克罗恩病与肠结核患者出院后随访分析

摘要

目的 探讨克罗恩病(Crohn's disease,CD)和肠结核(intestinal tuberculosis,ITB)患者出院后的病情变化和预后.方法 选取住院诊断为CD和ITB患者各50例,电话随访得到患者出院后进一步的诊治和疾病预后等具体资料,并进行总结分析.结果 肠结核随访成功34例,平均随访(28.77 ±10.53)个月,最后确诊31例；CD随访成功32例,平均随访(29.56±14.90)个月,最后确诊32例.肠结核患者服药依从性好,平均服药(13.77 ±7.06)个月,已愈29例,复发2例.CD患者服药以5-氨基水杨酸为主,服药依从性欠佳,平均服药(15.31 ±11.12)个月,缓解稳定9例(28.1％),好转16例(50.0％),病情加重7例(21.9％),出院后复发23例(71.9％),出院后手术治疗3例(9.4％).住院期间13例CD手术患者中,缓解稳定6例,好转5例,病情加重2例,短期内总体效果优于非手术治疗患者.结论 肠结核预后好、复发低,应指导按疗程服药,加强随诊.CD预后不佳、复发率高,应加强出院后随访,提高服药依从性.手术治疗对部分患者短期缓解稳定有益,这可能与CD临床表型有关.%Objective To study the diagnosis, treatment and prognosis of the post-discharged patients diagnosed Crohn' s disease and intestinal tuberculosis in clinic. Methods 50 cases of CD and 50 cases of ITB cases were selected. The detailed material such as the further treatment and its prognosis were obtained through telephone follow-up. Results 34 ITB cases were followed up and 31 cases were definitely diagnosed. The average followed up duration was (28. 77 ?10. 53) months. 32 CD cases were followed up and 32 cases were definitely diagnosed. The average followed up duration was (29.56 ?4.90) months. ITB patients had a good drug compliance. The average drug-administration duration was ( 13.77 ?.06) months. 29 cases were cured and 2 cases relapsed. But the compliance was bad. CD patients took 5-ASA mostly and drug administration compliance was poor. The average drug-administration duration was (15.31 ?1. 12) months. 9 cases (28. 1% ) were in steady remission status. 16 cases were mend (50.0% ). 7 cases were deteriorated (21.9% ). 23 cases (71.9% ) were relapsed after discharged. And 3 cases (9.4% ) were operated after discharged. In 13 CD surgical patients, 6 cases were in steady remission status. 5 cases were mend. 2 cases were deteriorated. The general effect was better than non-operative patients. Conclusion The prognosis of intestinal tuberculosis was good and had a low recurrence. Patients should be instructed to take medicine course of treatment and follow up on time. The prognosis of CD was bad and had a high recurrence, patients should be advised to have regular follow-up after discharged to improve drug compliance. Surgical treatment is beneficial for some patients, because it can obtain a short-time remission and stability, which may be associated with clinical phenotypes of the patients.