克隆氏症

克隆氏症 (克羅恩病)
	克隆氏症最常影響的3個部位
症狀	肚痛、發熱、胃口不佳、里急後重、腹瀉、減肥、便秘、瘺、關節疼痛、口內炎、潰瘍、牙齦病、疲倦
類型	炎症性腸病、疾病
風險因子	吸煙
診斷方法	活體組織切片、醫學影像
分類和外部資源
醫學專科	胃腸學
ICD-11	DD70
ICD-10	K50
ICD-9-CM	555
OMIM	266600
DiseasesDB	3178
MedlinePlus	000249
eMedicine	med/477 ped/507 radio/197
	[編輯此條目的維基數據]

克隆氏症（英語：Crohn's disease），又稱克羅恩病、克隆氏症候群或局部性腸炎，是一種發炎性腸道疾病，可能影響腸胃道從口腔至肛門的任何部分^[3]。症狀通常包含：腹痛、腹瀉（如果發炎嚴重可能會呈血性）、發燒和體重減輕^[3]^[4]。其他合併症可能發生於腸胃道之外且包括：貧血、皮疹、關節炎、葡萄膜炎和倦怠。可能會因為感染出現皮疹、壞疽性膿皮症（英語：Pyoderma gangrenosum）或結節性紅斑（英語：Erythema nodosum）。腸梗阻也常發生，那些具有此疾病的人罹患腸癌的風險更大^[4]。

克隆氏症是由環境、免疫和細菌等因素在遺傳易感個體上的組合所引起^[5]^[6]^[7]。它會導致慢性發炎疾病，其中身體的免疫系統可能針對腸胃道的微生物抗原進行攻擊^[6]^[8]。雖然克隆氏症是一種免疫相關疾病，但它不會以自體免疫疾病的形式表現（免疫系統不被身體本身所觸發）^[9]。確切的潛在性免疫問題尚未明確；然而它可能是免疫缺陷的狀態^[8]^[10]^[11]。整體風險中約有一半和超過70個的基因相關^[4]^[12]。吸煙者罹患克隆氏症的概率是沒吸煙者的兩倍^[13]。它也時常發生於腸胃炎後。診斷是基於許多發現結果包括：組織切片和腸壁外觀、醫學影像和疾病描述。可以呈現其他的類似病症包含：腸躁症和貝賽特氏症^[4]。

目前並無任何藥物治療和手術能根治克隆氏症。治療選項（英語：Management of Crohn's disease）的目的在於改善症狀，使病情緩解以及預防復發（英語：Relapse）。新診斷為克隆氏症的病人通常會接受短暫的類固醇治療，使病情有顯著的改善，之後並合併滅殺除癌錠或硫嘌呤等藥物防止復發。對於有煙癮的病患來說，在治療過程中最重要的一部分就是戒煙。患有克隆氏症的病患中，每五位就有一位需要每年定期回醫院覆診，其中約有一半的病患在發病後十年左右需要接受手術治療。雖然手術並非必要的治療方式，但適用於膿瘍、某些情況下的腸阻塞以及癌症。同時也建議患者在發病的八年後，需要隔幾年接受大腸鏡，以檢查是否有罹患大腸癌^[4]。

在歐洲以及北美等地區，克隆氏症的盛行率約為每1000人中有3.2人罹患克隆氏症^[14]。在亞洲以及非洲等地區較為罕見^[15]^[16]。就歷史的發展情形來說，克隆氏症在發達國家較為常見^[17]。但罹患克隆氏症的人口比例自1970年以來，在發展中國家已經不斷竄升^[16]^[17]。發炎性腸道疾病在2010年造成35000例死亡案例^[18]，而罹患克隆氏症的病患的預期壽命有輕微的減少^[4]。克隆氏症好發的年齡層位於十多歲至二十多歲，但依然會在各種年齡層中出現^[3]^[4]。且不因性別有所不同^[3]。克隆氏症的名稱是用來紀念布里爾·伯納德·克羅恩（英語：Burrill Bernard Crohn），這位腸胃科醫師和另外兩位同事在1932年於紐約西乃山醫院（英語：Mount Sinai Hospital (Manhattan)）描述許多在迴腸末端以及小腸等容易受感染的部分有發炎狀況，病患的病情^[19]。治療克隆氏症的方法有二：

