爬行脂肪组织在鉴别溃疡性结肠炎和克罗恩病中的应用  

Application of Creeping Fat in Differential Diagnosis of Ulcerative Colitis and Crohn's Disease

作　　者：徐锡涛[1] 冯琦[2] 周易[1] 朱炯[2] 郑青[1] 冉志华[1] XU Xitao;FENG Qi;ZHOU Yi;ZHU Jiong;ZHENG Qing;RAN Zhihua(Division of Gastroenterology and Hepatology,Renfi Hospital,School of Medicine,Shanghai Jiao Tong University;Shanghai Institute of Digestive Diseas;Shanghai Inflammatory Bowel Disease Researeh Center,Shanghai（200001;2Department of Radiology,Renfi Hospital,School of Medicine,Shanghai Jiao Tong University,Shangha)

机构地区：[1]上海交通大学医学院附属仁济医院消化内科上海市消化疾病研究所上海市炎症性肠病研究中心,200001 [2]上海交通大学医学院附属仁济医院放射科

出　　处：《胃肠病学》2018年第8期455-460,共6页Chinese Journal of Gastroenterology

基　　金：国家自然科学基金(项目批准号:81302092;81370508;81670497);上海交通大学医学院附属仁济医院临床科研培育基金(课题编号:PYMDT-005);上海交通大学医工交叉研究基金(YG2015QN38);上海交通大学中央高校基本科研业务费资助

摘　　要：背景:溃疡性结肠炎(UC)和克罗恩病(CD)的疾病表现有一定的相似性,但两者治疗方法和转归截然不同。目的:探讨能谱CTE定量分析爬行脂肪组织在鉴别UC和CD中的应用价值。方法:回顾性分析2014年3月—2015年3月行能谱CTE检查的40例CD和15例UC患者,在能谱CTE图像上对两组患者的5个肠段进行评估,测定肠段对应爬行脂肪组织的能谱曲线斜率(λ_(HU))和标准化水浓度(NWC)。同时测量内脏脂肪面积(VFA)、皮下脂肪面积(SFA),计算两者比值(MFI)。建立Logistic回归方程,以ROC曲线比较能谱CTE和内脏脂肪法鉴别UC和CD的敏感性和特异性。以Pearson相关系数分析λ_(HU)、NWC与临床活动性、CRP和内镜评分的相关性。结果:CD患者肠段λ_(HU)和NWC总体上随疾病严重程度的增加而升高,UC患者各肠段间则无明显差异。Logistic回归模型的ROC曲线显示,能谱CTE鉴别UC和CD的特异性优于内脏脂肪法(86.7%对73.3%)。Pearson相关性分析显示CD患者λ_(HU)和NWC与SES-CD评分呈正相关。结论:能谱CTE定量分析爬行脂肪组织在UC和CD的鉴别中具有一定的临床应用价值。Background： Distinction between ulcerative colitis（ UC） and Crohn＇s disease（ CD） can be of pivotal importance for clinical management,as each entity often involves specific therapeutic strategies and prognosis. Aims： To investigate the value of creeping fat quantitatively analyzed by spectral CT enterography（ CTE） in the differential diagnosis of UC and CD.Methods： The spectral CTE data from a cohort of 40 CD patients and 15 UC patients from March 2014 to March 2015 were analyzed retrospectively. All the bowel segments of CD and UC patients on spectral CTE images were analyzed to obtain the slope of spectral HU curve（ λHU） and normalized water concentration（ NWC） of creeping fat. The visceral fat area（ VFA）,subcutaneous fat area（ SFA） and their ratios mesenteric fat index（ MFI） were measured. Logistic regression model was established,and ROC curve was used to predict the sensitivity and specificity of spectral CTE and visceral fat in the differential diagnosis of UC and CD. Pearson test was used to analyze correlations between λHU,NWC and clinical activity,CRP and endoscopic index. Results： λHUand NWC in CD patients increased progressively with increase of disease severity,however,λHU and NWC in UC patients with lesions of different segments showed no significant differences. The ROC curve of Logistic regression model showed that spectral CTE had a higher specificity than visceral fat（ based on VFA and MFI）（ 86. 7% vs. 73. 3%） in differentiating UC and CD. λHU and NWC in CD patients were correlated positively with SES-CD score. Conclusions： Using spectral CTE to quantitatively analyze the creeping fat has some clinical application values in the differential diagnosis of UC and CD.

关 键 词：CROHN病 结肠炎 溃疡性 爬行脂肪 能谱CTE 诊断 鉴别 

分 类 号：R574.62[医药卫生—消化系统]