多普勒超声评价克罗恩病活动性的价值

Doppler ultrasound in assessment of the activity of Crohn disease

目的探讨多普勒超声观察肠系膜上动脉及病变段肠壁内动脉在评估克罗恩病(CD)活动性中的价值。方法根据Harvey-Bradshaw指数(HBI)将33例CD患者分为活动组(n=16)和静止组(n=17),采用彩色脉冲多普勒超声定量测量肠系膜上动脉血流,能量多普勒超声对病变段肠壁内血流进行半定量Limberg评分,评价疾病活动性,比较两组间多普勒超声参数,并将其与相应C反应蛋白(CRP)及HBI进行相关分析。结果肠系膜上动脉舒张末期流速、阻力指数在活动组与静止组之间的差异有统计学意义(P均<0.05)。两组间病变段肠壁内血流Limberg评分差异有统计学意义(P<0.001)。舒张末期流速与CRP呈正相关(r=0.602,P<0.001),与HBI无显著相关性;阻力指数与CRP(r=-0.676,P<0.001)、HBI(r=-0.415,P=0.020)呈负相关;肠壁血流Limberg分级与CRP(r=0.587,P<0.001)、HBI(r=0.498,P=0.003)相关性较好。结论多普勒超声可作为评价CD活动性的可靠工具,指导临床采取合适的治疗措施,对病变随访和疗效监测也具有重要意义。

Objective To observe the value of Doppler ultrasound in assessment of the activity of Crohn disease（CD） through evaluation on hemodynamic indices of superior mesenteric artery（SMA） and mural arteries in the involved bowel wall.Methods All 33 patients with CD were assigned into active group（n=16） or inactive group（n=17） according to Harvey-Bradshaw index.Patients were examinated with the Doppler ultrasound,and the results were compared with C-reactive protein and Harvey-Bradshaw Index.Results The mean end diastolic velocity and resistive index was significantly different between active and inactive CD（all P0.05）.The end diastolic velocity was in positive correlation with C-reactive protein（r=0.602,P0.001）,but no statistical correlation was found with Harvey-Bradshaw Index.The resistive index was in negative correlation with C-reactive protein（r=-0.676,P0.001） and Harvey-Bradshaw Index（r=-0.415,P=0.020）.Moreover,the Limberg scores of mural arteries were significantly different between active and inactive CD（P0.001）.In all patients,the Limberg scores were in good correlation with C-reactive protein（r=0.587,P0.001） and Harvey-Bradshaw Index（r=0.498,P=0.003）.Conclusion Doppler ultrasound is useful in the assessment of CD activity,monitoring the response to treatment,modulating therapy and following-up.