利用TNF-α的抗體
利用可調節T細胞過敏反應的interleukin-10

參看[編輯]

參考[編輯]

^ Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies.. The Lancet. 2007, 369 (9573): 1641–57. PMID 17499606. doi:10.1016/S0140-6736(07)60751-X.
^ Hanauer, Stephen B.; William Sandborn. Management of Crohn's Disease in Adults (PDF). American Journal of Gastroenterology. 2001-03-01, 96 (3): 635–43 [2006-11-08]. PMID 11280528. doi:10.1111/j.1572-0241.2001.03671.x. （原始內容存檔 (PDF)於2011-09-27）.
^ ^3.0 ^3.1 ^3.2 ^3.3 Crohn's Disease. National Digestive Diseases Information Clearinghouse (NDDIC). July 10, 2013 [12 June 2014]. （原始內容存檔於2014-06-09）.
^ ^4.0 ^4.1 ^4.2 ^4.3 ^4.4 ^4.5 ^4.6 Baumgart DC, Sandborn WJ; Sandborn. Crohn's disease. The Lancet. 2012, 380 (9853): 1590–605. PMID 22914295. doi:10.1016/S0140-6736(12)60026-9.
^ Cho JH, Brant SR. Recent Insights into the Genetics of Inflammatory Bowel Disease. Gastroenterology. 2011, 140 (6): 1704–12. PMID 21530736. doi:10.1053/j.gastro.2011.02.046.
^ ^6.0 ^6.1 Dessein R, Chamaillard M, Danese S. Innate Immunity in Crohnʼs Disease. Journal of Clinical Gastroenterology. 2008, 42: S144–7. PMID 18806708. doi:10.1097/MCG.0b013e3181662c90.
^ Stefanelli T, Malesci A, Repici A, Vetrano S, Danese S. New Insights into Inflammatory Bowel Disease Pathophysiology: Paving the Way for Novel Therapeutic Targets. Current Drug Targets. 2008, 9 (5): 413–8. PMID 18473770. doi:10.2174/138945008784221170.
^ ^8.0 ^8.1 Marks DJ, Rahman FZ, Sewell GW, Segal AW. Crohn's disease: An immune deficiency state. Clinical reviews in allergy & immunology. 2010, 38 (1): 20–31. PMID 19437144. doi:10.1007/s12016-009-8133-2.
^ Casanova JL, Abel L. Revisiting Crohn's disease as a primary immunodeficiency of macrophages.. The Journal of experimental medicine. Aug 31, 2009, 206 (9): 1839–43. PMID 19687225. doi:10.1084/jem.20091683.
^ Lalande JD, Behr MA. Mycobacteria in Crohn's disease: How innate immune deficiency may result in chronic inflammation. Expert review of clinical immunology. 2010, 6 (4): 633–41. PMID 20594136. doi:10.1586/eci.10.29.
^ Yamamoto-Furusho JK, Korzenik JR. Crohn's disease: Innate immunodeficiency?. World Journal of Gastroenterology. 2006, 12 (42): 6751–5 [2016-01-18]. PMID 17106921. （原始內容存檔於2013-06-06）.
^ Barrett JC, Hansoul S, Nicolae DL, Cho JH, Duerr RH, Rioux JD, Brant SR, Silverberg MS, Taylor KD, Barmada MM, Bitton A, Dassopoulos T, Datta LW, Green T, Griffiths AM, Kistner EO, Murtha MT, Regueiro MD, Rotter JI, Schumm LP, Steinhart AH, Targan SR, Xavier RJ, Libioulle C, Sandor C, Lathrop M, Belaiche J, Dewit O, Gut I, Heath S, Laukens D, Mni M, Rutgeerts P, Van Gossum A, Zelenika D, Franchimont D, Hugot JP, de Vos M, Vermeire S, Louis E, Cardon LR, Anderson CA, Drummond H, Nimmo E, Ahmad T, Prescott NJ, Onnie CM, Fisher SA, Marchini J, Ghori J, Bumpstead S, Gwilliam R, Tremelling M, Deloukas P, Mansfield J, Jewell D, Satsangi J, Mathew CG, Parkes M, Georges M, Daly MJ. Genome-wide association defines more than 30 distinct susceptibility loci for Crohn's disease. Nature Genetics. 2008, 40 (8): 955–62. PMC 2574810 . PMID 18587394. doi:10.1038/ng.175.
^ Cosnes J. Tobacco and IBD: Relevance in the understanding of disease mechanisms and clinical practice. Best Practice & Research Clinical Gastroenterology. 2004, 18 (3): 481–96. PMID 15157822. doi:10.1016/j.bpg.2003.12.003.
^ Molodecky, NA; Soon, IS; Rabi, DM; Ghali, WA; Ferris, M; Chernoff, G; Benchimol, EI; Panaccione, R; Ghosh, S; Barkema, HW; Kaplan, GG. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review.. Gastroenterology. Jan 2012, 142 (1): 46–54.e42; quiz e30. PMID 22001864. doi:10.1053/j.gastro.2011.10.001.
^ Prideaux, L; Kamm, MA; De Cruz, PP; Chan, FK; Ng, SC. Inflammatory bowel disease in Asia: a systematic review.. Journal of Gastroenterology and Hepatology. Aug 2012, 27 (8): 1266–80. PMID 22497584. doi:10.1111/j.1440-1746.2012.07150.x.
^ ^16.0 ^16.1 Hovde, Ø; Moum, BA. Epidemiology and clinical course of Crohn's disease: results from observational studies.. World journal of gastroenterology : WJG. Apr 21, 2012, 18 (15): 1723–31. PMC 3332285 . PMID 22553396. doi:10.3748/wjg.v18.i15.1723.
^ ^17.0 ^17.1 Burisch, J; Munkholm, P. Inflammatory bowel disease epidemiology.. Current opinion in gastroenterology. Jul 2013, 29 (4): 357–62. PMID 23695429. doi:10.1097/MOG.0b013e32836229fb.
^ Lozano, R; Naghavi, M. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.. Lancet. Dec 15, 2012, 380 (9859): 2095–128. PMID 23245604. doi:10.1016/S0140-6736(12)61728-0.
^ Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis: A pathologic and clinical entity. 1932. The Mount Sinai journal of medicine, New York. 2000, 67 (3): 263–8. PMID 10828911.

