共聚焦激光显微内镜在评估缓解期溃疡性结肠炎患者肠道黏膜组织学炎症活动中的价值

The value of confocal laser endomicroscopy in evaluating the histologic inflammatory activity of intestinal mucosa in patients with ulcerative colitis in remission stage

目的:探讨共聚焦激光显微内镜(CLE)在评估缓解期溃疡性结肠炎(UC)患者肠道黏膜组织学炎症活动中的价值。方法:对2014年1月~2016年12月我院内镜下达到粘膜愈合的左半结肠炎或广泛结肠炎UC缓解期患者进行CLE检查,采用Qilu分类评估直肠及乙状结肠肠道黏膜活动性炎症情况,同时对CLE检查部位行病理活检,采用Geboes评分评估肠道黏膜活动性炎症情况。结果:纳入21例患者,获取符合评估质量的匹配的直肠及乙状结肠CLE及病理结果34份,7份(7/7)CLE-A级病变Geboes评分均≤3,1份(1/9)CLE-B级病变Geboes评分>3,13份(13/15)CLE-C级病变Geboes评分>3,3份(3/3)CLE-D级病变Geboes评分均>3,其中CLE-C级及CLE-D级提示活动性炎症,其诊断内镜下粘膜愈合患者活动性炎症的敏感性、特异性及准确性分别为94.1%、88.2%、88.9%。结论:CLE是一种判断缓解期UC患者是否达到组织学愈合的有效方法,有助于指导医师临床用药。

Objective: To investigate the value of confocal laser endomicroscopy(CLE)in judging intestinal mucosal histologic inflammation in patients with ulcerative colitis(UC)in remission stage. Methods: The UC patients in mucosal healing stage were examined by CLE from January 2014 to December 2016 in our hospital, and the active inflammation of rectum and sigmoid colon mucosa was evaluated by Qilu classification. At the same time, pathological biopsy was performed on the site of CLE, and Geboes score was used to evaluate the active inflammation of intestinal mucosa. Results: Twenty-one patients were enrolled in this study. 34 CLE and pathological specimen of rectum and sigmoid colon were obtained. Geboes scores of 7(7/7)CLE-A grade lesions were all≤3, Geboes scores of 1(1/9)CLE-B lesions>3, and Geboes scores of 13(13/15)CLE-C grade lesions>3, and Geboes scores of 3(3/3)CLE-D grade lesions were all>3, and the sensitivity, specificity and accuracy of CLE-C and CLE-D in diagnosing active inflammation were 94.1%, 88.2% and 88.9%, respectively. Conclusions: CLE is an effective method to judge whether UC patients obtain histological healing in remission stage or not, which is helpful to guide the clinical use of drugs.