多层螺旋CT对溃疡性结肠炎诊断及病情评估的临床意义研究

发布时间：2018-05-25 08:33

本文选题：溃疡性结肠炎 + 多层螺旋CT　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：探讨多层螺旋CT（mult-slice spiral computed tomography，MSCT）在溃疡性结肠炎（ulcerative colitis，UC）诊断及病情评估中的应用价值，旨在全面认识UC的MSCT影像学表现和MSCT在UC诊断及病情评估中的临床意义。方法：收集2007年1月~2014年4月在大连医科大学附属第一医院及大连市中心医院的149例住院UC患者的病例资料进行回顾性分析。所有患者的诊断均符合我国炎症性肠病诊断共识意见，并均行全腹MSCT检查。对性别、年龄、临床分型、临床严重程度与病变范围和结肠镜活动度分级之间的关系、MSCT的阳性检出率、MSCT表现类型、MSCT与结肠镜在UC诊断和病情评估中的关系等临床资料分别进行统计学分析。结果：1.本组UC患者的基本特征 1.1一般资料：入选的149例UC患者，男性81例，女性68例，男女比例1.19:1，年龄30~86岁，平均年龄53.8±3.97岁。临床分型：初发型24例（16.1%），慢性复发型99例（66.4%），慢性持续型26例（17.4%）。病变范围：E133例（22.1%），E267例（45%），E349例（32.9%）。临床严重程度分级：S168例（45.6%），S260例（40.3%），S321例（14.1%）。结肠镜活动度分级：无0级患者，I级39例（26.2%），II级34例（22.8%），III级30例（20.1%），IV级46例（30.9%）。 1.2UC严重程度与病变范围的关系：轻度UC (S1)以E1、E2为主，中度UC (S2)则以E2、E3为主，重度UC (S3)以E3为主，UC严重程度与病变范围的关系具有显著统计学意义（P0.01)。 1.3UC严重程度与结肠镜活动度分级的关系：S1组以I、II级为主，S2及S3组以III、IV级为主，临床严重程度与结肠镜活动度分级显著相关（P0.01)。 2. UC患者腹部MSCT病变的表现 2.1UC患者腹部MSCT的阳性检出率：149例UC患者，腹部MSCT检出肠道阳性病变的102例，阳性检出率为68.46%。 2.2UC患者腹部MSCT病变的主要表现：肠壁增厚87例（85.29%）；肠腔狭窄11例（10.78%）；结肠轮廓改变8例（7.84%）；肠管轻度扩张6例（5.88%）；肠系膜密度增高、模糊26例（25.49%）；淋巴结增大24例（23.52%）。 2.3MSCT与结肠镜对UC病变范围判断的符合率：MSCT检出UC病变在直肠12例，与E1符合率为36.36%；MSCT检出病变在左半结肠50例，与E2符合率为74.62%；MSCT检出病变广泛累及脾曲以近乃至全结肠40例，与E3符合率为81.63%；三组相比，Χ2=20.8609，P0.01，表明随着病变范围增大，二者符合率有增高趋势。E2、E3组MSCT与结肠镜对病变范围判断的符合率高于E1组，均有统计学差异（Χ2分别为13.7397，17.4181，P0.01）；E3组符合率高于E2组，但无统计学差异（Χ2=20.8609，P0.05）。 3.腹部MSCT检查与UC病情轻重的关系 3.1腹部MSCT检查阳性率与UC临床严重程度的关系：S1、S2、S3组UC患者腹部MSCT阳性的检出率分别为52.94%、80.00%、85.71%，腹部MSCT对UC患者的阳性检出率，S3组＞S2组＞S1组，三组相比，Χ2=14.1796，P0.01，表明随着病情严程度度增加，MSCT的阳性检出率有增加趋势。S2、S3组MSCT的阳性检出率高于S1组，均有统计学差异（Χ2分别为10.3456，7.2226，P0.01）；S3组阳性检出率高于S2组，但无统计学差异（P0.05）。 3.2腹部MSCT检查阳性率与UC患者结肠镜活动度分级的关系：结肠镜活动度I、II、III、IV级的患者，腹部MSCT的阳性检出率分别为41.03%、55.88%、80.00%、93.48%，腹部MSCT对UC病变的阳性检出率，IV级＞III级＞II级＞I级，四组相比，Χ2=32.0711，P0.01，表明随着结肠镜活动度分级的增加，MSCT阳性检出率有增高趋势。III级、IV级MSCT的阳性检出率均高于I级，，有统计学差异（Χ2分别为11.5224，29.2240，P0.01）；IV级MSCT的阳性检出率高于II级，有统计学差异（Χ2=13.8301，P0.01）；II级MSCT的阳性检出率高于I级，III级高于II级，IV级高于III级，但均无统计学差异（P0.05）。结论：1.腹部MSCT对UC有一定的阳性检出率，对病变范围较大的，与结肠镜有较好的符合率。 2. UC腹部MSCT主要表现有：肠壁改变（肠壁增厚）、结肠形态改变（结肠轮廓改变、肠腔狭窄、肠管轻度扩张）及肠管周围改变（系膜区密度增高、模糊，淋巴结增大），其中以肠壁增厚最为常见。 3.腹部MSCT阳性检出率与UC疾病严重程度及结肠镜活动度分级相关，MSCT可作为结肠镜检查的补充手段，有助于病情评估。
[Abstract]:Objective: To investigate the value of mult-slice spiral computed tomography (MSCT) in the diagnosis and evaluation of ulcerative colitis (ulcerative colitis, UC) and to evaluate the MSCT imaging manifestations of UC and the clinical significance of MSCT in the diagnosis and evaluation of the condition of UC.
Methods: a retrospective analysis was made of 149 cases of UC patients hospitalized in the First Affiliated Hospital of Dalian Medical University and Dalian Central Hospital of Dalian in April January 2007. All the patients were in accordance with the consensus opinion of the diagnosis of inflammatory bowel disease in China, and all of them were examined in the whole abdomen by MSCT. The relationship between degree and extent of lesion and degree of mobility of colonoscopy, the positive detection rate of MSCT, the type of MSCT expression, and the relationship between MSCT and the clinical data of the colonoscopy in the diagnosis of UC and the evaluation of the disease were statistically analyzed.
Results: 1. basic features of UC patients in this group
1.1 general data: 149 cases of UC, 81 male and 68 female, male and female, 1.19:1, age 30~86, and average age 53.8 + 3.97 years. Clinical classification: primary 24 cases (16.1%), chronic relapse 99 (66.4%), chronic persistent 26 (17.4%), E133 cases (22.1%), E267 cases (45%), E349 cases. Grade: S168 (45.6%), S260 (40.3%), S321 (14.1%). Colonoscopy mobility classification: No 0 class, 39 I (26.2%), 34 class II (22.8%), 30 class III (20.1%), and IV class 46 (30.9%).
The relationship between 1.2UC severity and lesion range: mild UC (S1) with E1, E2, and moderate UC (S2) as E2, E3, and UC (S3) mainly as E3. The relationship between severity and extent of lesions was significant statistically significant.
