MRC结合FC对溃疡性结肠炎活动程度的诊断效能

The diagnostic efficiency of MRC combined with fecal calprotectin in the activity of ulcerative colitis

目的探讨磁共振结肠成像(MRC)结合粪便钙卫蛋白(FC)对溃疡性结肠炎(UC)活动程度的诊断价值。方法活动期UC患者41例为病例组,根据内镜评分(MES)将患者分为轻中度活动期组(n=12)和重度活动期组(n=29);同期32例健康体检者为对照组。活动期UC患者共192段肠管完成结肠镜检查,根据MES分为正常肠段组(n=39)、轻中度活动期肠段组(n=45)和重度活动期肠段组(n=108)。测量每段肠管的肠壁厚度,增强前和增强后的肠壁信号强度,评估每段肠管是否有肠壁水肿、周围增大淋巴结或梳齿征。通过有序多分类Logistic回归分析,获得简化MRC指数(MRC-S)。通过绘制ROC曲线分析MRC-S诊断肠段病变活动程度的最佳临界值。测量对照组、病例组的FC浓度。通过ROC曲线分析FC诊断受检者病变活动程度的最佳临界值。分析MRC-S、FC及两者联合对UC病变活动程度的诊断效能。结果轻中度、重度活动期肠段组MRC参数的均值或出现频率差异均高于正常肠段组(P<0.05),重度与轻中度活动期肠段组肠壁厚度差异无统计学意义。MRC-S对活动期(MRC-S≥1)、重度活动期(MRC-S≥2)肠段病变的诊断价值均较高(AUC分别为0.979、0.881)。FC对活动期(FC≥92.9μg/g)、重度活动期(FC≥3003.8μg/g)UC患者的诊断价值均较高(AUC分别为1.000、0.958)。MRC-S结合FC对重度活动期UC患者的诊断特异度明显提高,为91.7%。结论MRC-S、FC对UC患者病变活动程度的诊断均具有较高的价值,两者结合,诊断特异度进一步提高。

Objective To evaluate the diagnostic value of magnetic resonance colonography(MRC)combined with fecal calprotectin(FC)in the activity degree of ulcerative colitis(UC).Methods Forty-one patients with active UC were collected as the case group,and they were subdivided into mild and moderate active group(n=12)and severe active group(n=29)according to the mayo endoscopic score(MES).During the same period,32 healthy subjects were used as the control group.According to MES,192 sections of intestine after colonoscopy were divided into normal segment group(n=39),mild and moderate active segment group(n=45)and severe active segment group(n=108).The thickness and the signal intensity anterior and posterior enhanced of the intestinal wall of each segment were measured,and edema of the intestinal wall,enlarged lymph nodes or comb sign were evaluated.The simplified MRC index(MRC-S)was obtained by Logistic regression analysis.The ROC curve was drawn to analyze the optimal threshold value of MRC-S for the diagnosis of intestinal segment lesions.FC concentration was measured in control group and case group.ROC curve was used to analyze the optimal threshold value for FC diagnosis of lesion activity.The diagnostic efficacy of MRC-S,FC and their combination were analyzed on UC lesion activity.Results The mean value or occurrence frequency of MRC parameters were higher in the mild and moderate group and severe active bowel group than those in the normal bowel group(P<0.05).There were no significant differences in intestinal wall thickness between the severe active bowel group and the mild and moderate active bowel group.The diagnostic values of MRC-S in both active(MRC-S≥1)and severely active(MRC-S≥2)bowel lesions were higher(AUC was 0.979 and 0.881,respectively).The diagnostic values of FC were higher in both active(FC≥92.9μg/g)and severely active(FC≥3003.8μg/g)UC patients(AUC was 1.000 and 0.958,respectively).MRC-S combined with FC showed obvious diagnostic specificity for patients with severe active UC(91.7%).Conclusion Both MRC-S and FC have a high value in the diagnosis of the disease activity in UC patients.The combination of the two of them can further improve the specificity of diagnosis.