超声内镜联合放大内镜检查在溃疡性结肠炎病情评估中的临床价值

Clinical value of endoscopic ultrasonography combined with magnifying endoscopy in the evaluation of ulcerative colitis

目的 研究超声内镜联合放大内镜检查在溃疡性结肠炎(UC)病情评估中的临床意义。方法 选择经白光内镜和超声内镜检查的UC患者共107例,其中98例经放大内镜检查。分析白光内镜下评分与放大内镜炎症分级的相关性,比较两者不同分级下超声内镜测量的肠壁厚度和放大内镜下炎症程度。结果 UC患者白光内镜下评分与放大内镜下炎症程度呈正相关性(rs=0.71,P<0.05)。超声内镜下肠壁总厚度、黏膜层厚度、黏膜下层厚度与白光内镜下炎症程度均呈正相关(rs分别=0.67、0.72、0.63,P均<0.05)。依据放大内镜下UC黏膜表现分级为Matts Ⅰ级(27例)、Matts Ⅱ级(36例)、Matts Ⅲ级(24例)、Matts Ⅳ级(11例),超声内镜下肠壁厚度肠壁总厚度、黏膜层厚度、黏膜下层厚度和固有肌层厚度与放大内镜下不同炎症程度均无相关性(rs分别=0.28、0.39、0.25、0.30,P均>0.05),随着UC患者结肠炎症程度的加重,肠壁各层次间清晰度会发生变化,Matts Ⅲ~Ⅳ级患者肠壁各层次间的可辨率较Matts Ⅰ~Ⅱ级明显降低,差异均有统计学意义(χ^(2)分别=11.59、12.78,P均<0.05)。结论 放大内镜检查可对UC炎症程度进行评估,超声内镜可通过肠壁厚度和层次间清晰度变化判断UC内镜下严重程度,联合两者检查可提高UC内镜下诊断效率和精准度。

Objective To investigate the clinical value of endoscopic ultrasonography(EUS)combined with magnifying endoscopy(ME)in evaluation of ulcerative colitis.Methods A total of 107 UC patients were examined by white light endoscopy(WLE)and EUS,and 98 of them were additionally examined by ME.The correlation between the score under WLE and the inflammation degree ME was analyzed.The intestinal wall thickness measured by EUS with different grades and the interlayer clarity under magnification endoscopy were compared.Results There was a positive correlation between the WLE score and the degree of inflammation under ME(rs=0.71,P<0.05).The thickness of mucosa,submucosa and the total wall thickness(TWT)were positively correlated with the inflammation degree under WLE(rs=0.67,0.72,0.63,P<0.05).According to the mucosa appearance under ME,all patients were classified into four groups:MattsⅠ(27,cases),MattsⅡ(36,cases),MattsⅢ(24,cases),MattsⅣ(11 cases).There was no correlation between total intestinal wall thickness,mucosal thickness,submucosal thickness and muscularis propria thickness under endoscopic magnification with different inflammation degree(rs=0.28,0.39,0.25,0.30,P>0.05).With the aggravation of colonic inflammation in UC patients,the clarity of the intestinal wall between different levels will change.The discernibility of intestinal wall in MattsⅢ-Ⅳpatients was significantly lower than that in MattsⅠ-Ⅱ(χ^(2)=11.59,12.78,P<0.05).Conclusion ME can be used to assess the degree of inflammation in UC,EUS can assess the severity of UC by changes in wall thickness and interlayer clarity.Combining the two tests can improve the efficiency and accuracy of UC endoscopic diagnosis.