不同肠道对比剂在克罗恩病多层螺旋CT小肠造影检查中的应用效果比较

Comparing different intestinal contrast agents in multislice computed tomography enterography examination for Crohn’s disease

目的 比较不同肠道对比剂在克罗恩病(CD)多层螺旋CT小肠造影(MSCTE)检查中的应用效果。方法 选取2018年1月至2019年12月在北京市肛肠医院(北京市二龙路医院)因确诊为CD需进行MSCTE检查的60例患者作为研究对象,随机分为乳果糖组和甘露醇组,每组各30例。比较两组成像效果【小肠肠管(十二指肠、空肠、回肠)横断面直径,小肠扩张程度,肠壁结构显示清晰度】,CD患者MSCTE检查特征性影像学表现,不良反应及患者对肠道对比剂的接受程度。结果 两组测量所得小肠肠管(十二指肠、空肠、回肠)横断面直径,小肠扩张程度,肠壁结构显示清楚度,以及CD患者MSCTE检查特征性影像学表现比较差异均无统计学意义(均P>0.05)。口服肠道对比剂24 h内,乳果糖组出现1种不良反应6例,2种不良反应2例,3种不良反应0例;甘露醇组出现1种不良反应6例,2种不良反应2例,3种不良反应2例。两组均未出现电解质紊乱、脱水及心悸等不良反应,乳果糖组的不良反应总发生率低于甘露醇组(P<0.05)。乳果糖组患者对肠道对比剂的接受程度评分高于甘露醇组(P<0.05)。结论 乳果糖作为MSCTE检查的肠道对比剂,与传统肠道对比剂(甘露醇)相比,其应用效果基本一致,不良反应相对较少,口感较佳,患者的接受程度较高。另外乳果糖在一定程度上对肠道具有保护作用,较为适合CD患者。

Objectives To compare different intestinal contrast agents in multislice computed tomography enterography(MSCTE) examination for Crohn’s disease(CD). Methods Sixty patients requiring MSCTE examination for a diagnosis of CD at Beijing Anorectal Hospital—Beijing Erlong Road Hospital from January 2018 to December 2019 were recruited and randomly assigned to receive lactulose(n=30) or mannitol(n=30) as the contrast agents. The followings were compared between the two groups: imaging effect evaluated using the cross-sectional diameter of the small intestinal canal(duodenum, jejunum, and ileum), degree of small intestinal dilatation, and clarity of display of intestinal wall structures, distinctive imaging characteristics of MSCTE examination in patients with CD, adverse effects(AE), and score of acceptance of intestinal contrast agents. Results The two groups did not differ significantly in terms of the cross-sectional diameter of the small intestinal canal(duodenum, jejunum, and ileum),degree of small intestinal dilatation, clarity of display of intestinal wall structures, and distinctive imaging characteristics of MSCTE examination of CD(P>0.05). Within 24 hours of oral administration, in the lactulose group, six patients experienced one AE, two patients experienced two AEs, and no patient experienced three AEs;in the mannitol group, six patients experienced one AE, two patients experienced two AEs, and two patients experienced three AEs. No patient had AEs such as electrolyte disturbance, dehydration, and palpitations. The overall AEs rate was significantly lower, and the score of acceptance of intestinal contrast agent was significantly higher in the lactulose group than in the mannitol group(P<0.05). Conclusion Compared with traditional contrast agent of mannitol, lactulose can achieve comparable effect with fewer AEs. Its other advantages include better taste, better acceptance, and the potential to protect intestinal tract;therefore, it may be more suitable for CD patients.