早期克罗恩病的诊疗与管理策略

doi:10.12114/j.issn.1007-9572.2025.0361

中国全科医学 ›› 2026, Vol. 29 ›› Issue (35): 5169-5179.DOI: 10.12114/j.issn.1007-9572.2025.0361

早期克罗恩病的诊疗与管理策略

申熙辰¹, 李霜¹, 章迎欣¹, 张璐²^,^*()

1．310053　浙江省杭州市，浙江中医药大学第一临床医学院
2．310006　浙江省杭州市，浙江中医药大学附属第一医院　浙江省中医院消化内科

收稿日期:2025-08-02 修回日期:2025-12-24 出版日期:2026-12-15 发布日期:2026-10-26
通讯作者: 张璐
作者贡献：
申熙辰负责文章的构思与设计、资料的收集与整理、论文撰写；李霜、章迎欣参与论文构思、文章修订；张璐负责文章的质量控制及审校，对文章整体负责。
基金资助:
浙江省医药卫生科技计划项目(2021KY835，2022KY924)

Diagnosis and Management Strategies for Early-stage Crohn's Disease

SHEN Xichen¹, LI Shuang¹, ZHANG Yingxin¹, ZHANG Lu²^,^*()

1. The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China
2. Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University/Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou 310006, China

Received:2025-08-02 Revised:2025-12-24 Published:2026-12-15 Online:2026-10-26
Contact: ZHANG Lu

摘要/Abstract

摘要： 克罗恩病（CD）是一种慢性的免疫介导的胃肠道炎症疾病。由于早期CD缺乏特异的临床表现，其识别与诊断面临挑战，常导致诊断延迟，确诊时常已出现相关并发症，难以治愈。本文着重探讨早期CD的自然病程、定义、病理生理学、流行病学特征及其管理，指出应利用有效的筛查工具区分具有高危因素的患者群体，根据疾病的严重程度进行危险分层，采取伺机筛查的策略对可疑人群进行密切的监测和随访，并注意采用基因检测、特异性血清生物标志物、肠道菌群检测、影像学和内镜技术，临床需对患者进行早期合适的充分干预。

关键词: 克罗恩病, 早期诊断, 病理生理学, 流行病学, 疾病管理, 治疗学

Abstract:

Crohn's disease (CD) is a chronic immune-mediated inflammatory disorder affecting the gastrointestinal tract. Due to the absence of specific clinical manifestations in the early stages of CD, its identification and diagnosis present significant challenges, often resulting in diagnostic delays. By the time a diagnosis is made, related complications typically have developed, complicating the potential for a cure. This article focuses on the natural history, definition, pathophysiology, and epidemiological characteristics of early CD, and addresses its management. It highlights the need to use effective screening tools to identify patient populations with risk factors, perform risk stratification according to disease severity, and adopt an opportunistic screening strategy to ensure close monitoring and follow-up of suspected populations. Attention should also be paid to the use of genetic testing, specific serological biomarkers, gut microbiota analysis, imaging and endoscopic techniques. Clinically, early, appropriate, and adequate intervention should be provided for patients.

Key words: Crohn's disease, Early diagnosis, Pathophysiology, Epidemiology, Disease management, Therapeutics

中图分类号:

R 57

申熙辰,李霜,章迎欣,等. 早期克罗恩病的诊疗与管理策略[J]. 中国全科医学, 2026, 29(35): 5169-5179. DOI: 10.12114/j.issn.1007-9572.2025.0361.
SHEN Xichen,LI Shuang,ZHANG Yingxin, et al. Diagnosis and Management Strategies for Early-stage Crohn's Disease[J]. Chinese General Practice, 2026, 29(35): 5169-5179. DOI: 10.12114/j.issn.1007-9572.2025.0361.

图/表 1

图1 早期CD的诊疗策略流程图注：高危因素包括炎症性肠病（IBD）家族史、吸烟、婴儿期非母乳喂养和抗生素暴露、感染、低水平的膳食纤维摄入、高膳食脂肪的摄入、维生素D缺乏、高社会压力、运动和睡眠不足、贫血、较高的BMI、不明原因复发性口腔溃疡、不明原因关节痛或皮肤病变等；不良预后因素包括：诊断时年龄<40岁、较高的疾病严重程度、早期出现肛周病变、广泛性肠道病变、深大溃疡、存在高危血清学标志物、首次发作即需使用激素等。CD=克罗恩病，US=超声，UC=溃疡性结肠炎。

Figure 1 Flowchart of diagnosis and treatment strategies for early CD

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早期克罗恩病的诊疗与管理策略

Diagnosis and Management Strategies for Early-stage Crohn's Disease

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