超声内镜测量肠壁厚度对判断克罗恩病活动性的价值初探  

Evaluation of intestinal wall thickness measurement with endoscopic ultrasonography for Crohn disease activity

作　　者：陈虹璇[1] 覃山羽[1] 姜海行[1] 罗薇[1] 宁红建[1] 卢东红[1] 陶霖[1] 苏思标[1] 

机构地区：[1]广西医科大学第一附属医院消化内科,南宁530021

出　　处：《中华消化内镜杂志》2017年第6期400-404,共5页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金（31560257）;广西高等学校科研项目（桂教科研：LX2014076）

摘　　要：目的初步探讨内镜超声检查术（EUS）测量黏膜下层厚度对判断克罗恩病（CD）活动性的临床价值。方法对10例临床确诊为活动期CD的患者及10例同期健康对照者进行EUS检查，记录克罗恩病简易镜下评分（SES—CD），测量病变最重部位的黏膜下层厚度，随访并测量其缓解期相同病变部位黏膜下层厚度，对比CD患者治疗前后黏膜下层厚度改变，分析黏膜下层厚度与CD活动的相关性，计算出黏膜下层厚度诊断CD活动性的最佳阈值。结果10例CD患者活动期黏膜下层厚度为（6．48±1．95）mm，缓解期为（2．47±1．08）mm，两者比较差异有统计学意义（P〈0．01）；相关性分析显示黏膜下层厚度与克罗恩病活动指数（CDAI）值呈正相关（r=0．708，P〈0．01），与SES—CD评分呈正相关（r=0．807，P〈0．01）。对10例活动期CD患者黏膜下层厚度进行受试者工作特征曲线分析，曲线下面积为0．985（P〈0．01）。当黏膜下层厚度取3．85mm作为阈值时，判断CD活动性的敏感度为100％，特异度为90％，Youden指数为0．90。结论EUS测量黏膜下层厚度有助于评估CD的活动性，从而有助于指导临床治疗。Objective To evaluate measurement of the submucosal thickness with endoscopic ultrasonography （EUS） for activity of Crohn disease （CD）. Methods Ten patients with active stage of CD and 10 healthy controls （HC） underwent EUS. Simple endoscopic score for Crohn disease （SES-CD）and submucosal thickness at the most severe lesions were measured and recorded. Submucosal thickness of the same region in CD patients were measured at remissive stage. In order to analyze the relationship between submucosal thickness and the stage of CD, submucosal thickness were compared among patients at active stage of CD, remissive stage of CD and HC. And the cut-off value of submucosal thickness was calculated to diagnose the stage of CD. Results The mean submucosal thicknesses of active stage and remissive stage of CD were 6.48±1.95 mm and 2.47±1.08 ram,respectively （P〈0. 01）. The correlation analysis showed that submucosal thickness had a positive correlation with Crohn disease activity index （CDAI） （r = 0. 708, P〈 0. 01） and SES-CD（ r= 0. 807,P〈0. 01 ）. Receiver operating characteristic curve analysis was used for 10 cases of CD patients and the area under the curve was 0. 985 （ P〈0. 01 ）. The cut-off value of submucosal thickness to diagnose active stage of CD was 3.85 mm, and the sensitivity and specificity reached 100% and 90% respectively. The Youden index was 0. 9. Conclusion Measurement of gastrointestinal submucosal thickness by EUS could contribute to evaluate the stage of CD and to guide clinical treatment.

关 键 词：克罗恩病 腔内超声检查 疾病活动度 黏膜下层厚度 

分 类 号：R574.62[医药卫生—消化系统]