小肠胶囊内镜在克罗恩病诊疗中的应用研究

发布时间：2018-05-24 01:35

本文选题：小肠胶囊内镜 + 克罗恩病　；参考：《南方医科大学》2017年硕士论文

【摘要】：研究背景及目的:克罗恩病(Crohndisease,CD)是累及全消化道的慢性炎症性疾病,约80%患者累及小肠,其中1/3患者小肠是唯一病灶。长期以来,人们无法直观看到小肠内部全景,直到小肠胶囊内镜(small bowel capsule endoscopy,SBCE)和小肠镜的出现。SBCE是一种新型的内镜检查技术,现已经成为临床上小肠疾病的一线诊断技术,然而SBCE对CD的诊疗价值目前仍存在争议,本研究包括以下两部分:1、探讨SBCE对疑诊CD患者的诊断价值;2、分析确诊CD患者行SBCE检查发生检查未完成及胶囊滞留的危险因素、探讨SBCE在评估CD患者小肠黏膜愈合中的价值。研究方法1、小肠胶囊内镜在疑诊克罗恩病患者中的应用分析435例临床怀疑CD且行SBCE检查患者的临床资料(其中23例患者同时行双气囊小肠镜检查、15例患者同时行CT小肠造影检查)。分别统计三种检查方法对疑诊CD患者的诊断率、准确率、灵敏度、特异度。2、小肠胶囊内镜在确诊克罗恩病患者中的应用2.1统计确诊CD患者SBCE检查未完成率和胶囊滞留率,并利用logistic回归分析相关危险因素。2.2观察接受英夫利昔治疗的小肠CD患者临床疗效,分析治疗前和治疗后第30周时患者小肠及结肠黏膜愈合情况。并利用spearman相关检验分析Lewis评分与克罗恩病简化内镜评分(SES-CD)、克罗恩病活动度指数(CDAI)、C反应蛋白(CRP)的相关性。研究结果:1、小肠胶囊内镜在疑诊克罗恩病患者中的应用435例疑诊CD患者中有267例患者最终确诊为CD,其中三种方法的诊断率、'准确率、灵敏度、特异度分别是小肠胶囊内镜为64.6%、89.4%、94.0%、82.1%;双气囊小肠镜分别为78.2%、91.3%、94.4%、80%;CT小肠成像为73.3%、86.7%、90.9%、75%。2、小肠胶囊内镜在确诊克罗恩病患者中的应用2.1 302例确诊CD中,SBCE检查未完成率为33.44%,滞留率为5.6%,logistic回归发现白蛋白降低是SBCE检查未完成的危险因素[OR=3.040;P=0.001],腹泻是未完成的保护因素[OR=0.434;P=0.003]。CRP升高是胶囊滞留的危险因素[OR=3.967;P=0.034]。2.2 36例接受英夫利昔治疗的患者治疗后第30周患者临床缓解率为86.1%(31/36)结肠镜下黏膜愈合率为72.2%(26/36),SBCE下小肠黏膜愈合率为30.6%(11/36),且11例小肠黏膜愈合的患者均同时取得了结肠镜下黏膜愈合,有15例结肠镜下黏膜愈合的患者未取得小肠黏膜愈合。Lewis评分与CRP呈中度相关[r=0.564,P0.001];与 CDAI 成低度相关[r=0.435,P0.001],与 SES-CD 评分无相关性[r=0.153,P=0.117]。研究结论:SBCE对疑诊CD患者有较好的应用价值。白蛋白降低增加CD患者SBCE检查未完成风险,腹泻降低SBCE检查未完成风险;CRP升高增加胶囊滞留风险。英夫利昔可以有效诱导小肠受累的CD患者实现临床缓解和黏膜愈合。SBCE下lewis评分可用来评估小肠黏膜愈合情况,CD患者中回肠末端同小肠其他部位愈合情况并不同步,小肠和结肠均受累的CD患者评估疗效和黏膜愈合情况时,有必要联合SBCE和结肠镜进行评估。
[Abstract]:Background and purpose: Crohndisease (CD) is a chronic inflammatory disease involving the whole digestive tract. About 80% of the patients are involved in the small intestine, and the small intestine of the 1/3 patients is the only focus. For a long time, people can not see the whole small intestine in the small intestine until the small intestine capsule endoscopy (small bowel capsule endoscopy, SBCE) and small enteroscopy.SB appear in.SB. CE is a new type of endoscopic examination technology, which has become a diagnostic technique for clinical small intestinal diseases. However, the value of SBCE for diagnosis and treatment of CD is still controversial. This study includes two parts: 1, to explore the diagnostic value of SBCE for suspected CD patients; 2, the analysis of CD patients who did not complete the examination of SBCE examination and the retention of the capsule. Risk factors, the value of SBCE in evaluating the healing of small intestinal mucosa in CD patients. Method 1, the application of small intestinal capsule endoscopy in suspected Crohn's disease patients, 435 cases of clinically suspected CD and SBCE examination (of which 23 patients underwent double balloon enteroscopy at the same time and 15 patients at the same time with CT small bowel contrast examination). The rate of diagnosis, accuracy, sensitivity, specificity,.2, and the application of small intestine capsule endoscopy in the diagnosis of Crohn's disease