多参数超声成像对克罗恩病患儿黏膜愈合的诊断价值  

Value of multiparametric ultrasonography in the diagnosis of mucosal healing in pediatric patients with Crohn's disease

作　　者：彭娅 欧阳红娟 湛美正 欧阳湘南 李佩岚 刘金桥 Peng Ya;Ouyang Hongjuan;Zhan Meizheng;Ouyang Xiangnan;Li Peilan;Liu Jinqiao(Department of Ultrasound,the Affiliated Children's Hospital of Xiangya School of Medicine,Central South University(Hunan Children's Hospital),Changsha 410007,China;Department of Gastroenterology and Nutrition,the Affiliated Children's Hospital of Xiangya School of Medicine,Central South University(Hunan Children'sHospital),Changsha 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)超声科,长沙410007 [2]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)消化营养科,长沙410007

出　　处：《中华超声影像学杂志》2025年第2期161-166,共6页Chinese Journal of Ultrasonography

基　　金：湖南省卫健委科研计划课题(202209023987)。

摘　　要：目的探讨由灰阶超声(US)、彩色多普勒血流成像(CDFI)、实时剪切波弹性成像(SWE)构成的多参数超声成像在诊断克罗恩病(CD)患儿黏膜愈合(MH)中的价值。方法采用前瞻性研究方法,连续收集2024年1-8月于湖南省儿童医院就诊并接受内镜检查的CD患儿,根据简化克罗恩病内镜评分(SES-CD)将所有肠段分为两组:MH组与黏膜未愈合(NMH)组。比较两组间肠壁厚度(BWT)、肠壁层次、血流分级、SWE值及肠系膜脂肪层增厚比例的差异,并绘制ROC曲线评估各超声参数的诊断效能。通过多因素Logistic回归分析筛选与MH发生相关的独立预测因素,并基于此建立回归模型。结果共纳入60例CD患儿的234段肠管,分为MH组101段和NMH组133段。MH组和NMH组的BWT、肠壁层次、血流分级、SWE值及肠系膜脂肪层增厚比例的差异有统计学意义(均P<0.05)。多因素Logistic回归分析得出BWT、血流分级、SWE值是MH的独立预测因素(均P<0.05),该回归模型的ROC曲线下面积为0.906(95%CI=0.867~0.945,P<0.05),敏感性为0.865,特异性为0.851。结论多参数超声成像检查可有效评估CD患儿的MH状态,为临床准确评估病情及治疗效果提供重要依据。Objective:To explore the value of multiparametric ultrasonography,including grayscale ultrasound(US),color Doppler flow imaging(CDFI),and real-time shear wave elastography(SWE)in diagnosing mucosal healing(MH)in pediatric patients with Crohn's disease.Methods:This prospective study consecutively enrolled pediatric CD patients who underwent endoscopic examinations at Hunan Children's Hospital from January 2024 to August 2024.Based on the Simplified Endoscopic Score for Crohn's Disease(SES-CD),all intestinal segments were divided into two groups:the MH group and the non-mucosal healing(NMH)group.Differences in bowel wall thickness(BWT),bowel wall stratification,color Doppler grading,SWE values,and increased thickness of mesenteric fat were compared between the two groups.ROC curves were plotted to evaluate the diagnostic performance of each ultrasound parameter.Multivariate Logistic regression analysis was used to identify independent predictors of MH,and a regression model was developed based on these factors.Results:A total of 234 intestinal segments from 60 pediatric CD patients were included in the analysis,divided into the MH group(101 segments)and the NMH group(133 segments).There were significant differences between the MH and NMH groups in terms of BWT,bowel wall stratification,color Doppler grading,SWE values,and increased thickness of mesenteric fat(all P<0.05).The multivariate Logistic regression analysis identified BWT,color Doppler grading,and SWE values as independent predictors associated with MH(all P<0.05).The area under the ROC curve was 0.906(95%CI=0.867-0.945,P<0.05),with a sensitivity of 0.865 and specificity of 0.851.Conclusions:Multiparametric ultrasonography can effectively assess MH in pediatric CD patients,providing critical information for accurate clinical evaluation of disease status and treatment outcomes.

关 键 词：超声检查 克罗恩病 儿童 黏膜愈合 

分 类 号：R725.7[医药卫生—儿科] R445.1[医药卫生—临床医学]