230例克罗恩病患者暴露电离辐射量的临床调查

Clinical investigation of exposure to ionizing radiation in 230 cases with Crohn's disease

目的调查克罗恩病(CD)患者接受电离辐射暴露的剂量水平,探讨暴露于高水平辐射剂量CD患者相关危险因素。方法收集CD患者230例,按照蒙特利尔标准进行分型,按照标准化量表回顾性计算每位患者的累计有效剂量(CED),高水平辐射剂量定义为CED≥50 m Sv。以CED≥50m Sv的患者作为高水平辐射剂量组,并以同期CED<50m Sv的患者作为对照组,应用Logistic回归分析CD患者暴露于高水平辐射剂量下的相关危险因素。结果 CT肠道显像和腹盆腔CT检查分别占总辐射剂量的52.1%和39.6%,合计占总辐射剂量的91.7%,每位患者的平均辐射剂量为34.07(95%CI:30.845~37.304)m Sv,共计有51例(22.2%)CD患者的CED≥50 m Sv。病程长,有CD相关手术史,回肠型,狭窄或穿透型患者,在其病程中接受了更高剂量的辐射。Logistic回归分析显示,狭窄或穿透型(OR=3.711,95%CI:2.239~6.151,P<0.001),使用硫唑嘌呤(OR=4.218,95%CI:1.221~14.579,P=0.023)是CD患者暴露于高水平辐射剂量下的独立危险因素。结论有超过1/5的CD患者暴露于高水平电离辐射,且主要是由CT检查所致。狭窄或穿透型,使用硫唑嘌呤是CD患者暴露于高水平辐射剂量下的独立危险因素。临床诊疗及随访中监测每位CD患者接收的辐射剂量,减少不必要的CT检查,或改用无辐射的影像学检查(如MRE)是至关重要的。

Objective To investigate the cumulative effective dose （CED） of ionizing radiation received by patients with Crohn＇ s disease （CD） and to identify the risk factors associated with high levels of radiation in patients with Crohn＇ s disease. Methods A total of 230 patients were enrolled. The classification of CD was according to the Montreal standards, and the CED of each patient was calculated retrospectively based on standards tables. High levels of radiation was defined as no less than 50 mSv CED. Patients who accepted no less than 50 mSv CED were assigned to high level of the radiation group, and those who accepted simultaneously less than 50 mSv CED were assigned to the control group. The risk factors for patients associating with high levels of radiation were analyzed by Logistic regression. Results CT enterography and abdominopelvic CT accounted for 52. 1% and 39.6% , respeetively, and add up to 91.7% of total CED. The mean CED received per patient was 34. 07 mSv （95% CI：30. 845 -37. 304）, and 51 patients （22.2% of total patients） with CD were exposed to no less than 50 mSv CED. Patients with long disease duration, surgical intervention, ileal location, stricturing or penetrating pattern received a higher dose of radiation. In a Logistic regression, stricturing or penetrating pattern（ OR = 3. 711,95% CI：2. 239 - 6. 151 ,P 〈0. 001 ） and the requirement for azathioprine （ OR =4. 218,95% CI：1. 221 - 14. 579,P =0. 023） were independent risk factors for the high levels of radiation in CD. Conclusion More than one in five of patients with CD are exposed to high levels of ionizing radiation, mainly caused by CT examination. Stricturing or penetrating pattern and the usage of azathioprine are independent risk factors for the high levels exposure of radiation in CD patients. During the clinical management and follow-up, it is important to either monitor the effective dose received per patient, minimizing unnecessary CT examination, or to transform to use no radiation imaging examination, such as MR enterography.