摘要
目的:探讨术前CT小肠成像(CTE)对克罗恩病(CD)炎症活动度及初次肠切除术后早期吻合口复发(EAR)的预测价值。方法:选取70例行初次肠切除的CD患者为研究对象,依据炎症活动度分为活动期组(n=42)和缓解期组(n=28);依据术后6个月内发生EAR与否分复发组(n=16)和未复发组(n=54)。比较不同炎症活动度组、复发与未复发组的临床特征、CTE征象及CD简化内镜(SES-CD)评分;受试者工作特征(ROC)曲线分析CTE征象对CD炎症活动度及初次肠切除术后EAR的预测价值。结果:活动期组患者肠壁厚度、肠黏膜静脉期CT值、ΔCT值、肠腔狭窄率、肠系膜淋巴结肿大率、肠系膜纤维脂肪增生率、梳状征率、脓肿/瘘管率及肠壁分层强化分型A型与B型概率高于缓解期组,差异均有统计学意义(P<0.05)。复发组患者肠壁厚度、肠黏膜静脉期CT值、ΔCT值、肠系膜淋巴结肿大率、肠系膜纤维脂肪增生率、脓肿/瘘管率高于未复发组,差异均有统计学意义(P<0.05)。受试者工作特征曲线(ROC)曲线分析显示,CTE征象联合预测CD炎症活动度的曲线下面积(AUC)为0.967;预测术后EAR的AUC为0.977,均高于单个征象预测的AUC(P<0.05)。结论:术前CTE各征象联合评估对CD患者炎症活动度及初次肠切除后术后EAR均有较好的预测价值。
Objective:To investigate the predictive value of preoperative CT enterography(CTE)on evaluating the inflammatory activity of Crohn's disease(CD)and early anastomotic recurrence(EAR)after primaryenterectomy.Methods:70 patients with CD who underwent initial intestinal resection were selected as the research subjects,and were divided into an active group(n=42)and a remission group(n=28)based on inflammation activity.Perform endoscopic examination within 6 months after surgery,according to whether EAR occurred after surgery,the patients were classified into recurrence group(n=16)and non-recurrence group(n=54).The clinical characteristics,CTE signs and SES-CD score were compared among different inflammatory activity groups,recurrence and non-recurrence groups respectively.Receiver operating characteristic(ROC)curve was drawn to analyze the efficiency of CTE signs on evaluating the inflammatory activity of CD and predicting the EAR after primaryenterectomy in CD patients.Results:The thickness of intestinal wall,CT value of intestinal mucosa in venous phase,ΔCT value,intestinal stenosis rate,mesenteric lymph node enlargement rate,mesenteric fibrofatty hyperplasia rate,comb-like sign rate,abscess/fistula rate and probability of intestinal wall stratified enhancement type A and type B in the active group were higher than those in the remission group(P<0.05).The thickness of intestinal wall,CT value of intestinal mucosal venous phase,ΔCT value and rates of mesenteric lymph node enlargement,mesenteric fibrofat hyperplasia and abscess/fistula in the recurrence group were higher than those in the non-recurrence group(P<0.05).ROC curve analysis indicated that the area under the curve(AUC)of combination of CTE signs in predicting the inflammatory activity of CD was 0.967.The AUC for predicting EAR after primary enterectomy in patients with CD was 0.977,which was higher than the AUC predicted for a single sign(P<0.05).Conclusion:CTE signs and CTE comprehensive score have high value in the combined evaluation of CD inflammatory activity,and have good predictive value on EAR after primary enterectomy in CD patients.
作者
李冬雪
詹志勇
李超
于兰英
王洋
LI Dong-xue;ZHAN Zhi-yong;LI Chao;YU Lan-ying;WANG Yang(Department of Medical Imaging,Heilongjiang Provincial Hospital,Harbin 150036,Heilongjiang,China)
出处
《川北医学院学报》
2026年第1期89-93,共5页
Journal of North Sichuan Medical College
基金
黑龙江省医院科研项目(2019-139)。
