结肠镜和超声内镜对炎症性肠病诊断和病情评估的价值  

Value of Colonoscopy and Endoscopic Ultrasonography in Diagnosis and Evaluation of Disease Severity of Inflammatory Bowel Disease

作　　者：缪佳蓉[1] 南琼[1] 文韵玲 朱云珍 雷梓[2] 缪应雷[1] MIAO Jiarong;NAN Qiong;WEN Yunling;ZHU Yunzhen;LEI Zi;MIAO Yinglei(Yunnan Institute of Digestive Disease,Department of Gastroenterology,the First Affiliated Hospital of Kunming Medical University,Kunming,650032;Department of Pathology,the First Affiliated Hospital of Kunming Medical University,Kunming,Kunming,650032)

机构地区：[1]云南省消化病研究所昆明医科大学第一附属医院消化内科,650032 [2]昆明医科大学第一附属医院病理科,650032

出　　处：《胃肠病学》2020年第11期660-665,共6页Chinese Journal of Gastroenterology

基　　金：云南省科学技术厅-昆明医科大学应用基础研究联合专项资金[2017FE468(-028)];昆明医科大学百名中青年学术和技术骨干项目(60117190454);云南省高层次卫生技术人才培养项目(H-2018040)。

摘　　要：背景:超声内镜(EUS)能清晰显示肠壁层次结构,其用于炎症性肠病(IBD)诊断和活动性评估的价值尚处于探索阶段。目的:探讨结肠镜和EUS在IBD诊断和病情评估中的价值。方法:纳入2017年9月—2019年9月昆明医科大学第一附属医院收治的活动期IBD病例,对其结肠镜和EUS特点进行回顾性分析。结果:共105例活动期IBD患者纳入研究,其中溃疡性结肠炎(UC)68例,克罗恩病(CD)37例。Spearman相关系数分析显示,UC患者的溃疡性结肠炎内镜严重度指数(UCEIS)和CD患者的克罗恩病简化内镜评分(SES-CD)均与疾病严重程度呈显著正相关(rs=0.708,rs=0.646;P<0.001)。EUS下UC肠壁多呈对称性增厚,平均厚度(4.46±0.84)mm,以黏膜层增厚为主;CD肠壁多呈非对称性增厚,平均厚度(8.26±1.01)mm,以黏膜下层增厚为主。CD肠壁增厚较UC显著,且更易发现直径>2 mm的脉管结构和瘘管。UC患者黏膜层、黏膜下层厚度和肠壁总厚度均与疾病严重程度呈显著正相关(rs=0.720,rs=0.628,rs=0.671;P<0.001),CD患者各肠壁厚度参数与疾病严重程度均无明显相关性(P>0.05)。结论:结肠镜可诊断和评估IBD病情;EUS有助于鉴别活动期UC与CD,并可通过测量肠壁厚度评估UC疾病严重程度。联合使用结肠镜和EUS可提高IBD的诊治效率。Background:Endoscopic ultrasonography(EUS)can display the different layers and structures of the intestinal wall,however,its value in diagnosis and assessment of disease activity of inflammatory bowel disease(IBD)is still in exploration.Aims:To investigate the value of colonoscopy and EUS in diagnosis and evaluation of disease severity of IBD.Methods:A retrospective study was conducted in patients with active IBD admitted at the First Affiliated Hospital of Kunming Medical University from September 2017 to September 2019.The results and characteristics of colonoscopy and EUS were analyzed.Results:One hundred and five active IBD patients were enrolled,including 68 cases of ulcerative colitis(UC)and 37 cases of Crohn’s disease(CD).Spearman correlation coefficient analysis revealed that the endoscopic score of UC(ulcerative colitis endoscopic index of severity,UCEIS)and CD(simple endoscopic score for Crohn’s disease,SES-CD)were both positively correlated with the disease severity(rs=0.708,rs=0.646;P<0.001).EUS showed symmetric wall thickening in UC and asymmetric wall thickening in CD,with the mean total wall thickness of(4.46±0.84)mm and(8.26±1.01)mm,respectively.In UC patients,significant thickening of the mucosa was observed;while in CD patients,thickening of the submucosal layer was predominant.Vascular structures(larger than 2 mm in diameter)and fistulas were more likely to be found in CD.The thickness of mucosa,submucosa and the total wall were positively correlated with the disease severity in UC(rs=0.720,rs=0.628,rs=0.671;P<0.001),but not in CD(P>0.05).Conclusions:Colonoscopy is important for the diagnosis and evaluation of disease severity of IBD.EUS can differentiate active UC from CD and assess the disease severity of UC by measurements of wall thickness.Combined use of colonoscopy and EUS might improve the efficacy of diagnosis and treatment of IBD.

关 键 词：结肠炎 溃疡性 CROHN病 结肠镜检查 内镜超声检查 

分 类 号：R57[医药卫生—消化系统]