CT影像学检查对克罗恩病患者病情活动度的诊断价值

Value of CT imaging in diagnosis of clinical activity of patients with Crohn's disease

目的探讨CT影像学检查对克罗恩病(CD)患者病情活动度的诊断价值。方法收集2015年12月至2019年9月在上海市普陀区人民医院进行CT小肠成像检查的36例CD患者病例资料,根据克罗恩病活动指数(CDAI)将患者分为活动期组(CDAI≥150分,n=18)和缓解期组(CDAI<150分,n=18),将同期在医院进行体检的健康志愿者作为健康对照组(n=20)。检测并比较3组对象红细胞沉降率(ESR)、C反应蛋白(CRP)及血红蛋白(HGB)。1周后进行CT小肠成像检查,分析患者血液学指标和CT影像学特征与CDAI相关性。结果活动期组和缓解期组患者ESR和CDAI大于健康对照组,活动期组大于缓解期组(P<0.05);活动期组和缓解期组患者CRP水平高于健康对照组,活动期组高于缓解期组(P<0.05);活动期组和缓解期组患者HGB水平低于健康对照组,活动期组低于缓解期组(P<0.05);患者HGB与ESR、CRP及CDAI呈负相关(P<0.05);患者ESR与CRP及CDAI呈正相关(P<0.05);患者CRP与CDAI呈正相关(P<0.05);活动期组患者肠壁厚度、累及肠段数、病变肠壁动脉期相对强化值及病变肠壁门静脉期相对强化值大于缓解期组(P<0.05);活动期组患者分层强化、肠腔狭窄或梗阻、齿梳征、蜂窝组织炎、肠系膜密度增高、腹腔淋巴结肿大比例大于缓解期组(P<0.05);患者肠壁厚度、累及肠段数、病变肠壁动脉期相对强化值、病变肠壁门静脉期相对强化值、肠壁强化方式、肠管形态、齿梳征、肠系膜血管增生、蜂窝组织炎、腹腔脓肿与CDAI呈正相关(P<0.05)。结论CD患者呈CRP、ESR水平上升,HGB水平降低状态,与其病情活动度明显相关;且活动期和缓解期CD患者具有不同的CT影像学特征,与血液学指标变化一致。CT影像学检查对鉴别患者病情活动度具有临床应用价值。

Objective To investigate the value of CT imaging in diagnosis of clinical activity of patients with Crohn's disease(CD).Methods The medical records of 36 CD patients underwent CT enterography examinations in Putuo District People's Hospital from December 2015 to September 2019 were collected.Patients were divided into two groups according to the Crohn's disease activity index(CDAI),active stage group(CDAI≥150 points,n=18)and remission stage group(CDAI<150 points,n=18);meanwhile,another 20 healthy examinees in Putuo District People's Hospital were set as healthy control group.The erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and hemoglobin(HGB)were detected in three groups,and CT enterography examinations were performed 1 week later,then the correlation of blood indexes and CT imaging features with CDAI was analyzed.Results ESR and CDAI were the highest in active stage group,followed by remission group and healthy control group,with statistic difference(P<0.05).CRP level was the highest in active stage group,followed by remission group and healthy control group,with statistic difference(P<0.05).HGB level was the highest in healthy control group,followed by remission group and active stage group,with statistic difference(P<0.05).HGB was negatively correlated with ESR,CRP,and CDAI(P<0.05);ESR was positively correlated with CRP and CDAI(P<0.05);CRP was positively correlated with CDAI(P<0.05);The intestinal wall thickness,implicated intestinal segments,relative enhancement value of the arterial phase and the portal vein phase of diseased intestinal wall were higher in the active stage group than in the remission stage group(P<0.05).The proportion of intestinal stratification,intestinal stenosis and obstruction,comb sign,cellulitis,raised mesenteric fat density,and abdominal abscess of active stage group was higher than that in remission stage group(P<0.05).The intestinal wall thickness,implicated intestinal segments,relative enhancement value of the arterial phase and the portal vein phase of diseased intestinal wall,intestinal morphology,comb sign,mesenteric vascular hyperplasia,cellulitis and abdominal abscess were positively correlated with CDAI(P<0.05).Conclusion CD patients showed increased CRP and ESR levels,and decreased HGB levels,which were significantly related to their disease activity;and CD patients in the active and remission phases have different CT imaging characteristics,which are consistent with the changes in hematological indicators.CT imaging examination has clinical application value in identifying the patient's disease activity.