CT小肠成像评分对克罗恩病炎症活动度的评价

Inflammatory Activity of Crohn’s Disease Evaluated by CT Enterography Score

目的探讨CT小肠成像(CTE)评分在评价克罗恩病(CD)炎症活动度中的价值。资料与方法回顾性收集40例经临床、内镜、病理确诊的CD,分析内镜检查前后1周内CTE图像、C-反应蛋白(CRP)及粪便钙卫蛋白(FC)水平。根据简化内镜评分(SES-CD),将患者分为缓解组8例、轻度活动组18例和中重度活动组14例。观察患者的CTE征象,将与SES-CD相关且有统计学意义的CTE征象纳入CTE评分。分析SES-CD与CTE评分、CRP及FC水平的相关性,并绘制受试者工作特征(ROC)曲线,分析各标志物鉴别内镜下活动度的效能。结果SES-CD与CTE评分、FC水平、CRP水平呈正相关(r=0.628、0.537、0.445,P<0.01)。缓解组[10.00(9.25~11.00)分]、轻度活动组[13.50(12.00~15.00)分]与中重度活动组[15.00(14.00~16.00)分]CTE评分比较,差异有统计学意义(H=8.783,P<0.05)。以CTE评分11.50分、13.50分作为临界值预测临床缓解及中重度活动度,其诊断敏感度及特异度分别为90.6%、87.5%,92.9%、65.4%。结论CTE评分与SES-CD呈正相关,且有助于区分CD内镜下不同活动度,其诊断效能高于FC及CRP。

Purpose To explore the value of computed tomography enterography(CTE)score in assessing the activity of Crohn’s disease(CD).Materials and Methods Forty patients who were diagnosed as CD by clinical,endoscopy and pathology were retrospectively collected.All patients underwent endoscopy and CTE with the interval less than 1 week,the C-reactive protein(CRP)and fecal calprotectin(FC)were further analyzed within 1 week.Based on the simplified endoscopic score for Crohn’s disease(SES-CD),all patients were divided into 8 cases of remission group,18 cases of mild active group and 14 cases of moderate to severe active group.CTE signs of all patients were observed.The statistically significant CTE signs related to SES-CD analyzed by Spearman rank analysis were included into the CTE score.Correlations between SES-CD and CTE score,CRP and FC were further evaluated.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive ability of each marker of disease activity in patients with CD.Results SES-CD was strong positively correlated with CTE score,FC level and CRP(r=0.628,0.537 and 0.445,P<0.01).There were statistically significant differences in CTE scores among the remission group[10.00(9.25-11.00)points],mild activity group[13.50(12.00-15.00)points]and moderate to severe activity group[15.00(14.00-16.00)points](H=8.783,P<0.05).Based on the 11.5 and 13.5 as the cut-off values,the sensitivity and specificity of CTE score was 90.6%and 87.5%,92.9%and 65.4%,respectively,predicting remission and moderate-severe active in clinical practice.Conclusion CTE score is strongly correlated with SES-CD,distinguishing different activities from each other with higher diagnostic performance than FC and CRP levels.