摘要
目的探讨经腹壁肠管超声(TBUS)在评估克罗恩病疾病活动度及其并发症中的应用价值,并比较国际肠道超声节段活动评分(IBUS-SAS)与多排螺旋CT小肠造影成像(MDCTE)评分在其活动期的诊断效能。方法回顾性分析2021年3月至2023年5月南京鼓楼医院消化内科收治的103例克罗恩病住院患者的临床资料。入选患者均接受了TBUS和MDCTE检查。记录肠壁厚度、彩色多普勒血流信号(CDS)、炎性脂肪和肠壁分层等TBUS参数结果。将患者按克罗恩病活动指数分为活动期与缓解期;活动期患者进一步分为轻度活动期与中-重度活动期。绘制受试者操作特征曲线(ROC),以灵敏度、特异度、曲线下面积(AUC)和最佳截断值等指标评价TBUS主要参数及两种评分系统诊断克罗恩病活动期的效能。以内镜检查或组织病理学结果作为诊断肠狭窄的金标准,绘制ROC曲线,评价TBUS与MDCTE对克罗恩病合并肠狭窄的诊断效能。采用Spearman相关性分析探讨TBUS参数、IBUS-SAS、MDCTE评分与红细胞沉降率(ESR)、C反应蛋白(CRP)、粪便钙卫蛋白(FC)之间的相关性。结果ROC分析显示,在区分克罗恩病活动期与缓解期时,肠壁厚度(灵敏度为85.7%,特异度为90.9%,最佳截断值为4.4 mm),CDS(灵敏度为95.7%,特异度为63.6%),IBUS-SAS(灵敏度为91.4%,特异度为84.8%,最佳截断值为23.8分)和MDCTE评分(灵敏度为77.1%,特异度为75.8%,最佳截断值为6.5分)均具有较高的诊断效能。在区分克罗恩病轻度与中-重度活动期时,肠壁厚度、CDS和炎性脂肪均显示出较高的灵敏度(81.4%、69.8%、62.8%)和特异度(81.5%、77.8%、100.0%);IBUS-SAS(灵敏度83.7%,特异度为88.9%,最佳截断值为40.0分)与MDCTE评分(灵敏度为83.7%,特异度为85.2%,最佳截断值为8.5分)均有较高的诊断效能。在诊断克罗恩病合并肠狭窄时,MDCTE的AUC、灵敏度、特异度和准确度分别为0.942、94.0%、94.3%和94.2%;而TBUS的AUC、灵敏度、特异度和准确度分别为0.952、96.0%、94.3%和95.1%。Spearman相关性分析表明,肠壁厚度、CDS、炎性脂肪与ESR、CRP、FC呈正相关(r=0.252~0.451,均P<0.05)。结论TBUS参数在评估克罗恩病活动性和肠狭窄方面都显示出较好的应用价值,IBUS-SAS具有精确评估克罗恩病活动性的应用潜力。
Objective To investigate the value of transabdominal bowel ultrasonography(TBUS)in evaluating the active phase of Crohn′s disease(CD)and its complications,and to compare the diagnostic efficacy of the international bowel ultrasound segmental activity score(IBUS-SAS)and the multidetector computed tomography enterography(MDCTE)score in the active phase.Methods A totle of 103 CD patients who were admitted to the Nanjing Drum Tower Hospital from March 2021 to May 2023 were retrospectively analyzed.All patients underwent TBUS and MDCTE examinations.TBU parameters such as bowel wall thickness(BWT),color Doppler imaging signal(CDS),inflammatory fat(i-fat),and bowel wall stratification(BWS)were recorded.The patients were divided into the remission group and the active group based on the Crohn′s disease activity index.The latter group was further divided into the mild active group and the moderate-to-severe active group.Receiver operating characteristic curves(ROC)were plotted,and the diagnostic efficacy of TBUS parameters and two scoring systems in assessment of the active phase of CD was evaluated by sensitivity,specificity,area under the curve(AUC),and optimal cut-off values.Endoscopic or histopathological results were served as the gold standard for the diagnosis of intestinal strictures.The diagnostic efficacy of TBUS and MDCTE in CD complicated with intestinal stenosis were evaluated by ROC analysis.Spearman correlation analysis was performed to analyze the correlation between TBUS parameters,imaging scores,and clinical laboratory indicators such as erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),and faecal calprotectin(FC).Results In distinguishing the active phase and the remission phase of CD,BWT(a sensitivity of 85.7%,specificity of 90.9%,and cut-off value of 4.4 mm),CDS(a sensitivity of 95.7%,and specificity of 63.6%),IBUS-SAS(a sensitivity of 91.4%,specificity of 84.8%,and cut-off value of 23.8),and MDCTE score(a sensitivity of 77.1%,specificity of 75.8%,and cut-off value of 6.5)had high diagnostic efficacies.In distinguishing mild and moderate-severe active phases of CD,BWT,CDS and i-fat demonstrated high sensitivity(81.4%,69.8%and 62.8%)and specificity(81.5%,77.8%and 100.0%);IBUS-SAS(a sensitivity of 83.7%,specificity of 88.9%,and cut-off value of 40.0)and MDCTE score(a sensitivity of 83.7%,specificity of 85.2%,and cut-off value of8.5)had high diagnostic efficacy.In the diagnosis of CD complicated with intestinal stenosis,the AUC,sensitivity,specificity,and accuracy of MDCTE was 0.942,94.0%,94.3%,and 94.2%,respectively.The AUC,sensitivity,specificity,and accuracy of TBUS in the diagnosis of CD complicated with intestinal stenosis was 0.952,96.0%,94.3%,and 95.1%,respectively.The results of Spearman correlation analysis revealed that BWT,CDS,and i-fat have positively correlated with ESR,CRP,and FC(r value:0.252 to 0.451,all P<0.05).Conclusion sTBUS demonstrates good application value in evaluating the activity of CD and intestinal stenosis.IBUS-SAS has the potential application for precise assessment of CD activity.
作者
龙星云
龚黎
彭春艳
张晓琦
孔文韬
Long Xingyun;Gong Li;Peng Chunyan;Zhang Xiaoqi;Kong Wentao(Department of Ultrasonography,Nanjing Drum Tower Hospital,Nanjing 210008,China;Department of Gastroenterology,Nanjing Drum Tower Hospital,Nanjing 210008,China)
出处
《中华消化杂志》
北大核心
2025年第5期331-337,共7页
Chinese Journal of Digestion
关键词
克罗恩病
炎性肠疾病
超声检查
诊断
Crohn disease
Inflammatory bowel disease
Ultrasound examination
Diagnosis
