高分辨率显微内镜对溃疡性结肠炎黏膜愈合的评估价值

Evaluative value of high-resolution microendoscopy on mucosal healing in ulcerative colitis

目的探讨高分辨率显微内镜(HRME)评估临床缓解期溃疡性结肠炎(UC)患者黏膜愈合的诊断价值。方法随机选择30例UC患者,采集HRME图像,以病理结果作为金标准制定HRME评估结肠黏膜状态的诊断标准。再对67例患者进行前瞻性研究,先行标准内镜评估结肠黏膜状态并获取活检标本,再对标本采集HRME图像。利用统计学方法比较标准内镜与HRME评估溃疡性结肠黏膜愈合的准确性。结果根据腺体形态、腺体排列方式、腺体开口及炎细胞浸润等指标制定HRME评估UC黏膜状态的标准,分为0~3级共4个级别。67例患者113个位点的前瞻性研究结果显示:标准内镜评估UC患者黏膜愈合的敏感度、特异度、阳性预测值、阴性预测值分别为44.68%(21/47)、90.91%(60/66)、77.78%(21/27)、69.77%(60/86),与病理结果比较,一致性检验的Kappa值为0.379(P<0.05);HRME成像评估UC患者黏膜愈合的敏感度、特异度、阳性预测值、阴性预测值分别为87.23%(41/47)、95.45%(63/66)、93.18%(41/44)、91.30%(63/69),与病理结果比较,一致性检验的Kappa值为0.835(P<0.05)。结论HRME可对UC患者结肠黏膜实现实时虚拟病理组织成像,评估黏膜愈合的准确性优于标准内镜。

Objective To investigate the value of high resolution microendoscopy (HRME) for assessment of mucosal healing in patients with ulcerative colitis (UC) during clinical remission. Methods A total of 30 UC patients were randomly selected to collect HRME images. Pathological results were used as the gold standard to establish the diagnostic criteria of HRME on evaluation of colonic mucosal status. And then a prospective study was performed on 67 patients, who underwent standard endoscopy to evaluate colonic mucosal status and obtain biopsy specimens. The specimens were collected for HRME imaging. The accuracy of standard endoscopy and HRME in assessing ulcerative colonic mucosal healing was compared. Results According to the gland morphology, gland arrangement, gland opening and inflammatory cell infiltration, the HRME criteria for assessing UC mucosal status were formulated and divided into 0-3 grades with 4 levels. The prospective study of 67 patients with 113 sites showed that the sensitivity, specificity, positive predictive value, and negative predictive value of standard endoscopy for assessing mucosal healing in UC patients were 44.68%(21/47), 90.91%(60/66), 77.78%(21/27), and 69.77%(60/86), respectively, and the corresponding indicators of HRME imaging was 87.23%(41/47), 95.45%(63/66), 93.18%(41/44), and 91.30%(63/69), respectively. Compared with pathological results, the Kappa value of the consistency test of standard endoscopy and HRME imaging were 0.379 and 0.835, respectively (both P<0.05). Conclusion HRME can achieve real-time virtual pathological imaging of colonic mucosa for UC patients, which is more accurate than standard endoscopy for assessing mucosal healing.