剪切波弹性成像在克罗恩病炎症性狭窄和纤维性狭窄鉴别诊断中的应用  

Application of shear wave elastography in differentiating fibrotic stricture from inflammatory stricture in patients with Crohn's disease

作　　者：李诗慧 李蔓英[1] 毛仁 谢晓燕[1] 陈瑜君[1] Li Shihui;Li Manying;Mao Ren;Xie Xiaoyan;Chen Yujun(Department of Medical Ultrasonics,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of Gastroenterology,the First Afiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院超声医学科,广州510080 [2]中山大学附属第一医院消化内科,广州510080

出　　处：《中华炎性肠病杂志（中英文）》2024年第5期364-370,共7页Chinese Journal of Inflammatory Bowel Diseases

基　　金：广州市科技计划项目(202201011157)。

摘　　要：目的评估剪切波弹性成像(SWE)鉴别诊断克罗恩病(CD)炎症性狭窄和纤维性狭窄的可行性。方法采用横断面调查研究方法。连续性收集2020年1月—2023年6月在中山大学附属第一医院接受SWE检查的狭窄型CD患者。收集患者的一般资料、实验室检查指标及超声检查指标。实验室检查指标包括C反应蛋白(CRP)和红细胞沉降率(ESR)。超声检查指标包括肠壁厚度、近段肠管扩张、肠壁层次结构、Limberg分级及弹性指标SWE值。利用改良的狭窄肠道纤维化评分,将患者分为炎症性狭窄组和纤维性狭窄组。统计分析2组临床资料的差异。采用Spearman相关分析评估超声指标和纤维化评分的相关性。绘制受试者工作特征(ROC)曲线,计算SWE鉴别炎症性狭窄和纤维性狭窄的诊断效能。结果共纳入60例CD患者,男44例,女16例;年龄(34.3±11.1)岁;病程60(24,117)个月。其中炎症性狭窄组43例,纤维性狭窄组17例。两组CRP(P=0.049)、肠壁厚度(P=0.020)、肠壁层次结构(P=0.001)、SWE值(P<0.001)差异均有统计学意义,但其他指标差异均不存在统计学意义(均P>0.05)。肠壁厚度、肠壁层次结构和SWE值均与纤维化评分呈正相关(均rs>0.3)。在鉴别炎症性狭窄和纤维性狭窄时,SWE值取15.9 kPa作为截断值,灵敏度为0.824,特异度为0.791,ROC曲线下面积为0.850(95%CI:0.740~0.952,P<0.001)。结论SWE检查可用于CD炎症性和纤维性狭窄的鉴别诊断,为狭窄型CD患者提供更多诊断依据。Objective To assess the feasibility of shear wave elastography(SWE)in differentiating inflammatory and fibrotic strictures in Crohn's disease(CD).Methods A cross-sectional survey study was conducted.The patients with stricture-type CD who underwent SWE examination at the First Affiliated Hospital of Sun Yat-sen University from January 2020 to June 2023 were continuously collected.The general data,laboratory examination indicators,and ultrasound examination indicators were collected.Laboratory examination indicators included C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR).Ultrasound examination indicators included intestinal wall thickness,proximal bowel dilation,intestinal wall layer structure,Limberg grading,and the elasticity indicator SWE value.Patients were divided into inflammatory stricture group and fibrotic stricture group by using a modified fibrosis score of the narrowed intestine.Statistical analysis was performed to compare the differences in clinical data between the two groups,and Spearman correlation analysis was used to evaluate the correlation between ultrasound indicators and fibrosis score.Receiver operating characteristic(ROC)curves were plotted,and the diagnostic efficacy of SWE for inflammatory stricture and fibrotic stricture was calculated.Results A total of 60 CD patients[44 men,16 women;mean age,34.3±11.1 years;mean disease duration 60(24,117)months]were included.There were 43 patients in the inflammatory stricture group and 17 in the fibrotic stricture group.The differences in CRP(P=0.049),intestinal wall thickness(P=0.020),intestinal wall layer structure(P=0.001),and SWE value(P<0.001)between the two groups were statistically significant,but the differences in other indicators were not statistically significant(all P>0.05).Intestinal wall thickness,intestinal wall layer structure,and SWE value were all positively correlated with fibrosis scores(all r s>0.3).In distinguishing inflammatory stricture from fibrotic stricture,a cut-off value of 15.9 kPa for SWE value yielded

关 键 词：克罗恩病 剪切波弹性成像 狭窄 纤维化 

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