腹部超声检查在IBD早期诊断及活动性评估中的价值

Value of Abdominal Ultrasound in the Early Diagnosis and Activity Evaluation of IBD

目的:探讨腹部超声检查对炎症性肠病(IBD)早期诊断及病情评估的应用价值。方法:选取本院2013年4月-2016年11月收治的经结肠镜检查和病理活检确诊的炎症性肠病患者89例,其中克罗恩病45例,溃疡性结肠炎44例,另选健康体检者50例,分别设为CD组、UC组和对照组。采用腹部超声检查三组肠壁厚度、肠壁内血流分级及动脉阻力指数(RI),采用克罗恩病活动指数(CDAI)与改良Mayo评分表分别对克罗恩病与溃疡性结肠炎患者进行评分。结果:(1)CD组与UC组肠壁厚度明显高于对照组,肠壁内血流Ⅱ~Ⅲ级例数明显多于对照组,且肠壁动脉阻力指数明显低于对照组,差异均有统计学意义(P<0.05)。(2)根据结肠镜检查、CDAI及改良Mayo评分结果显示,CD组活动期32例,缓解期13例;UC组活动期33例,缓解期11例;两组活动期肠壁厚度明显高于缓解期,血流Ⅱ~Ⅲ级例数明显多于缓解期,且肠壁动脉阻力指数低于缓解期,差异均有统计学意义(P<0.05)。(3)以肠壁厚度≥4 mm为临界值,超声检查对CD组疾病活动性评估诊断敏感性为84.37%,特异性为100%,阳性预测值100%,阴性预测值72.22%,尤登指数0.89;对UC组疾病活动性评估诊断敏感性87.87%,特异性100%,阳性预测值100%,阴性预测值73.33%,尤登指数0.91。结论:腹部超声检查在早期诊断炎症性肠病及活动性评估方面具有较高的应用价值,值得临床借鉴。

Objective： To explore the value of abdominal ultrasound in the early diagnosis and evaluation of inflammatory bowel disease （ IBD ） .Method： A total of 89 patients with inflammatory bowel disease diagnosed by colonoseopy and pathologie biopsy were enrolled in our hospital from April 2013 to November 2016, 45 eases of Crohn＇s disease, 44 cases of ulcerative colitis, and 50 cases of healthy subjects were selected as CD group, UC group and the control group.Abdominal ultrasound were used to detect intestinal wall thickness, intestinal wall blood flow classification and arterial resistance index （ RI ） of three groups, the use of Crohn＇s disease Activity index （ CDAI ） and improved Mayo score were scored for patients with Crohn＇s disease and ulcerative colitis.Result： （ 1 ） The thickness of intestinal wall of CD group and UC group were significantly higher than that of the control group, the number of blood flow Ⅱ~Ⅲ grade in i＊ltestinal wall were significantly higher than that of the control group, and the index of intestinal artery resistance were significantly lower than that of the control group （ P〈0.05 ） . （ 2 ） According to the results of colonoscopy, CDAI and modified Mayo scores, there were 32 eases of aetive stage, 13 eases of remission stage in CD group, 33 eases of active stage and 11 cases of remission stage in UC group.The thickness of the intestinal wall of aetive stage of two groups were significantly higher than that of remission stage, and the number of blood flow Ⅱ-Ⅲ were significantly higher than that of remission period, and the index of intestinal artery resistance were lower than that of the remission period （ P〈0.05 ） . （ 3 ） In CD group, the sensitivity of the ultrasonography was 84.37%, the specificity was 100%, the positive predictive value was 100%, the negative predictive value was 72.22%, the Yuden index 0.89.in UC group, the sensitivity was 87.87%, specificity was 100%, positive predictive value was 100%, negative predictive value was 73.33%, and Yuden index was 0.91. Conclusion： Abdominal uhrasonography has a high value in the early diagnosis of inflammatory bowel disease and activity assessment, and it is worthy of clinical reference.