胶囊结肠镜对结肠黏膜炎症性改变的诊断价值初探

Diagnostic value of colon capsule endoscopy for active ulcerative colitis

目的 探讨胶囊结肠镜下结肠黏膜损伤的内镜影像学特点对诊断溃疡性结肠炎的临床价值.方法 连续收集2009年7月至2010年6月间19例患者,其中男12例、女7例,平均年龄（44.2±14.6）岁,入组者以血便、腹泻、腹痛为主要临床表现,具备溃疡性结肠炎相关诊断依据.研究中将胶囊结肠镜和传统结肠镜下结肠黏膜病变严重程度分为轻、中、重三级,以传统结肠镜诊断为金标准,统计胶囊结肠镜与传统结肠镜下黏膜分级的一致性（Kappa值和P值）,并同时观察胶囊结肠镜检查过程中肠道清洁度、全结肠检查完成率、患者不良反应等情况.结果 胶囊结肠镜下黏膜轻度病变2例,中度8例,重度9例 而传统结肠镜下则轻度3例,中度8例,重度8例.经统计Kappa=0.826,确切概率计算P＜0.001,提示一致性良好.胶囊内镜全结肠检查完成率达100%（19/19）,肠道清洁度优良率达79%（15/19）,检查全过程中未出现明显不良反应.结论 胶囊结肠镜能客观反映溃疡性结肠炎患者黏膜病变程度,具有部分替代传统结肠镜进行结肠病变监测的价值.

Objective To investigate diagnostic value of colon capsule endoscopy （CCE） for mucosal lesions of patients with active ulcerative colitis. Methods A total of 19 consecutive patients, including 12 males and 7 females, were enrolled from July 2009 to June 2010, with a mean age at 44. 16 ＋ 14.64.Dominant symptoms were hematochezia, diarrhea and abdominal pain, consistent with the criteria of ulcerative colitis. All cases were scored into 3 grades according to severity of mucosal lesions. Using conventionalcolonoscopic findings as golden standard, the consistence of mucosal classification of CCE was calculated with kappa- and P-value. Meanwhile, related data such as the rate of completion, colonic cleanliness and adverse reactions were also collected and analyzed. Results CCE revealed that mild, moderate and severe cases were 2, 8 and 9, respectively, while the 3 types shown by conventional colonoscopy were 3, 8 and 8,respectively. Kappa-value was 0. 826 and P-value was less than 0. 001, which indicated good consistence. In addition, the completion rate of CCE and excellent/fine rate of the colonic cleanliness were 100% （19/19）and 79% （ 15/19）, respectively. There were no adverse reactions recorded. Conclusion With high diag-nostic consistency to conventional colonoscopy in classification of mucosa severity, CCE precisely reveals the mucosal lesions of ulcerative colitis and becomes a potential alternative to partially replace conventional colonoscopy, especially in surveillance.