彩色多普勒超声对小儿克罗恩病活动性评估的预测价值

Predictive value of color Doppler ultrasonography for Crohn's disease activity assessment in pediatric patients

目的探讨彩色多普勒超声评价儿童克罗恩病(Crohn’s Disease,CD)的活动性,并与儿童克罗恩活动指数(Pediatric Crohn’s Disease Activity Index,PCDAI)进行相关性比较。方法选取2015年1月~2020年12月在广州市妇女儿童医疗中心确诊为克罗恩病患儿68例,其中PCDAI评分<15分(非活动期)14例,15~45分(活动期)54例,分别对增厚肠壁根据能量多普勒超声表现进行Limberg分型,应用频谱多普勒超声测量肠壁动脉峰值收缩期速度(PSV)、舒张末期速度(EDV)、阻力指数(RI),并对比各组之间的差异,同时将对RI及PCDAI进行相关性分析。结果非活动期患儿受累肠壁血流以Limberg I、Ⅱ型为主,活动期以Ⅲ、IV型为主,差异有统计学意义(u=4.51,P<0.01)。非活动期受累肠壁动脉平均RI显著高于活动期,有显著差异性(t=3.39,P<0.01),PSV值非活动期与重度活动期组存在轻微的差异有统计学意义(t=2.13,0.01<P<0.05),但与其它活动期组无差异显著性,EDV值两组间无差异显著性。非活动期与活动期组RI与PCDAI呈显著负相关(P<0.01)。结论彩色多普勒超声通过检测CD患儿受累肠壁血流分布及动力学变化,提示疾病活动性变化,对小儿CD诊断和治疗具有一定的临床价值。

Objective Color Doppler ultrasonography was used to evaluate the activity of children with Crohn's disease(CD),and the correlation was compared with Pediatric Crohn's Disease Activity Index(PCDAI).Methods We retrospectively analyzed 68 of children with crohn's disease diagnosed by the Guangzhou Women and Children’s Medical Center from January 2015 to December 2020.The PCDAI of 14 cases were less than 15(inactivity)and 54 cases were between 15~45(activity).The Limberg classification of thickened intestinal walls were determined by Power-Doppler results.The parameters including artery peak systolic velocity(PSV),end-diastolic velocity(EDV),resistance index(RI)were measured and statistically analyzed by Spectrum-Doppler.Correlation analysis between RI and PCDAI was also conducted.Results The Limberg classifications were mainly type I and typeⅡin inactivity CD,and typeⅢand type IV in activity CD,which had significant difference(u=4.51,P<0.01).The average RI of the affected intestinal wall in inactivity CD was significantly higher than that in the activity CD(t=3.39,P<0.01),the PSV value in the inactivity CD was slightly different from that in the severely activity CD(t=2.13,0.01<P<0.05),but there was no significant difference between the other activity groups,and there was no significant difference in the EDV value between inactive and active groups.RI was negatively correlated with PCDAI in inactive and active groups(P<0.01).Conclusion Color Doppler ultrasound can indicate disease activity by detecting hemodynamic changes of the affected intestinal wall in CD patients,which is of great value for clinical diagnosis and treatment of CD.