The relationship between the severity of 1.3UC and the degree of mobility of colonoscopy: group S1 was mainly I, II, and S2 and S3 were dominated by III and IV, and the clinical severity was significantly associated with the classification of colonoscopy activity (P0.01).
The manifestations of abdominal MSCT lesions in 2. UC patients
The positive rate of abdominal MSCT in 2.1UC patients was 149 cases of UC, 102 cases of intestinal positive lesions detected by abdominal MSCT, and the positive detection rate was 68.46%.
The main manifestations of abdominal MSCT lesions in 2.2UC patients were: 87 cases of thickening of the intestinal wall (85.29%); 11 cases of intestinal stenosis (10.78%); 8 cases of colon contour change (7.84%); mild bowel dilatation in 6 cases (5.88%); mesenteric density increased, 26 cases (25.49%); lymph node enlargement 24 (23.52%).
The coincidence rate of 2.3MSCT and colonoscopy in judging the range of UC lesions: MSCT was found in 12 cases of UC lesions in rectum and 36.36% in E1, 50 in left semicolon and 74.62% in E2, 40 with MSCT and 40 in whole colon, 81.63% with E3, 81.63% in MSCT and 81.63% in the three group, 2=20.8609, P0.01, compared with the three groups. The results showed that with the increase of the lesion range, the coincidence rate of the two was increased.E2. The coincidence rate of MSCT in group E3 and colonoscopy was higher than that in group E1 (13.7397,17.4181, P0.01), and the coincidence rate in E3 group was higher than that in E2 group, but there was no statistical difference (2=20.8609, P0.05).
3. abdominal MSCT examination and the relationship between the severity and severity of UC
3.1 the relationship between the positive rate of abdominal MSCT examination and the clinical severity of UC: the positive rates of MSCT positive in the abdomen of S1, S2 and S3 group were 52.94%, 80%, 85.71%, and the positive rate of the abdominal MSCT to the UC patients, the S3 group > S2 group > S1 group, and the three groups, indicating that the positive detection rate increased with the severity of the condition. The positive rate of MSCT in group S3 was higher than that in group S1 (10.3456,7.2226, P0.01), and the positive rate of S3 group was higher than that of S2 group, but there was no statistical difference (P0.05) in group S3.
3.2 the relationship between the positive rate of the abdominal MSCT examination and the degree of mobility of the colonoscopy in the UC patients: the positive rates of the abdominal MSCT were 41.03%, 55.88%, 80%, 93.48%, respectively, and the positive rate of the abdominal MSCT to UC lesions, and the positive rates of the abdominal MSCT to the UC lesions, and the IV grade > III > II grade > four. The positive detection rate of MSCT positive was higher than that of I, and the positive rate of IV grade MSCT was higher than that of I, and the positive rate of IV grade MSCT was higher than that of II, and the positive rate of IV grade MSCT was higher than that of II, and the positive rate was higher than that of the class II, and the positive rate was higher than that of the class MSCT. II grade and IV grade were higher than III grade, but there was no statistical difference (P0.05).
Conclusion: 1. abdominal MSCT has a positive positive rate for UC, and has a good coincidence rate with colonoscopy.
The main manifestations of 2. UC abdominal MSCT include: intestinal wall change (intestinal wall thickening), colonic morphological changes (colon contour change, intestinal stenosis, intestinal tube dilation) and changes around the intestinal canal (the density of mesangial region, fuzzy, lymph node enlargement), among which the thickening of the intestinal wall is the most common.
3. the positive rate of abdominal MSCT is correlated with the severity of UC disease and the grading of colonoscopy activity. MSCT can be used as a supplementary method for colonoscopy and is helpful for disease assessment.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R574.62;R816.5

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