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排便急迫对患者的生活质量和日常功能影响非常大；它与排便频率增加、稀便和疾病严重程度有关。 几种患者报告的工具，如急迫程度数字评定量表，可用于评估排便急迫的严重程度。

克罗恩病的症状之一排便急迫及其与疾病活动度的相关性

排便急迫是指突然、紧急需要排便。¹排便急迫被视为克罗恩病临床疾病活动度的显著指征。²与其他症状（如腹痛、便血或排便次数）相比，存在这种情况的人通常会将排便急迫视为更严重、更令他们担心的症状。^3,4此外，排便急迫报告为克罗恩病患者最常见、最令人困扰的症状之一。^5-10

克罗恩病中排便急迫感的推测作用机制

影响克罗恩病排便急迫的因素

导致克罗恩病排便急迫的潜在作用机制在很大程度上尚不清楚。 但是，排便急迫与排便频率增加、稀便以及疾病的整体严重程度等因素呈正相关，尤其是当小肠受到累及时。¹¹排便急迫在患有复杂性肛周克罗恩病的患者中很常见，但在其他形式的疾病中也比较常见。^12,13有意思的是，出现排便急迫的克罗恩病患者通常表现出肛门括约肌疲劳增加。 然而，这种疲劳似乎与局部炎症没有直接关系。¹⁴另外，克罗恩病患者的排便急迫往往与累及结肠和回盲部的疾病更密切相关，而不是仅与回肠疾病有关。^9,15,16

溃疡性结肠炎和克罗恩病排便急迫的共同作用机制和独特作用机制

溃疡性结肠炎和克罗恩病排便急迫的作用机制可能相似，包括

• 小肠和大肠的广泛性病变并伴直肠炎症
• 纤维化导致直肠壁僵硬、不顺应和容量减少
• 结肠运动功能受损，以及
• 直肠快速充盈，随后括约肌快速松弛。^11,17

克罗恩病可能特有的排便急迫机制包括

• 肛周瘘管性克罗恩病，由于直接侵袭肛门，有时需要积极的手术治疗，尤其是在未确诊的病例中，经常威胁到肛门括约肌的完整性，以及
• 近端肠道转运、粪便流动性和胆酸吸收不良。^14,17

克罗恩病患者排便急迫的患病率

横断面研究和观察性研究表明，64% 至 87% 的克罗恩病患者报告出现排便急迫。 即便进行治疗，甚至当疾病处于非活动状态时，这种症状也可能持续存在。 此外，多达一半的炎症性肠病 (IBD) 患者在缓解期出现排便急迫。^{8-10,13,15,18-20}

排便急迫对患者生活质量和社会心理功能的影响

排便急迫对患者的生活质量和社会心理功能有很大的负面影响。^8,13,21,22

排便急迫导致约 55% 的克罗恩病患者的日常功能恶化。¹³这些患者可能

• 上下班出行能力受限
• 身体锻炼受限
• 出现症状时被迫离开社交场合
• 感觉受困或失去对生活的控制，以及
• 出现不可预测的排便活动和对排便需求的强烈关注，导致受到社会歧视。^13,21,22

克罗恩病排便急迫评估

IBD 患者强调了制定排便急迫量表的重要性，该量表应能区分不同的严重程度，而不是简单地用“是”或“否”来表示；²³

可以衡量排便急迫程度的患者报告结局的工具包括

• 急迫程度数字评定量表 (NRS)²⁴
• 克罗恩病症状和影响调查问卷 (SIQ-CD)¹⁸
• 克罗恩病患者报告结局的体征和症状 (CD-PRO/SS) 日记⁶，以及
• 克罗恩病日记。²⁵

急迫程度数字评定量表

NRS 是根据 FDA 指南新开发的患者报告结局工具 (图 1)。^26-28急迫程度 NRS 是一个 11 分制量表，用来衡量患者需要排便的急迫程度。^26,28

患者记录他们每天的排便急迫程度评分，以便医疗服务提供者可以计算出 7 天的平均值，从而了解患者每周的排便急迫症状。^26,28评分越高 (图 1)，患者的排便需求就越迫切。^26,28

图 1. 急迫程度数字评定量表^28,29

图 1 说明： 患者使用急迫程度数字评定量表报告过去 24 小时内排便急迫（突然或立即需要排便）的严重程度。 急迫程度数字评定量表是一个 11 分制量表，范围从 0（表示无排便急迫）到 10（表示排便急迫最严重）。 该量表已被验证是衡量溃疡性结肠炎成年患者排便急迫严重程度的可靠指标。

在溃疡性结肠炎研究中，

• 具有临床意义的改善定义为与基线相比量表评分下降 3 分或更多，以及
• 排便急迫缓解定义为评分为 0 或 1。²⁴

另外还在患有中度至重度活动性克罗恩病的患者中评估了急迫程度 NRS 的有效性和可靠性。患者证实了问题的回忆时限、回答选项和说明的相关性、适当性和可理解性。 大多数参与者表示，急迫程度 NRS 评分下降一到两分代表有意义的改善。³⁰

克罗恩病症状和影响调查问卷

SIQ-CD 是一个包含 31 项评估问题的量表，其中包括症状专项评分和影响专项评分。¹⁸

SIQ-CD 的症状专项包括 4 个子项

• 胃肠道
• 疼痛和不适
• 营养相关，以及
• 能量相关。¹⁸

SIQ-CD 的影响专项包括 6 个子项

• 情绪
• 日常表现
• 生活方式和活动
• 社会活动
• 饮食，以及
• 额外影响。¹⁸

克罗恩病患者报告结局的体征和症状日记

CD-PRO/SS 日记由 2 个量表组成。 肠道体征和症状量表包括 3 项，腹部症状量表包括 3 项。⁶

CD-PRO/SS 工具旨在根据患者的直接反馈，为临床试验量化克罗恩病的胃肠道体征和症状提供一种标准化的方法。⁶

克罗恩病日记

克罗恩病日记评估克罗恩病的症状和影响。 该日记包含 17 项内容，评估 24 小时内的核心症状和影响以及 7 天内的肠外表现。²⁵

患者与医疗服务提供者关于克罗恩病排便急迫的沟通

对于患者来说，排便急迫等症状可能难以启齿且令人尴尬，这可能导致患者不愿向医疗服务提供者报告症状。^13,31

医疗服务提供者通常不会询问患者有关排便急迫等潜在敏感和令人尴尬的症状。^13,31

医疗服务提供者可能会低估溃疡性结肠炎特异性症状的影响，也可能无法识别哪些症状对患者的生活质量影响最大。^32-34

上次审阅日期： 2026年2月11日

参考文献

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