Clinical features and influencing factors analysis of anorectal stenosis in Crohn′s disease
10.3760/cma.j.cn101480-20190807-00102
- VernacularTitle:克罗恩病肛管直肠狭窄的临床特征及影响因素分析
- Author:
Haifeng ZHOU
1
;
Xiao HAN
1
;
Wenjie XU
1
;
Yunfei GU
1
Author Information
1. 南京中医药大学附属医院肛肠科 210029
- Publication Type:Journal Article
- Keywords:
Crohn′s disease;
Anorectal stenosis;
Clinical features;
Influencing factors
- From:
Chinese Journal of Inflammatory Bowel Diseases
2020;04(3):229-234
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical features of anorectal stenosis in Crohn′s disease (CD) and analyze the associated influencing factors.Methods:Clinical data of 87 CD patients with anorectal stenosis in Affiliated Hospital of Nanjing University of Chinese Medicine from November 2010 to June 2019 were analyzed retrospectively. Clinical manifestations, complications, body mass index, Montreal classification, simple Crohn′s disease activity index (CDAI) , perianal disease activity index (PDAI) , laboratory examination indexes, the locations and types of stenoses were collected. The patients were divided into mild, moderate and severe stenosis according to the grade of stenosis. Univariate analysis and multivariate Logistic regression analyses were performed to identify the influencing factors for anorectal stenosis in Crohn′s disease.Results:A total of 87 patients were enrolled. The main clinical manifestations were difficult defecation and perianal swelling pain. The abnormal BMI was observed in 40 patients (46.0%) and the history of abdominal surgery in 30 (34.5%) . The anal fistula was found in 48 patients (55.2%) and canceration in 1 (1.1%) . The activity phase scored by simple CDAI was observed in 49 patients (56.3%) and the activity phase scored by PDAI in 46 patients (52.9%) . The ileocolonic type of Montreal classification was observed in 53 patients (60.9%) . The abnormal laboratory examination indexes were as follows: C-reactive protein (CRP) ≥8 mg/L occurred in 44 patients (50.6%) , erythrocyte sedimentation rate (ESR) ≥20 mm/1 h (female) or 15 mm/1 h (male) in 52 (59.8%) , hemoglobin<120 g/L (male) or 110 g/L (female) in 39 (44.8%) , platelet count (PLT) >300 × 10 9/L in 27 (31.0%) and albumin<35 g/L in 29 (33.3%) . The locations and types of anorectal stenosis were as follows: among 37 patients, stenosis of 27 patients located between the dental line and the anorectal line; stenosis length ≤4 cm was observed in 32 patients and>4 cm in 5 patients. Among 87 patients, single stenosis occurred in 55 patients (63.2%) and multiple stenosis in 32 patients (36.8%) ; membranous stenosis occurred in 24 patients (27.6%) and tubulous stenosis in 63 (72.4%) ; mild stenosis occurred in 16 patients (18.4%) , moderate stenosis in 30 (34.5%) and severe stenosis in 41 (47.1%) . Univariate analysis results showed that history of abdominal surgery (χ 2 = 12.621, P<0.01) , PDAI (χ 2 = 8.256, P = 0.004) , CRP (χ 2 = 6.071, P = 0.014) and PLT (χ 2 = 9.745, P = 0.002) were associated strongly with the degree of stenosis in CD anorectal stenosis. Multivariate Logistic regression analysis between mild-to-moderate and severe stenoses showed that history of abdominal surgery ( OR = 5.787, 95% CI: 0.899-3.350, P = 0.002) , PDAI ( OR = 0.296, 95% CI: -2.629-0.792, P = 0.029) were the independent risk factors of the degree of stenosis. Conclusions:In the anorectal stenosis in CD, tubulous and severe stenoses are the main types. Most of the stenoses are between the dental line and the anorectal line, and the length of the stenoses is usually ≤ 4 cm. The history of abdominal surgery and active phase scored by PDAI can increase the risk of severe stenosis in CD patients with anorectal stenosis.
