超声造影参数与克罗恩病活动性的相关性研究

Correlation between contrast-enhanced ultrasound parameters and Crohn′s disease activity

目的:探讨超声造影(CEUS)定量参数与克罗恩病(CD)活动性常用评估指标的相关性,并与实验室炎症指标的预测效能进行对比,以评估CEUS对预测克罗恩病活动性的临床意义。方法:病例对照研究。回顾性分析2019年10月至2021年12月南京医科大学第一附属医院经内镜确诊且行超声造影检查的67例克罗恩病患者的临床资料,搜集其常规超声及CEUS参数、C反应蛋白(CRP)、红细胞沉降率(ESR)、粪便钙卫蛋白(FC)、克罗恩病活动指数(CDAI)及克罗恩病简化内镜评分(SES-CD)。以SES-CD为标准,将患者分为缓解组与活动组,评估实验室炎症指标及超声造影参数与CDAI、SES-CD的相关性,并利用受试者工作特征(ROC)曲线分析各指标对克罗恩病内镜下活动性的预测效能。结果:共67例患者纳入本研究,根据SES-CD评分,将患者分为两组,其中活动组50例,缓解组17例。除上升斜率及达峰时间外,两组的峰值强度(PI)、造影曲线下面积、实验室炎症指标差异均有统计学意义(均P<0.05),且与CDAI、SES-CD均呈中度正相关(P<0.05)。ROC曲线分析显示,各项非侵入性指标中,PI、造影曲线下面积预测克罗恩病内镜下活动性的曲线下面积(AUC)最高,分别为0.912、0.891;以SES-CD>3分为界值,相应敏感度分别为78.0%和72.0%,特异度分别为100.0%和94.1%。结论:超声造影可以客观、重复地评估克罗恩病患者的疾病活动性,具有较大的临床应用价值,可作为克罗恩病患者诊断及随访的可靠影像学方法。

Objective By investigating the correlation between quantitative parameters of contrast enhanced ultrasound(CEUS)and commonly used activity assessment indicators of Crohn′s disease(CD),and comparing the predictive power of laboratory inflammatory indicators with CEUS on Crohn′s disease(CD),the significance of CEUS was evaluated.Methods A case-control study.From October 2019 to December 2021,the clinical data of 67 patients with CD who were diagnosed by endoscopy and underwent contrast-enhanced ultrasonography were retrospectively analyzed in the First Affiliated Hospital with Nanjing Medical University,and their routine ultrasound and CEUS parameters,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),fecal calprotectin(FC),Crohn′s disease activity index(CDAI)and simplified endoscopic score for Crohn′s disease(SES-CD)were collected.Using SES-CD as the standard,the patients were divided into a remission group and an active group,and the correlation of laboratory inflammatory indexes and contrast-enhanced ultrasound parameters with CDAI and SES-CD were evaluated.Besides,the ROC curve was used to analyze the predictive efficacy of each index on CD endoscopic activity.Results A total of 67 patients were included in this study.According to the SES-CD score,there were 17 patients in the remission group and 50 patients in the active group.Except for the coefficient of the enhancement wash in slope and time to peak(TTP),the peak intensity(PI),area under the angiography curve,and laboratory inflammatory indexes were significantly different between the two groups(P<0.05),which also showed a moderate positive correlation with CDAI and SES-CD(P<0.05).ROC analysis showed that among the non-invasive indicators,PI and area under the angiography curve had the highest AUCs for predicting CD endoscopic activity,which were 0.912 and 0.891,respectively;with SES-CD taking>3 as the cut-off value,the corresponding sensitivities were 78.0%and 72.0%,with specificities of 100.0%and 94.1%,respectively.Conclusion CEUS can objectively and repeatedly evaluate the disease activity of CD patients,and has great clinical application value,which can be used as a reliable imaging method for diagnosis and follow-up of patients with Crohn′s disease.