超声对克罗恩病累及阑尾与化脓性阑尾炎的鉴别诊断  

Ultrasonographic Features in Differential Diagnosis Between Crohn's Disease Involving Appendix and Suppurative Appendicitis

作　　者：张爱华 王璇 陈海兰 陈燕[2] 黄小花[2] 刘新秀[2] ZHANG Aihua;WANG Xuan;CHEN Hailan;CHEN Yan;HUANG Xiaohua;LIU Xinxiu(Department of Ultrasound in Medicine,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建省第三人民医院超声科,福建闽侯350108 [2]福建医科大学附属第一医院超声医学科,福建福州350005

出　　处：《中国医学影像学杂志》2023年第9期950-955,共6页Chinese Journal of Medical Imaging

基　　金：2020年福建省科技厅引导性项目(2020Y0030)。

摘　　要：目的探讨超声特征对克罗恩病(CD)累及阑尾与化脓性阑尾炎的鉴别诊断价值。资料与方法回顾性收集2017年7月—2022年3月福建医科大学附属第一医院临床确诊CD且病变累及阑尾的60例患者,收集同期经手术病理证实的化脓性阑尾炎82例,对两组患者的临床资料[腹痛特点,是否伴腹泻、排便异常及肛周脓肿,白细胞计数(WBC)及C反应蛋白(CRP)]和超声征象(阑尾壁厚度、层次结构、血流信号、是否可压缩,阑尾腔积液,阑尾周边网膜系膜及回盲部是否出现病变)进行单因素分析,将具有统计学意义的超声参数设为因变量进行Logistic回归分析。结果单因素分析显示,临床资料中,两组是否伴腹泻、排便异常、肛周脓肿,CRP、WBC值是否升高,CRP或WBC中至少1项升高差异有统计学意义(χ^(2)=90.84、42.28、16.73、36.33、16.30,P均<0.05),转移性右下腹痛差异无统计学意义(P>0.05);超声征象中,两组阑尾壁增厚、层次消失和阑尾腔积液差异有统计学意义(χ^(2)=71.86、71.66,P均<0.01)。超声征象的多因素分析显示,阑尾壁增厚、层次消失为CD累及阑尾的独立危险因素。结论CD累及阑尾与化脓性阑尾炎均可表现为转移性右下腹痛,但前者常出现阑尾壁增厚、层次消失,伴慢性消化道症状,部分患者以肛周脓肿为首发症状;后者多表现为阑尾腔积液,阑尾壁薄、层次结构可见,常伴WBC或CRP升高。Purpose To explore the ultrasonographic features in differential diagnosis between Crohn's disease(CD)involving appendix and suppurative appendicitis.Materials and Methods A total of 60 patients in the First Affiliated Hospital of Fujian Medical University from July 2017 to March 2022 with CD involving appendix were collected and analyzed retrospectively.During the same period,82 patients with suppurative appendicitis confirmed by pathology were collected.Single factor analysis was carried out on the clinical data[characteristics of abdominal pain,diarrhea,abnormal defecation and perianal abscess,white blood cell count(WBC)and C-reactive protein(CRP)]of the patients and ultrasound features(the thickness of the appendix wall,hierarchy,blood flow signal,whether the appendix wall was compressible,fluid accumulation in the appendix cavity,and whether there were lesions in the omen tum mesentery and ileocecal region around the appendix),then Logistic regression analysis was carried out with significant ultrasound parameters as the dependent variables.Results Single factor analysis showed that there were significant differences between the two groups in the presence of diarrhea or abnormal defecation,perianal abscess,increase of CRP,increase of WBC,and increase of at least one of CRP and WBC(χ^(2)=90.84,42.28,16.73,36.33,16.30,all P<0.05),but there was no significant difference in metastatic right lower abdominal pain between the two groups(P>0.05).There were also statistically significant differences between the two groups in the thickening of appendiceal wall,disappearance of stratification and effusion of appendiceal cavity in ultrasound feature(χ^(2)=71.86,71.66,both P<0.01).Multiple factors analysis of ultrasonic feature showed that the thickening of the appendix wall and the disappearance of stratification were the independent risk factor for CD involving the appendix.Conclusion Both CD involving appendix and suppurative appendicitis can show metastatic right lower abdominal pain.The former is mostly manifested

关 键 词：克罗恩病累及阑尾 化脓性阑尾炎 超声检查 诊断 鉴别 

分 类 号：R574[医药卫生—消化系统] R574.61[医药卫生—内科学] R445.1[医药卫生—临床医学]