Background: Intestinal fistula is one of the common complications of Crohn's disease (CD) that might require surgical treatment. The clinical characteristics and outcomes of CD with intestinal fistula are much different from CD alone. This study was to investigate whether the coagulation status of CD is changed by intestinal fistula.
Methods: Data were retrospectively analyzed for 190 patients with a definitive diagnosis of CD who were registered at the Jinling Hospital between January 2014 and September 2015. Baseline clinical characteristics and laboratory indices of initial admission and 7 days after intestinal fistula resections were collected. Student's t-test and the Wilcoxon rank-sum test were used to compare differences between the two groups.
Results: Compared with CD patients without intestinal fistula, prothrombin time (PT) in patients with intestinal fistula was significantly longer (12.13 ± 1.27 s vs. 13.18 ± 1.51 s, P < 0.001 in overall cohort; 11.56 ± 1.21 s vs. 12.61 ± 0.73 s, P = 0.001 in females; and 12.51 ± 1.17 s vs. 13.37 ± 1.66 s, P = 0.003 in males). Platelet (PLT) count was much lower in intestinal fistula group than in nonintestinal fistula group (262.53 ± 94.36 × 109/L vs. 310.36 ± 131.91 × 109/L, P = 0.009). Multivariate logistic regression showed that intestinal fistula was significantly associated with a prolonged PT (odds ratio [OR] = 1.900, P < 0.001), a reduced amount of PLT (OR = 0.996, P = 0.024), and an increased operation history (OR = 5.408, P < 0.001). Among 65 CD patients receiving intestinal fistula resections, PT was obviously shorter after operation than baseline (12.28 ± 1.16 s vs. 13.02 ± 1.64 s, P = 0.006).
Conclusions: Intestinal fistula was significantly associated with impaired coagulation status in patients complicated with CD. Coagulation status could be improved after intestinal fistula resections.
克罗恩病合并肠瘘患者的凝血功能障碍摘要背景：肠瘘是克罗恩病的常见并发症之一，可能需要手术处理。合并有肠瘘的克罗恩病在临床特征和预后上，与未合并肠瘘的克罗恩病相比差异较大。本研究是为了探究克罗恩病的凝血功能是否会因伴有肠瘘而改变。 方法： 2014年1月至2015年9月，南京大学附属金陵医院普通外科收治的190名确诊克罗恩病的患者入组。收集入院时和肠瘘切除术后第7天的临床资料及实验室指标。利用t检验和秩和检验比较组间差异。 结果：与未合并肠瘘的克罗恩病患者相比，合并肠瘘的克罗恩病患者的凝血酶原时间明延长 (所有患者：12.13±1.27秒 vs. 13.18±1.51秒, P<0.001; 女性亚组：11.56±1.21秒 vs. 12.61±0.73秒, P=0.001; 男性亚组：12.51±1.17秒 vs. 13.37±1.66秒, P=0.003)。肠瘘组的血小板计数明显低于非肠瘘组 (262.53±94.36 ×109/L vs. 310.36±131.91 ×109/L, P=0.009)。多因素回归分析发现肠瘘与凝血酶原时间延长(OR=1.900, P=0.000)，血小板计数增加(OR=0.996, P=0.024)和手术史增多(OR=5.408, P<0.001)相关。在65名接受肠瘘切除手术的克罗恩病患者中，术后凝血酶原时间较术前明显缩短(12.28±1.16秒 vs. 13.02±1.64秒, P=0.006)。 结论：克罗恩病患者合并的肠瘘与其凝血功能障碍显著相关，凝血功能可在肠瘘切除术后改善。.
Keywords: Coagulation; Crohn's Disease; Inflammatory Bowel Disease; Intestinal Fistula; Prothrombin Time.