nMaRIA对克罗恩病小肠黏膜愈合的诊断效能

The diagnostic efficacy of MaRIA for small intestinal mucosal healing in Crohn'sdisease

目的评估克罗恩病(CD)患者小肠黏膜愈合至关重要.磁共振活度指数(MaRIA)是评估CD的传统指标.本研究旨在以内镜为金标准,探究对比MaRIA在临床缓解的CD患者远近端小肠黏膜愈合的诊断效能.方法选取2019年1月至2020年1月期间就诊于本院临床缓解的L1型CD病例80例,L4型50例.临床缓解依据CDAI,CDAI<150分为缓解期.CD患者在入组时均行常规血液检测、结肠镜和胶囊内镜以及小肠磁共振检查,并留取粪便测定FC浓度.L1型患者按克罗恩内镜活动度(CDEIS)进行内镜评分,L4型患者按胶囊内镜评分即Lewis评分.MaRIA根据MRI图像计算所得.回顾性分析MaRIA对不同节段小肠黏膜愈合的诊断效能.结果L1型临床缓解的CD患者中MaRIA诊断小肠黏膜愈合的灵敏度为0.802,特异度为0.775,ROC曲线下面积(AUC)为0.804(P<0.05).L4型临床缓解的CD患者中MaRIA诊断小肠黏膜愈合的灵敏度为0.823,特异度为0.806,AUC为0.812(P<0.05).L1型临床缓解的CD患者MaRIA与CDEIS呈中度关联(r=0.659,P<0.05),L4型临床缓解的CD患者MaRIA与Lewis评分呈中度关联(r=0.733,P<0.05).结论MaRIA可较好诊断临床缓解的克罗恩病患者小肠黏膜愈合情况.MaRIA诊断临床缓解克罗恩病患者的近端小肠黏膜愈合效能较远端小肠相对更佳.

Objective To evaluate the importance of small intestinal mucosal healing in patients with Crohn's disease(CD).The magnetic resonance index of activity(MaRIA)is the traditional index to evaluate CD.The purpose of this study is to explore and compare the diagnostic efficacy of MaRIA for small intestinal mucosal healing in patients with CD in clinical remission,by using endoscopy as the gold standard.Methods From January 2019 to January 2020,80 patients in clinical remission with L1 type CD and 50 patients with L4 type CD in our hospital were selected.Clinical remission was based on CDAI,and CDAI<150 was classified as remission.All patients with CD underwent routine blood test,colonoscopy and capsule endoscopy,and small intestinal magnetic resonance examination at the time of enrollment,and their feces were collected to determine FC concentration.Patients with L1 were scored according to Crohn's Disease Index of Severity(CDEIS),and patients with L4 were scored according to capsule endoscopy,namely Lewis score.MaRIA calculated the results based on MRI images.The diagnostic efficacy of MaRIA for intestinal mucosal healing at different levels was analyzed retrospectively.Results The sensitivity and specificity of MaRIA in diagnosing small intestinal mucosal healing in patients with CD with L1 clinical remission were 0.802,0.775,and the area under ROC curve(AUC)was 0.804,with statistical significance(P<0.05).The sensitivity,specificity and AUC of MaRIA in diagnosing small intestinal mucosal healing in CD patients with L4 clinical remission were 0.823,0.806 and 0.812,with statistical significance(P<0.05).There was a moderate association between MaRIA and CDEIS in CD patients with L1 clinical remission(r=0.659,P<0.05),and a moderate association between MaRIA and Lewis score in CD patients with L4 clinical remission(r=0.733,P<0.05).Conclusion MaRIA can better diagnose small intestinal mucosal healing in patients with Crohn's disease in remission.In the diagnosis of MaRIA,the healing eficiency of the proximal small intestine mucosa in patients with Crohn's disease is relatively better than that of the distal small intestine.