结肠型克罗恩病与溃疡性结肠炎的临床影像特征对比分析

Comparison of clinical and imaging features between colonic Crohn′s disease and ulcerative colitis

目的:探讨结肠型克罗恩病(CD)与溃疡性结肠炎(UC)的临床及影像特征差异。方法:回顾性纳入2013年1月至2020年7月中山大学附属第六医院收治的40例结肠型CD与40例UC患者,所有患者均行CT肠道造影检查,且临床资料完整。比较两组患者临床特征及CT特征的差异,并将差异有统计学意义(P<0.05)的特征纳入到二元Logistic回归模型中,筛选可诊断结肠型CD的预测因子。结果:结肠型CD和UC患者在发病年龄[(29.3±10.7)岁比(46.6±13.4)岁,P<0.001]、体质指数[(18.4±2.7)kg/m^(2)比(21.0±4.0)kg/m^(2),P=0.001]、出现血便症状的比例(47.5%比90.0%,P<0.001),差异均有统计学意义。结肠型CD较UC更易出现升结肠受累(70.0%比20.0%,P<0.001)。UC患者比结肠型CD患者更常出现病变连续性分布(80.0%比57.5%,P=0.03)及肠壁环周均匀性增厚(77.5%比47.5%,P=0.006),更少见肠周炎性渗出(20.0%比67.5%,P<0.001)及肛瘘(10.0%比57.5%,P<0.001)。结肠型CD患者更多表现为不同部位严重程度不一致(75.0%比45.0%,P=0.006),肠壁厚度多高于UC患者[(9.5±3.4)mm比(8.1±2.2)mm,P=0.024]。多因素回归模型显示,升结肠受累(OR=9.209,95%CI:2.238~37.902,P=0.002)、肠周炎性渗出(OR=9.861,95%CI:2.384~40.786,P=0.002)及肛瘘(OR=19.263,95%CI:3.714~99.905,P<0.001)是诊断结肠型CD的独立预测因子。结论:综合CT特征与患者的临床表现,可在一定程度上鉴别结肠型CD与UC,为临床进一步的治疗决策提供重要的参考价值。

Objective To investigate the clinical and imaging features of colonic Crohn′s disease(CD)and ulcerative colitis(UC).Methods A retrospective analysis was performed on 40 patients with colonic CD and 40 patients with UC who admitted to The Sixth Affiliated Hospital of Sun Yat-sen University from January 2013 to July 2020.All the patients underwent CT enterography examination and had complete clinical data.The differences of clinical and CT features between the two groups were compared.The characteristics(P<0.05)were incorporated into the binary logistic regression model,and the predictors of diagnosing colonic CD were screened.Results There were significant differences in age of onset(29.3±10.7 vs.46.6±13.4,P<0.001),body mass index[(18.4±2.7)kg/m^(2) vs.(21.0±4.0)kg/m^(2),P=0.001]and ratio of bloody stool symptom(47.5%vs.90.0%,P<0.001)between colonic CD group and UC group.Ascending colon involvement was more common in colonic CD than that in UC(70.0%vs.20.0%,P<0.001).Continuous distribution of lesions(80.0%vs.57.5%,P=0.03)and circumferential uniform thickening of intestinal wall(77.5%vs.47.5%,P=0.006)were more common in UC patients,peri-intestinal fat inflammation(20.0%vs.67.5%,P<0.001)and anal fistula(10.0%vs.57.5%,P<0.001)were less common in UC patients.It was more likely that the severity of different parts was inconsistent(75.0%vs.45.0%,P=0.006),and the thickness of intestinal wall was thicker[(9.5±3.4)mm vs.(8.1±2.2)mm,P=0.024]in patients with colonic CD as compared to patients with UC.Multivariate regression models showed that involvement of ascending colon(OR=9.209,95%CI:2.238 to 37.902,P=0.002),peri-intestinal fat inflammation(OR=9.861,95%CI:2.384 to 40.786,P=0.002)and anal fistula(OR=19.263,95%CI:3.714 to 99.905,P<0.001)are independent predictors for diagnosis of colonic CD.Conclusions Combining with CT features and clinical manifestations,colonic CD and UC can be effectively distinguished,which provides an important reference value for further clinical treatment decision.