阑尾周围炎症对溃疡性直肠炎的诊断价值

The diagnostic value of peri-appendiceal inflammation in ulcerative proctitis

目的分析阑尾开口炎症(AOI)和阑尾周围红斑(PARP)对UC的诊断价值。方法回顾性分析2009年2月至2017年9月首都医科大学附属北京朝阳医院479例内镜下疑似初发或活动期UC的病例,根据病理结果确诊,以溃疡性结肠炎内镜下严重程度指数(UCEIS)评估内镜下特征和疾病严重程度。根据病变累及范围将患者分为直肠炎组、直肠乙状结肠炎组、左半结肠炎组、横结肠受累组和全结肠炎组,比较各组,以及是否合并AOI或PARP的UC患者的UC诊断率和各项内镜特征的差异。采用2个独立样本的秩和检验、k个独立样本的秩和检验和Spearman相关分析进行统计学分析。结果直肠炎组、直肠乙状结肠炎组、左半结肠炎组、横结肠受累组和全结肠炎组的UC诊断率分别为61.4% (94/153)、76.9%(83/108)、88.0%(44/50)、97.3%(36/37)和76.9%(83/108),差异有统计学意义(χ^(2)=49.874,P<0.01),其中直肠炎组的UC诊断率最低。病变侵及范围与UC诊断准确率呈正相关(r=0.231,P<0.01)。直肠炎组、直肠乙状结肠炎组、左半结肠炎组、横结肠受累组和全结肠炎组确诊UC患者中分别有50.0% (47/94)、20.5%(17/83)、11.4%(5/44)、11.1%(4/36)和37.4%(40/107)合并AOI或PARP,差异有统计学意义(χ^(2)=39.272,P<0.01),其中直肠炎组确诊UC患者AOI或PARP的发生率最高。AOI或PARP的发生率与病变受累范围呈负相关(r=-0.112,P=0.032)。不合并AOI或PARP的直肠炎组患者的UC内镜确诊率低于总体直肠炎组患者[44.3%(47/106)比61.4%(94/153)],差异有统计学意义(χ^(2)=7.381,P=0.007)。确诊直肠型UC与其他直肠病变的内镜下特点主要差异表现在血管纹理、黏膜的颗粒样改变、黏液脓性改变、糜烂和溃疡的范围,差异均有统计学意义(χ^(2)=50.806、40.897、18.578、25.548,P均<0.01)。确诊直肠型UC患者的UCEIS评分高于非UC患者,差异有统计学意义[5分(4分,6分)比4分(4分,5分),Z=-5.922,P<0.01]。合并AOI或PARP与不合并AOI或PARP的直肠型UC的直肠内镜下表现和UCEIS评分差异均无统计学意义(P均>0.05)。合并AOI或PARP的UC患者阑尾局部与受累直肠的结肠镜下表现具有一致性。结论 AOI或PARP有助于直肠型UC与其他直肠黏膜病变的鉴别。

Objective To analyze the diagnostic value of appendiceal orifice inflammation(AOI)and peri-appendiceal red patch(PARP)in ulcerative colitis(UC).Methods From February 2009 to September 2017,a total of 479 cases of suspected initial or active UC under endoscopy in Beijing Chao-Yang Hospital,Capital Medical University were retrospectively analyzed.The diagnosis was made according to the pathological results.Characteristics under endoscopy and disease severity were evaluated based on the ulcerative colitis endoscopic index of severity(UCEIS)score.The patients were divided into proctitis group,rectosigmoid colitis group,left hemicolitis group,transverse colon involved group and pancolitis group according to the extent of lesions involved.Rectal type UC patients were divided into complicated with AOI or PARP and without AOI or PARP.The differences of diagnostic rate of UC and characteristics under endoscopy among groups were compared.Rank sum test of two or k independent samples and Spearman correlation analysis were used for statistical analysis.Results The diagnostic rates of UC of proctitis group,rectosigmoid colitis group,left hemicolitis group,transverse colon involved group and pancolitis group were 61.4%(94/153),76.9%(83/108),88.0%(44/50),97.3%(36/37)and 76.9%(83/108),respectively,and the differences were statistically significant(χ^(2)=49.874,P<0.01).The diagnostic rate of UC in proctitis group was the lowest.The more sites involved,the higher the accuracy of endoscopic diagnosis(r=0.231,P<0.01).The percentage of UC patients complicated with AOI or PARP of proctitis group,rectosigmoid colitis group,left hemicolitis group,transverse colon involved group and total colitis group were 50.0%(47/94),20.5%(17/83),11.4%(5/44),11.1%(4/36)and 37.4%(40/107),respectively,and the difference was statistically significant(χ^(2)=39.272,P<0.01).The incidence of AOI or PARP was the highest in the UC patients of proctitis group.And the incidence of AOI or PARP was negatively correlated with the extent of lesion involved(r=-0.112,P=0.032).The endoscopic diagnosis rate of UC in the patients of proctitis group without AOI or PARP was lower than that in the general proctitis group(44.3%,47/106 vs.61.4%,94/153),the difference was statistically significant(χ^(2)=7.381,P=0.007).Compared with other rectal lesions,the main differences in colonoscopic characteristics of rectal type UC were vascular pattern,mucosal granularity changes,mucopus,erosions and ulcers,and the differences were statistically significant(χ^(2)=50.806,40.897,18.578 and 25.548,all P<0.01).The UCEIS score of rectal type UC patients was higher than that of non-UC patients,and the difference was statistically significant(5(4,6)vs.4(4,5),Z=-5.922,P<0.01).However,there were no differences in colonoscopic findings and UCEIS scores in rectal site between rectal type UC patients complicated with AOI or PARP and without AOI or PARP(all P>0.05).The colonoscopic findings of the local appendix and affected rectum were consistent in UC patients complicated with AOI or PARP.Conclusion AOI or PARP can help differentiate rectal type UC from other rectal mucosal lesions.