Page 108 - 南京医科大学自然版

南京医科大学学报（自然科学版） 第45卷第4期
·544 · Journal of Nanjing Medical University（Natural Sciences） 2025年4月

·临床研究·

临床及内镜特征联合外周血炎症相关指标的评估在回肠末端

病变的病因诊断价值初探

赵小静 ，张 丽 ，王 璐 ，王 舒 ，林俊杰 ，张红杰 ，马晶晶 1*
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南京医科大学第一附属医院消化内科，江苏 南京 210029；甘肃省肿瘤医院消化肿瘤科，甘肃 兰州 730050
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［摘 要］ 目的：总结分析回肠末端病变患者临床、内镜特征及临床转归，探究患者临床及内镜特征联合外周血炎症相关指标
改变对克罗恩病（Crohn’s disease，CD）的诊断价值，为临床诊疗提供有益依据。方法：本研究为单中心回顾性研究，纳入2014
年1月—2021年6月于南京医科大学第一附属医院行结肠镜检查发现回肠末端病变的患者，收集患者一般信息、病历资料、内
镜及病理报告等，统计并分析所纳入患者的临床、内镜特征及病因诊断。根据诊断结果筛选出CD及非特异性回肠末端溃疡患
者，比较两组患者在初诊时的临床、内镜特征及外周血炎症相关指标变化。结果：共纳入回肠末端病变患者956例，其中93例
诊断明确，包括CD、肠结核、良性肿瘤、腺癌等，425例失访，另有438例患者病因诊断不明，诊断不明患者中有293例复查肠镜，
其中182例显示病变消失。最终筛选出CD患者22例，非特异性回肠末端溃疡患者73例。与后者相比，CD患者初诊时腹痛发
生率更高，且更易表现为回盲瓣受累的内镜特征。血小板、血红蛋白、白蛋白、血小板/淋巴细胞比值、中性粒细胞/淋巴细胞比
值等外周血炎症相关指标对于辅助诊断CD有一定价值，5项指标联合诊断价值更高，曲线下面积为0.83。结论：回肠末端病变
大多数为非特异性良性病变，且预后较好。对于肠镜下首次发现回肠末端病变尤其是溃疡的患者，需关注其临床症状、内镜下
特征，同时结合外周血炎症相关指标改变，有助于回肠末端病变的病因诊断。
［关键词］ 回肠末端病变；临床特征；内镜特征；外周血炎症相关指标
［中图分类号］ R574 ［文献标志码］ A ［文章编号］ 1007⁃4368（2025）04⁃544⁃07
doi：10.7655/NYDXBNSN240978

Diagnostic value of clinical and endoscopic features combined with peripheral blood
inflammatory markers in etiology of terminal ileum lesions

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ZHAO Xiaojing ，ZHANG Li ，WANG Lu ，WANG Shu ，LIN Junjie ，ZHANG Hongjie ，MA Jingjing 1*
1 Department of Gastroenterology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029；
2 Department of Digestive Oncology，Gansu Cancer Hospital，Lanzhou 730050，China
［Abstract］ Objective：To summarize the clinical and endoscopic features，as well as clinical outcomes，of patients with terminal
ileum lesions，and to explore the diagnostic value of combining clinical and endoscopic features with changes in peripheral blood
inflammatory markers for Crohn’s disease（CD），providing valuable evidence for clinical diagnosis and treatment. Methods：This study
was a single⁃center retrospective study，including patients who underwent colonoscopy between January 2014 and June 2021 at the
First Affiliated Hospital of Nanjing Medical University，with ileal terminal lesions identified. General information，medical records，
endoscopy and pathological reports of the patients were collected，and clinical and endoscopic characteristics and etiological diagnosis
were statistically analyzed. The patients with CD and non⁃specific terminal ileum ulcer were screened，and the clinical and endoscopic
characteristics and peripheral blood inflammatory markers of the two groups were compared. Results：A total of 956 patients with
terminal ileal lesions were included，93 of whom had a clear diagnosis，including CD，intestinal tuberculosis，benign tumors，
adenocarcinoma，etc.，425 were lost to follow⁃up，and another 438 patients with unknown causes. Among the patients with unknown
diagnoses，293 underwent follow⁃up colonoscopy，and 182 of them showed disappearance of lesions. Finally，22 patients with CD and
73 patients with non⁃specific terminal ileal ulcer were screened out. Compared with the latter，patients with CD have a higher incidence

［基金项目］ 国家自然科学基金（82370535，82200582）
通信作者（Corresponding author），E⁃mail：mjj7698@126.com（ORCID：0000⁃0003⁃0006⁃2757）
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