超声检查对克罗恩病患者疾病活动度的评估价值

The value of ultrasonography for evaluation of the activity in Crohn＇ s disease

目的探讨超声检测对克罗恩病内镜下疾病活动度的评估价值。方法收集2009年3月至2011年3月在本院就诊或随访的克罗恩病患者62例，采用克罗恩病简单内镜下评分将疾病分为非活动性病变和活动性病变，然后分别通过普通超声检测病变肠壁厚度、彩色多普勒超声进行肠壁血流分级、对比增强超声定量获取肠壁感兴趣区（ROI）灰度值上升百分率。采用受试者工作特征曲线来评估上述3项指标对内镜下疾病活动度的评估价值。结果内镜检查显示，62例克罗恩病患者中活动性病变44例，非活动性病变18例。活动性与非活动性克罗恩病患者超声检测显示肠壁厚度分别为（5．57±1．73）mm和（4．38±2．16）mm，肠壁血流2-3级者分别有28例和3例，肠壁ROI灰度值上升百分率分别为（82±27）％和（40％±25）％，差异均有统计学意义（均P〈0．05）。选择4．8mm作为肠壁厚度的最佳截点，其评估内镜下克罗恩病活动度的敏感度、特异度和准确度分别为86．4％、66．7％和80．6％。肠壁血流分级评估内镜下克罗恩病活动度的敏感度、特异度和准确度分别为63．6％、83．3％和69．4％。选择55％作为肠壁ROI灰度值上升百分率的最佳截点，其评估内镜下克罗恩病活动度的敏感度、特异度和准确度分别为93．2％、83．3％和90．3％。结论相比普通超声和彩色多普勒超声，对比增强超声的定量检测能够有效地将肠镜下不同活动度的克罗恩病区别开来，可作为评估克罗恩病患者疾病活动度的理想方法。

Objective To investigate the evaluation value ofuhrasonography （US） on the activity of Crohn＇ s disease under endoscopy. Methods A total of 62 cases with Crohn＇ s disease in our hospital from March 2009 to March 2011 were enrolled in the study. Crohn＇ s disease was grouped as inactive and active by colonoscopy using Simplified Endoscopic Scoring, mural thickness of the intestine being involved was assessed via conventional US, bowel wall vascularity was graded using color Doppler US, and the percentage of increase in bowel wall brightness in regions of interest （ROI） was acquired quantitatively through contrast-enhanced US. Receiver operating characteristic curve was applied to evaluate the value of parameters above in assessing the disease activity as determined by endoscopy. Results Of 62 subjects with Crohn＇ s disease, colonoscopy showed active lesions in 44 cases and inactive lesions in 18 cases, whose intestinal mural thickness was （5.57＋1.73） mm and （4.38＋2.16） mm, the number of cases with grade 2-3 vascularity was 28 and 3, and the percentage of increase in ROI brightness was （82_＋27）% and （40%＋25）%, respectively （all P〈0.05）. A optimal cut-off value of 4.8 mm for intestinal mural thickness was determined, with the sensitivity, specificity and accuracy for assessing the disease activity under endoscopy of 86.4%, 66.7% and 80.6%, respectively.