外部連結[編輯]

[Baumgart-1] Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies.. The Lancet. 2007, 369 (9573): 1641–57. PMID 17499606. doi:10.1016/S0140-6736(07)60751-X.

[HanauerCrohns-2] Hanauer, Stephen B.; William Sandborn. Management of Crohn's Disease in Adults (PDF). American Journal of Gastroenterology. 2001-03-01, 96 (3): 635–43 [2006-11-08]. PMID 11280528. doi:10.1111/j.1572-0241.2001.03671.x. （原始內容存檔 (PDF)於2011-09-27）.

[NIDDK2013-3] 3.0 ^3.1 ^3.2 ^3.3 Crohn's Disease. National Digestive Diseases Information Clearinghouse (NDDIC). July 10, 2013 [12 June 2014]. （原始內容存檔於2014-06-09）.

[Baumgart2012-4] 4.0 ^4.1 ^4.2 ^4.3 ^4.4 ^4.5 ^4.6 Baumgart DC, Sandborn WJ; Sandborn. Crohn's disease. The Lancet. 2012, 380 (9853): 1590–605. PMID 22914295. doi:10.1016/S0140-6736(12)60026-9.

[5] Cho JH, Brant SR. Recent Insights into the Genetics of Inflammatory Bowel Disease. Gastroenterology. 2011, 140 (6): 1704–12. PMID 21530736. doi:10.1053/j.gastro.2011.02.046.

[Bact08-6] 6.0 ^6.1 Dessein R, Chamaillard M, Danese S. Innate Immunity in Crohnʼs Disease. Journal of Clinical Gastroenterology. 2008, 42: S144–7. PMID 18806708. doi:10.1097/MCG.0b013e3181662c90.

[7] Stefanelli T, Malesci A, Repici A, Vetrano S, Danese S. New Insights into Inflammatory Bowel Disease Pathophysiology: Paving the Way for Novel Therapeutic Targets. Current Drug Targets. 2008, 9 (5): 413–8. PMID 18473770. doi:10.2174/138945008784221170.

[pmid19437144-8] 8.0 ^8.1 Marks DJ, Rahman FZ, Sewell GW, Segal AW. Crohn's disease: An immune deficiency state. Clinical reviews in allergy & immunology. 2010, 38 (1): 20–31. PMID 19437144. doi:10.1007/s12016-009-8133-2.

