| BackgroundInflammatory bowel disease(IBD)is a chronic recurrent episode inflammable intestinal inflammatory diseases occur in young and middle-aged people,including Crohn's Disease(CD),ulcerative colitis(UC)and undetermined inflammatory bowel disease,mainly affecting the gastrointestinal tract,and often have extraintestinal symptoms.The incidence of IBD in developing countries such as China has been increasing in recent years.The diagnosis of Crohn's disease needs to be combined with the patient's clinical manifestations,endoscopic findings,pathological findings and Imaging examination to evaluate and diagnose.Gastrointestinal tract is the most common site of extranodal lymphoma,of which intestinal lymphoma accounts for about 30%,mainly in the small intestine,ileocecal and colorectal parts,and these sites are also a common site for CD.Intestinal lymphoma,especially intestinal non-B-cell lymphoma,lacks specific clinical manifestations,and has more similarities with CD in clinical symptoms,endoscopic features,imaging findings,etc.,and is easily misdiagnosed,delaying the treatment of patients.Therefore,the differential diagnosis of these two diseases is very important,and further exploration of a more comprehensive differential diagnosis method is needed.IBD,which also called “green cancer”,cannot be cured and bring great suffering to patients.The quality of life(QOL)and mental health of patients are generally lower than these of normal person.But currently there are deficiencies in the diagnosis and treatment of mental disorders of IBD patients in clinicians.In addition,there are differences in the degree of activity of IBD,and the characteristics and treatment methods of CD and UC are different.So far,the impact of these differences on patients' mental disorders are not clear.Therefore,further research is needed on the relationship and influencing factors of mental disorders,insomnia and quality of life in patients with IBD,which will provide more evidences for the improvement of IBD treatment and the adoption of psychological intervention.Objectives1.To find out the differential diagnosis points of CD and intestinal non-B cell lymphoma,to provide a more comprehensive reference for improving the accuracy of differential diagnosis;2.To analyze the patient's treatment status,quality of life,insomnia and mental state by questionnaire analysis.This provides a comprehensive basis for the assessment of traditional treatment and a preliminary exploration of the possibility of psychological intervention.Methods1.Adopting retrospective analysis of the general condition,clinical signs and symptoms,medical history,laboratory examination,endoscopy and imaging of 30 cases of patients with CD and 27 cases of intestinal non-B-cell lymphoma from January 2012 to August 2018 in our hospital.All the data were analyzed by Fisher's exact probability test or Chi-square test.P < 0.05 was considered to be statistically significant.The statistically significant indicators between the two groups were further analyzed for sensitivity,specificity,positive predictive value,negative predictive value,and accuracy.2.Using the questionnaire survey method to search the general condition,clinical features,hospital anxiety and self-rating scale(HADS)score,Inflammatory bowel disease quality of life survey scale(IBDQ)score,Pittsburgh Sleep Quality Index(PSQI)scores and other information of 61 patients with CD and 56 patients with UC,who were admitted to our hospital from January 2018 to December 2018.The measurement data were performed using mann-whitney U nonparametric test or t test;the count data were determined by Fisher's exact probability test or Chi-square test.P value less than 0.05 was considered to be statistically significant.The correlation between HADS-D,HADS-A,IBDQ and PSQI was analyzed by Pearson correlation.Results1.The age of onset in the CD group was significantly lower than that in the intestinal lymphoma group(22.83±7.93 vs 45.89±17.51,P<0.001).There was no significant difference in gender distribution between the two groups;abdominal pain was the most common symptom in both groups;abdominal abscess,fistula,perianal lesions,extraintestinal manifestations,history of appendectomy,changes in bowel traits and intestinal stenosis were more common in Crohn's disease group(P<0.05);B symptoms were more common in lymphoma group(P<0.05).The platelet count concentration was significantly higher in the Crohn's disease group than in the intestinal lymphoma group(423.50 ± 94.244 VS 292.54 ± 91.38,P<0.001).D-dimer(1.17 ± 0.953 VS 0.5718 ±1.00433,P<0.001)and erythrocyte sedimentation rate(ESR)(55.86±30.23 VS 37.28±17.154,P=0.005)were significantly higher in patients with intestinal lymphoma than Crohn's disease group.Endoscopy,ileocecal involvement,intestinal stenosis,pebbles or paving stone changes and longitudinal ulcers were more common in Crohn's disease group(P<0.05),invasive ulcers and irregular ulcers in intestinal lymphoma Groups were more common(P < 0.05).In imaging,intestinal fistula,abdominal abscess,comb-like signs and mesangial angiogenesis are more common in Crohn's disease,abdominal lymph node fusion,acute intestinal perforation,and continuous lesions are more common in intestinal lymphoma(P<0.05).).The indicators with high sensitivity to Crohn's disease include endoscopic segmental lesions and elevated platelet concentrations,and high specificity include perianal lesions,extraintestinal manifestations,paving stone-like changes,etc.The high sensitivity to intestinal non-B cell lymphoma is enlarged retroperitoneal lymph node fusion,and the high specificity are B symptom,acute intestinal perforation,and enlarged retroperitoneal lymph node.2.The diagnosis age of CD patients is less than UC(29.48 VS 37.02),the proportion of unmarried is significantly higher than UC(39.34%VS16.07%),the proportion of underweight is higher than UC(44.26%VS17.86%),the difference was statistics significance(P<0.05).In clinical features,CD patients in remission are higher than UC patients(55.74% VS 33.93%);the incidence of perianal lesions is higher than UC(32.79 VS 5.36%);the proportion history of IBD-related surgery was also higher than UC(52.46% VS 3.57%);the difference was statistically significant(P<0.05).The incidence of anxiety in IBD was 27.35%,the incidence of depression was 24.79%;the percentage of insomnia were more than 60% in both groups.The incidence of moderate to severe anxiety in UC group was higher than that in CD group(19.64% vs 4.92%)(P<0.05).There were no significant differences in the incidence of depression and quality of life between these two groups.There was no statistical difference between the active and remission periods of anxiety and depression in both group.There are significant correlations between IBDQ,HADS-A,HADS-D and PSQI in IBD patients.The correlations between IBDQ and PSQI,HADS-A and HADS-D in CD group was-0.484,-0.674 and-0.581,respectively.The correlations between IBDQ and PSQI,HADS-A and HADS-D in UC group was-0.418,-0.616 and-0.688,respectively.There are positive correlations between PSQI,HADS-A and HADS-D both in CD and UC groups.Conclusions1.The differential diagnosis of CD and intestinal non-B-cell lymphoma is complicated.The clinical diagnosis should be combined with intestinal CT,endoscopy and examination to find the differential diagnosis data,so as to improve the diagnosis rate.Suspected lymphoid tumors should be examined by endoscopy and multiple deep dig biopsies to reduce missed diagnosis and misdiagnosis.2.Patients with CD and UC,whether in the active or remission status,have high incidence of anxiety,depression and insomnia status.There are significant correlations between anxiety,depression,insomnia and quality of life,which have mutually reinforcing effects.Clinical evaluation of mental disorders and quality of life in patients with IBD should be highly valued,and needed necessary psychological intervention. |
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