554，0.752）。结论 L1型、L2型及L3型CD患者的临床表现、实验室检查、疾病行为等均存在差异，基于这些特征将有助于鉴别CD患者的不同病变部位。

Abstract:

Objective To analyze the clinical characteristics, laboratory examination results and disease behavior of Crohn's disease (CD) based on disease locations which were divided into 3 groups [terminal ileal ± limited cecal disease (L1) group, colonic (L2) group and ileocolonic (L3) group] according to the Montreal classification.Methods From January in 2021 to June in 2022, 181 CD patients (66 cases of L1 group, 20 cases of L2 group and 95 cases of L3 group) who were hospitalized at Renmin Hospital of Wuhan University were retrospectively collected. The clinical data and laboratory examination results of the patients were collected, and statistical analysis were used to display the differences of the three groups.Results The mean age of the L1 group was higher than that of L3 group (P < 0.05). In the L1 group, the proportions of patients with mucopurulent stool were lower than those of patients in the L2 and L3 groups (P < 0.05). The mean platelet (PLT) counts in the L1 group were lower than that of L3 group (P < 0.05). The proportions of perianal disease in L1 group were lower than those of L2 and L3 group (P < 0.05). The results of logistic regression analysis demonstrated that L2 and L3 subtypes of CD patients had higher Crohn's disease activity index (CDAI) scores [odds ratio O^R = 1.017 (95% CI: 1.004, 1.031); O^R = 1.026 (95% CI: 1.016, 1.037), respectively, all P < 0.05], and L3 were independent risk factors for perianal CD diseases [O^R = 7.088 (95% CI: 2.390, 21.018), P < 0.05]. The results of ROC analysis showed that erythrocyte sedimentation rate (ESR), PLT and others could be used as biomarkers for CD patients to predict different disease locations. Compared with L1 location for CD patients, when ESR took the threshold of 29.50 mm/h, the area under the curve (AUC) was 0.724 (95% CI: 0.579, 0.868) (P < 0.05), and the sensitivity and specificity for predicting L2 location were 77.8% (95% CI: 0.519, 0.926) and 64.1% (95% CI: 0.510, 0.754), respectively. In addition, when PLT took the threshold of 307 ×10⁹/L, the AUC for predicting L3 location was 0.702 (95% CI: 0.618, 0.785) (P < 0.05), and the sensitivity and specificity were 72.3% (95% CI: 0.602, 0.826) and 65.2% (95% CI: 0.554, 0.752), respectively.Conclusions There were differences of clinical symptoms, laboratory examination results and disease behaviors among L1, L2 and L3 groups, which could help differential diagnosis the disease locations for CD patients.