超声在克罗恩病活动度评价中的研究进展

Research progress of ultrasonography for evaluation of Crohn's disease activity

克罗恩病(Crohn’s disease,CD)是炎症性肠病的一种,活动期与静止期交替发展,有终生复发倾向。治疗方案的选择建立在对病情进行全面评估的基础上,治疗过程中应根据对治疗的反应和对药物的耐受情况随时调整治疗方案,所以非常需要反复的肠道炎症活动度评估。临床上对CD活动度评价并没有金标准,内镜、克罗恩病活动指数、CT、磁共振肠道成像、超声各自都有其局限性,超声因其无辐射、便利、成本低、患者耐受程度高等原因使用广泛,二维超声、多普勒超声、超声弹性成像和超声造影在CD活动度评价中都提供了有效的参数,这些参数中有些价值高,如肠壁厚度、肠壁层次、肠壁血流、应变率和相对强化等;有些参数的价值则存在争议,如肠系膜上动脉血流量、达峰时间等。一些研究将几个超声参数合并计算各自权重得到一个超声评分方法。超声评价CD活动度对于疗效评估、黏膜愈合评估和术后复发评估等临床问题提供了很有价值的帮助。

Crohn’s disease(CD)is one of inflammatory bowel diseases,characterized by lifelong relapsingremitting clinical course.The choice of treatment protocols is based on the comprehensive evaluation of the disease.And the treatment protocols should be adjusted according to the response to the treatment and the drug tolerance.Repeated assessment of the activity of intestinal inflammation is very necessary.Each of endoscopy,Crohn’s Disease Activity Index,CT,magnetic resonance enterography,and ultrasonography(US)has its own disadvantages.US is widely used in clinical practice because of its no radiation,convenience,low cost,and high degree of patient tolerance.The two-dimensional ultrasound,Doppler ultrasound,elastosonography,and contrast-enhanced ultrasonography each provides some effective parameters for evaluation of CD activity.Some parameters are of high value,such as bowl wall thichness,bowl wall stratification,color Doppler signal,strain ratio,and relative enhancement,etc.The values of some parameters are disputed,such as the blood flow of superior mesenteric artery,time to peak,etc.Some studies combine several ultrasound parameters and calculate their respective weights to obtain an ultrasound scoring method.US,as a valid tool to evaluate CD activity,provides valuable help in solving clinical problems such as evaluation of therapeutic effect,mucosal healing,and postoperative recurrence.