胶囊内镜联合Lewis评分在诊断小肠型克罗恩病中的价值  

Diagnostic Value of Capsule Endoscopy in Small Bowel Crohn′s Disease

作　　者：郑玮玮[1] 陈金通[2] 黄燕妮[2] 徐双双 刘益娟 王承党[1] ZHENG Weiwei;CHEN Jintong;HUANG Yanni;XU Shuangshuang;LIU Yijuan;WANG Chengdang(Gastroenterology Department, The First Affiliated hospital of Fujian Medical University, Fuzhou 350005;Department of Digestive Diseases, Fujian Medical University,Fuzhou 350005;The First Clinical Medical College of Fujian Medical University,Fuzhou 350005)

机构地区：[1]福建医科大学附属第一医院消化内科,福州350005 [2]福建医科大学消化系病研究室,福州350005 [3]福建医科大学第一临床医学院,福州350005

出　　处：《福建医科大学学报》2019年第6期397-400,共4页Journal of Fujian Medical University

基　　金：福建省卫计委医学创新课题(2018-CX-32)

摘　　要：目的探讨胶囊内镜(CE)和Lewis评分对小肠型克罗恩病(CD)的诊断价值。方法回顾性分析119例疑诊小肠CD患者的临床资料,分为CD组66例和非CD组53例,比较两组CE下小肠病变的表现和Lewis评分。结果CD组Lewis评分441分(191~638分),高于非CD组[101分(56~219分)(P<0.05)]。Lewis评分评价CD的AUC为0.799(P<0.05),最佳界值为257.5分。CD组中纵行溃疡、不规则型溃疡和卵石征均高于非CD组(P<0.05)。不同病变类型中诊断CD特异性最高的为卵石征、息肉样增生、纵行溃疡,分别为98.1%,90.6%和84.9%。敏感性最高的是不规则型溃疡、Lewis评分、圆形溃疡,分别为77.3%,72.7%及72.2%。Lewis评分的敏感性、特异性、阳性预测值、阴性预测值均>70%。结论CE可以显著提高小肠CD的诊断率,小肠纵行溃疡、卵石征、息肉样增生对诊断小肠CD的特异性较高,结合Lewis评分能更全面地鉴别CD和非CD。Objective To investigate the diagnostic value of capsule endoscopy and Lewis score in small bowel Crohn′s disease.Methods 119 patients suspected of small intestinal Crohn′s disease(CD)underwent capsule endoscopy in our hospital were retrospectively analyzed.They were divided into CD group and non-CD group.The manifestation of small intestinal lesions and Lewis scores were compared between the two groups.Results There were 66 cases in CD group and 53 cases in non-CD group.Lewis score was 441(191-638)in CD group,which was higher than that in non-CD group 101(56-219)(P<0.05).Longitudinal ulcer,irregular ulcer,and cobblestone appearance in CD group were higher than those in non-CD group(P<0.05).The highest specificity of CD′s diagnosis in different pathological types were cobblestone appearance,polypoid hyperplasia and longitudinal ulcer,which were 98.1%,90.6%,and 84.9%,respectively.The highest sensitivity were irregular ulcer,Lewis score,and circular ulcer,which were 77.3%,72.7%,and 72.2%,respectively.The sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of Lewis score were more than 70%.Conclusion CE can significantly improve the diagnostic rate of small bowel CD.Longitudinal ulcer,cobblestone appearance,and polypoid hyperplasia have higher specificity in the diagnosis of small intestinal CD.Combined with Lewis score,CD and non-CD can be more comprehensively differentiated.

关 键 词：胶囊内窥镜检查 CROHN病 小肠 诊断 

分 类 号：R322.45[医药卫生—人体解剖和组织胚胎学] R574[医药卫生—基础医学]