诊断学理论与实践 ›› 2024, Vol. 23 ›› Issue (02): 119-125.doi: 10.16150/j.1671-2870.2024.02.004
收稿日期:
2023-12-10
出版日期:
2024-04-25
发布日期:
2024-07-04
通讯作者:
顾于蓓 E-mail:gyb11809@rjh.com.cn基金资助:
Received:
2023-12-10
Published:
2024-04-25
Online:
2024-07-04
摘要:
2023年,小肠疾病领域取得了多项重要发现和突破。基于数据库的小肠肿瘤全球流行病学研究首次发布。研究显示,2020年全球的小肠癌发病率为0.6/10万,较2010年至2020年的全球平均小肠癌发病率呈上升趋势(不同大洲平均年变化百分比为2.20%~21.67%)。小肠癌的发病负担存在地域差异性,其中北美最高,年龄标化发病率为1.4/10万人。我国男性的小肠癌发病率为0.32/10万人,女性为1.95/10万人。小肠癌发病危险因素(β为0.008~0.198; OR为1.07~10.01)包括较高的人类发展指数、国内生产总值;存在吸烟、饮酒习惯;缺乏运动、肥胖;存在糖尿病、脂代谢紊乱及炎症性肠病病史。在治疗方面,舒林达克和厄洛替尼联合治疗可有效减少家族性腺瘤息肉病患者的息肉负荷。对于小肠克罗恩病,软件方面,人工智能辅助内镜识别被证实可减少漏诊率,提高医疗质量;硬件方面,电动螺旋小肠镜是一把双刃剑,虽然具有更高的全小肠检查率,但在安全性得到充分保障前,仍无法大规模临床推广;药物方面,随着对疾病发病机制的深入了解,针对炎症过程的靶向治疗逐渐成为研究的热点,小分子制剂如乌帕替尼、filgotinib临床数据不断积累;外科方面,最新证据支持新诊断的回肠或回结肠克罗恩病患者接受回结肠切除术作为一线治疗的疗效不劣于肿瘤坏死因子α单抗治疗。小肠出血的诊治也在不断进步,沙利度胺作为突破性药物用于治疗毛细血管畸形所致小肠出血,为广大患者带去福音。此外,小肠梗阻的外科治疗理念逐步更新,通过评分体系,可预测小肠梗阻患者适宜接受外科手术切除或接受内科保守治疗。未来随着医疗技术、理念和人工智能的不断发展和创新,小肠疾病的诊治将会更加精准和高效。
中图分类号:
张硕文, 顾于蓓. 2023年小肠疾病诊治进展[J]. 诊断学理论与实践, 2024, 23(02): 119-125.
ZHANG Shuowen, GU Yubei. Advances in study on the diagnosis and treatment of small intestinal diseases in 2023[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(02): 119-125.
表1
小肠癌发病相关危险因素
危险因素 | OR | 95% CI | P值 |
---|---|---|---|
人类发展指数 | 2.14 | 1.65~2.77 | <0.001 |
国内生产总值 | 2.11 | 1.52~2.91 | <0.001 |
吸烟 | 1.23 | 1.15~1.32 | <0.001 |
饮酒 | 1.21 | 1.13~1.30 | <0.001 |
饮食习惯 | 1.02 | 0.99~1.04 | 0.244 |
缺乏运动 | 1.20 | 1.07~1.34 | 0.002 |
炎症性肠病 | 10.01 | 4.19~24.47 | <0.001 |
肥胖 | 1.07 | 1.03~1.10 | <0.001 |
高血压 | 1.04 | 1.00~1.07 | 0.051 |
糖尿病 | 1.19 | 1.11~1.27 | <0.001 |
脂代谢紊乱 | 1.12 | 1.08~1.16 | <0.001 |
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