多层螺旋CT小肠造影对克罗恩病活动度的评估价值

Evaluation of Crohn＇s disease activity with multi-slice CT enterography

目的 探讨多层螺旋CT小肠造影（MSCTE）在克罗恩病活动度中的评估价值.方法 收集2013年1月至2014年6月在浙江大学附属邵逸夫医院经临床、内镜、病理学等方法证实并有完整MSCTE检查资料的克罗恩病患者88例,根据Harvey-Bradshaw指数（HBI）将患者分为活动期组（61例）与缓解期组（27例）,比较两组间MSCTE表现差异;分析88例患者MSCTE表现与C反应蛋白（CRP）及血沉（ESR）的相关性.结果 活动期组肠壁厚度[（8.2±2.6）mm]及最大强化值[（112±16）HU]高于缓解期组肠壁厚度[（5.4±1.6）mm]及最大强化值[（93±17）HU],差异有统计学意义（P＜0.01）.活动期组肠壁分层样强化、“梳征”、系膜区淋巴结肿大、肠周蜂窝织炎、瘘管、肠管狭窄的发生率（88.5％、72.1％、77％、45.9％、26.2％、65.6％）高于缓解期组（29.6％、18.5％、25.9％、0、3.7％、37％）,差异有统计学意义（P＜0.05）.缓解期组肠壁均匀强化的发生率（70.4％）高于活动期组（11.5％）,差异有统计学意义（P＜0.01）.活动期组及缓解期组肠周脓肿（14.8％、3.7％）的发生率差异无统计学意义（P＞0.05）.CRP与肠壁厚度、肠壁强化值、肠系膜血管改变、淋巴结增大、肠周蜂窝织炎、肠瘘有相关性（r＞0.2,P ＜0.05）,而ESR与肠壁强化值、肠系膜血管改变、淋巴结增大、肠周蜂窝织炎有相关性（r＞0.2,P＜0.05）.结论 CT小肠造影能充分显示肠壁表现及肠管外并发症,对克罗恩病活动性的评估具有重要价值.

Objective To discuss the diagnostic value of Crohn＇s disease activity with multi-slice CT enterography.Methods MSCTE examination data of 88 cases of CD patients by clinical,endoscopy,pathology confirmed in Sir Run Run Shaw Hospital from January 2013 to June 2014 were analysed.According to the Harvey-Bradshaw index,all of CD patients were divided into the active phase group and remission phase group.Imaging findings of two groups were compared.To explore the relationship between MSCTE findings and CRP/ESR of CD patients.Results The wall thickness （8.2 ± 2.6）mm and enhancement degree（112 ± 16）HU in active phase group were higher than the wall thickness（5.4 ± 1.6）mm and enhancement degree（93 ± 17）HU in the remission phase group（P 〈 0.01）.The incidences of intestinal wall stratification enhancement,comb sign,swollen lymph nodes,phlegmon,intestinal fistula,intestinal stenosis in active phase group （88.5%,72.1%,77%,45.9%,26.2%,65.6%） were significantly higher than those in remission phase group （29.6%,18.5%,25.9%,0,3.7%,37%） （P 〈0.05）.The incidences of intestinal wall homogeneous enhancement in remission phase group（70.4%） were higher than those in active phase group（11.5%） （P 〈 0.01）.There was no significant difference in the incidences of abscesse in two groups （P 〉 0.05）.CRP was correlated with the wall thickness and enhancement degree,abnornlal mesentery vascularity,lymph node enlargement,phlegmon,intestinal fistula （r 〉 0.2,P 〈 0.05）.ESR was correlated with the wall enhancement degree,abnormal mesentery vascularity,lymph node enlargement and phlegmon （r 〉 0.2,P 〈 0.05）.Conclusion CT enterography can adequately demonstrate mural abnormalities and assess the presence of extramural complications,which are helpful in evaluating the activity of Crohn＇s disease.