Van Assche评分对克罗恩病肛瘘临床愈合的预测作用  

Predictive value of Van Assche score for the clinical healing of anal fistula in Crohn s disease

作　　者：张梦慈 徐健[1] 文妍 刘玥 季琛 陈红锦 ZHANG Mengci;XU Jian;WEN Yan;LIU Yue;JI Chen;CHEN Hongjin(The Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第四附属医院,江苏南京210029

出　　处：《邵阳学院学报（自然科学版）》2023年第2期99-108,共10页Journal of Shaoyang University：Natural Science Edition

基　　金：江苏省研究生实践创新计划(SJCX18_0456)。

摘　　要：目的评估克罗恩病(Crohn’s disease,CD)肛瘘患者基于磁共振成像(magnetic resonance imagin,MRI)下的Van Assche评分对临床愈合的预测意义,确定临床愈合的影响因素。方法收集2010年8月至2017年10月在南京医科大学第四附属医院胃肠外科诊治的CD患者。纳入应用IFX联合挂线治疗、术前行MRI的CD肛瘘患者。收集MRI影像及临床数据,分析CD肛瘘患者基于术前MRI下的Van Assche评分对临床愈合的预测意义,通过logistic回归模型评估临床愈合的影响因素。结果93例符合标准的CD肛瘘患者纳入研究(男性73.1%),中位随访时间34.5(IQR,22~58)个月。临床愈合率和应答率分别为60.2%(56/93)、39.8%(37/93)。临床愈合组的Van Assche评分相对偏低(13.6 vs 16.4,P=0.005)。受试者工作特征曲线是在Van Assche评分基础上构建的,用于预测临床愈合率。受试者工作特征曲线(receiver operating characteristic,ROS)下的面积为0.674,其敏感度、特异度分别为87.50%、40.54%。Van Assche评分的截断值是18.0,且评分>18.0的患者更易达到临床愈合(OR=4.33,P=0.008)。结论Van Assche评分与CD肛瘘临床愈合之间存在较大的差异性,并非预测患者临床愈合的可靠指标。术前Van Assche评分≤18.0的患者,可能需要更密切的随访或积极的药物治疗。Objective To evaluate the predictive significance of Van Assche score based on magnetic resonance imaging(MRI)for clinical healing in patients with perianal fistulizing Crohn’s disease(PFCD)and to identify influencing factors of clinical healing.Methods CD patients who were diagnosed and treated by Department of Colorectal Surgery the Fourth Affiliated Hospital of Nanjing Medical University from August 2010 to October 2017 were collected.Patients with PFCD undergoing combined therapy who performed pelvic MRI before surgery were included in this study.MRI images and clinical data were collected to analyze the significance of Van Assche score based on preoperative MRI in predicting clinical healing of patients with PFCD,and the influencing factors of clinical healing were evaluated by logistic regression model.Results Ninety-three patients with PFCD who met the criteria were included in this study(male 73.1%),and the median follow-up time was 34.5(22~58 months).The clinical healing rate and response rate were 60.2%(56/93)and 39.8%(37/93),respectively.The Van Assche score in the clinical healing group was relatively low(13.6 vs 16.4,P=0.005).The receiver operating characteristic curve was a clinically healed patient constructed on the basis of the Van Assche score.The area under the receiver s operating characteristic curve was 0.674,and the sensitivity and specificity were 87.50%and 40.54%,respectively.The cutoff value for the Van Assche score was 18.0,and patients with a score>18.0 were more likely to achieve clinical healing(OR=4.33,P=0.008).Conclusion There is a large difference between the Van Assche score and the clinical healing of PFCD,which is not a reliable indicator for predicting clinical healing.Patients with a preoperative Van Assche score of≤18.0 may require closer follow-up or active medication treatment.

关 键 词：克罗恩病 肛瘘 临床愈合 Van Assche评分 预测因素 

分 类 号：R516.1[医药卫生—内科学]