were statistically analyzed by three methods of examination, respectively, and 2.1 of the patients with Crohn's disease diagnosed by small intestine capsules were statistically diagnosed with CD, and the uncompleted and capsule retention rates of the CD patients were examined by the logistic regression analysis of the risk factors.2.2 for inflixime treatment. The clinical efficacy of small intestinal CD patients was analyzed before and thirtieth weeks after treatment. Spearman correlation test was used to analyze the correlation between Lewis score and the simplified endoscopic score (SES-CD), Crohn's disease activity index (CDAI), and C reactive protein (CRP). The results were as follows: 1, small intestinal capsule endoscopy was suspected Of the 435 patients with Crohn's disease, 267 of the 435 suspected patients were finally diagnosed with CD, of which three methods were diagnosed as' accuracy, sensitivity, and specificity were 64.6%, 89.4%, 94%, 82.1% of small intestinal capsule, respectively, 78.2%, 91.3%, 94.4%, 80%, respectively, and CT small intestine imaging for 73.3%, 86.7%, 86.7%, 90.9%, 75%.2, small. In the diagnosis of Crohn's disease, intestinal capsule endoscopy was used in the diagnosis of 2.1302 cases of CD. The failure rate of SBCE examination was 33.44%, the retention rate was 5.6%. Logistic regression found that the decrease of albumin was the risk factor of unfinished SBCE examination [OR=3.040; P=0.001], diarrhea was the unfinished protective factor [OR=0.434; P=0.003].CRP rise was the risk of capsule retention. The risk factor [OR=3.967, P=0.034].2.2 36 cases of patients receiving inflixime treatment, thirtieth weeks after treatment, the rate of clinical remission was 86.1% (31/36), the healing rate of mucosa was 72.2% (26/36), the healing rate of small intestinal mucosa was 30.6% (11/36) under SBCE, and 11 cases of small intestinal mucosa healed at the same time, and there were 15 cases in 15 cases. .Lewis score of non intestinal mucosa healing in patients with intestinal mucosa healing under enteroscopy was moderately associated with CRP, [r=0.564, P0.001], [r=0.435 in low degree of CDAI and P0.001], and no correlation with SES-CD score. P=0.117]. study concluded that SBCE was of good application value for suspected CD patients. Risk, diarrhea reduced SBCE examination uncompleted risk, CRP increased the risk of capsule retention. Inflixime can effectively induce CD patients with small intestinal involvement in clinical remission and mucosal healing.SBCE Lewis score can be used to evaluate the healing of small intestinal mucosa, in CD patients, the end of the ileum and the other parts of the small intestine are not synchronized, small It is necessary to combine SBCE and colonoscopy to assess the efficacy and mucosal healing of CD patients with intestinal and colonic involvement.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.62

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