结肠镜、超声内镜及CTE在炎症性肠病诊断中的价值研究

发布时间：2018-05-27 20:35

本文选题：炎症性肠病 + 结肠镜　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探讨结肠镜、超声内镜(endoscopic ultrasonography,EUS)及CT小肠造影(computed tomographic enterography,CTE)在炎症性肠病(inflammatory bowel disease, IBD)诊断和活动性评估中的价值,以指导临床诊治。[方法]选取2014年9月至2016年9月间在昆明医科大学第一附属医院经内镜、CT、MRI及病理确诊的105例IBD患者,其中溃疡性结肠炎((ulcerativecolitis,UC) 68例,克罗恩病(crohn's disease,CD) 37例,回顾性分析其结肠镜、EUS及CTE的影像学表现,探讨IBD在这3种检查下的表现特征和阳性检出率,并比较该3种检查在评估疾病活动性中的价值。[结果]1.结肠镜可直观观察肠道病变,并可通过改进的Baron分级标准、SES-CD评分预测疾病活动性;2. EUS除了观察消化道黏膜病变以外,还可观察消化道管壁及管壁外病变,并通过测量UC管壁厚度评估疾病严重度:轻、中、重度UC患者EUS下的肠壁总厚度分别为3.59±0.69mm、4.54±0.96mm、5.99± 1.16mm,黏膜层厚度分别为 1.02±0.14mm、1.22±0.25mm、1.61±0.27mm,黏膜下层厚度分别为 1.41±0.36mm、2.07±0.70mm、2.67±0.51mm,差异均具有统计学意义;3. CTE观察CD患者小肠病变具有明显优势,本研究中检出9例患者(30.00%)存在小肠病变,弥补了结肠镜的不足;4.UC组,结肠镜、EUS、CTE单独检查发现病变的阳性率分别是86.76%、77.94%、71.43%;结肠镜联合 CTE 为 92.86%高于单独 CTE( χ2 =4.383, P=0.036),结肠镜+EUS+CTE 为 92.86%高于单独 CTE (χ2=4.383, P=0.036)。CD 组,结肠镜、EUS、CTE单独检查发现病变的阳性率分别是62.16%、86.49%、76.67%;以下检查阳性率均高于单独结肠镜,EUS为86.49% (χ2 =5.736, P=0.017),结肠镜联合 EUS 为 89.19%( χ2 =7.341,P=0.007),,结肠镜联合 CTE 为 90.00%( χ2 =6.780,P=0.009),结肠镜+EUS+CTE 为 93.33% (χ2=8.856,P=0.003);5. UC组疾病活动性预测价值由高到低排列:改进的Baron分级标准(r=0.748,P0.001)、EUS 黏膜层厚度(r=0.720,P0.001)、EUS 管壁总厚度(r=0.671,P0.001)、EUS 黏膜下层厚度(r=0.628,P0.001) ; CD 组 SES-CD评分可预测疾病活动性(r=0.646,P0.001)。[结论]1.结肠镜可直观观察肠道病变,并可通过改进的Baron分级标准、SES-CD评分预测疾病活动性;2. EUS可通过测量肠壁厚度评估UC活动性;3. CTE观察CD患者小肠病变具有明显优势;4.诊断IBD时联合使用结肠镜、EUS及CTE检查,可提高病变检出率;5.在IBD的诊治中需密切结合临床表现、结肠镜、EUS及CTE的证据进行综合判断,预测疾病严重程度,选择最佳治疗方案。
[Abstract]:[objective] to evaluate the value of colonoscopy (EUS) and computed tomographic enterography (CTEUS) in the diagnosis and active evaluation of inflammatory bowel disease (IBD) in order to guide clinical diagnosis and treatment. [methods] from September 2014 to September 2016, 105 patients with IBD confirmed by endoscopy and pathology in the first affiliated Hospital of Kunming Medical University, including 68 cases of ulcerative colitis and 37 cases of Crohn's disease, were selected. The imaging findings of EUS and CTE in colonoscopy were retrospectively analyzed, and the characteristics and positive rate of IBD in these three examinations were discussed, and the value of these three examinations in evaluating disease activity was compared. [result] 1. Colonoscopy can directly observe intestinal lesions and predict disease activity by modified Baron grading criteria (SES-CD score). In addition to observing the mucosal lesions of the digestive tract, EUS can also observe the wall and extrawall lesions of the digestive tract, and evaluate the severity of the disease by measuring the thickness of the UC wall. The total thickness of intestinal wall under EUS was 3.59 卤0.69mm / 4.54 卤0.96mm / 5.99 卤1.16mm, the thickness of mucosal layer was 1.02 卤0.14mm / 1.22 卤0.25mm / 1.61 卤0.27mm, and the thickness of submucosal layer was 1.41 卤0.36mm / 2.07 卤0.70mm 2.67 卤0.51mm, respectively. In this study, 9 cases of small intestine lesions were detected in 9 patients with CD, which made up for the deficiency of colonoscopy in the UC group. The positive rate of colonoscopy combined with CTE was 92.86% higher than that of CTE alone (蠂 2 4.383, P < 0.036), and the positive rate of colonoscopy EUS CTE was 92.86% higher than that of CTE alone (蠂 24.383, P=0.036).CD group), and the positive rate of colonoscopy alone was 86.76% and 77.94% respectively (蠂 24.383, P=0.036).CD group), and the positive rate of colonoscopy combined with CTE was 92.86% and 92.86% respectively (蠂 24.383, P=0.036).CD group). The positive rates were 62.16% and 86.49%, respectively, and the positive rates of the following examinations were 86.49% (蠂 2 / 5.736, P 0.017), 89.19% (蠂 ~ 2 7.341 1 P 0.007), 90.005% (蠂 ~ 2 6.780%) and 93.33% (蠂 ~ 2 8.856P0. 003P ~ 0. 003P ~ 0. 005), respectively (蠂 2 7. 34 1 P 0. 007), and the positive rates of colonoscopy combined with CTE were 90. 005% (蠂 2 6.780) and 93 33% (蠂 2 = 28. 856P 0. 003P 0. 003) respectively. The predictive value of disease activity in UC group ranged from high to low: the modified Baron grading standard was 0.748g / P0.001P0.001EUS mucosal thickness. The total thickness of EUS wall was 0.671g / P0.001EUS (r 0.628P0.001), and the SES-CD score of CD group could predict the activity of disease. [conclusion] 1. Colonoscopy can directly observe intestinal lesions and predict disease activity by modified Baron grading criteria (SES-CD score). EUS can evaluate UC activity by measuring the thickness of intestinal wall. CTE observation of small intestine lesions in CD patients has obvious advantages. In the diagnosis of IBD, the combined use of colonoscopy combined with EUS and CTE can increase the detection rate of lesions by 5. 5%. In the diagnosis and treatment of IBD, clinical manifestations should be closely combined, and the evidence of colonoscopy and CTE should be comprehensively judged to predict the severity of the disease and to select the best treatment plan.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574

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