[9] Casanova JL, Abel L. Revisiting Crohn's disease as a primary immunodeficiency of macrophages.. The Journal of experimental medicine. Aug 31, 2009, 206 (9): 1839–43. PMID 19687225. doi:10.1084/jem.20091683.

[10] Lalande JD, Behr MA. Mycobacteria in Crohn's disease: How innate immune deficiency may result in chronic inflammation. Expert review of clinical immunology. 2010, 6 (4): 633–41. PMID 20594136. doi:10.1586/eci.10.29.

[11] Yamamoto-Furusho JK, Korzenik JR. Crohn's disease: Innate immunodeficiency?. World Journal of Gastroenterology. 2006, 12 (42): 6751–5 [2016-01-18]. PMID 17106921. （原始內容存檔於2013-06-06）.

[genetic_link-12] Barrett JC, Hansoul S, Nicolae DL, Cho JH, Duerr RH, Rioux JD, Brant SR, Silverberg MS, Taylor KD, Barmada MM, Bitton A, Dassopoulos T, Datta LW, Green T, Griffiths AM, Kistner EO, Murtha MT, Regueiro MD, Rotter JI, Schumm LP, Steinhart AH, Targan SR, Xavier RJ, Libioulle C, Sandor C, Lathrop M, Belaiche J, Dewit O, Gut I, Heath S, Laukens D, Mni M, Rutgeerts P, Van Gossum A, Zelenika D, Franchimont D, Hugot JP, de Vos M, Vermeire S, Louis E, Cardon LR, Anderson CA, Drummond H, Nimmo E, Ahmad T, Prescott NJ, Onnie CM, Fisher SA, Marchini J, Ghori J, Bumpstead S, Gwilliam R, Tremelling M, Deloukas P, Mansfield J, Jewell D, Satsangi J, Mathew CG, Parkes M, Georges M, Daly MJ. Genome-wide association defines more than 30 distinct susceptibility loci for Crohn's disease. Nature Genetics. 2008, 40 (8): 955–62. PMC 2574810 . PMID 18587394. doi:10.1038/ng.175.

[Cosnes2004-13] Cosnes J. Tobacco and IBD: Relevance in the understanding of disease mechanisms and clinical practice. Best Practice & Research Clinical Gastroenterology. 2004, 18 (3): 481–96. PMID 15157822. doi:10.1016/j.bpg.2003.12.003.

[14] Molodecky, NA; Soon, IS; Rabi, DM; Ghali, WA; Ferris, M; Chernoff, G; Benchimol, EI; Panaccione, R; Ghosh, S; Barkema, HW; Kaplan, GG. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review.. Gastroenterology. Jan 2012, 142 (1): 46–54.e42; quiz e30. PMID 22001864. doi:10.1053/j.gastro.2011.10.001.

[15] Prideaux, L; Kamm, MA; De Cruz, PP; Chan, FK; Ng, SC. Inflammatory bowel disease in Asia: a systematic review.. Journal of Gastroenterology and Hepatology. Aug 2012, 27 (8): 1266–80. PMID 22497584. doi:10.1111/j.1440-1746.2012.07150.x.

[Hov2012-16] 16.0 ^16.1 Hovde, Ø; Moum, BA. Epidemiology and clinical course of Crohn's disease: results from observational studies.. World journal of gastroenterology : WJG. Apr 21, 2012, 18 (15): 1723–31. PMC 3332285 . PMID 22553396. doi:10.3748/wjg.v18.i15.1723.

[Bur2013-17] 17.0 ^17.1 Burisch, J; Munkholm, P. Inflammatory bowel disease epidemiology.. Current opinion in gastroenterology. Jul 2013, 29 (4): 357–62. PMID 23695429. doi:10.1097/MOG.0b013e32836229fb.

[18] Lozano, R; Naghavi, M. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.. Lancet. Dec 15, 2012, 380 (9859): 2095–128. PMID 23245604. doi:10.1016/S0140-6736(12)61728-0.

[CrohnBB-19] Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis: A pathologic and clinical entity. 1932. The Mount Sinai journal of medicine, New York. 2000, 67 (3): 263–8. PMID 10828911.

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