CT小肠造影评估活动期克罗恩病患儿病情严重程度的价值

Value of CT enterography to the severity evaluation of active pediatric Crohn's disease

目的观察活动期克罗恩病(CD)患儿CT小肠造影征象特征,探讨其评估活动期CD患儿病情严重程度的价值。方法2020年1月—2023年2月西安市儿童医院诊治CD患儿27例,入院时均行儿童克罗恩病活动指数(PCDAI)评分,PCDAI评分11~30分15例为轻度组,PCDAI评分>30分12例为中重度组。2组均于PCDAI评分后行CT小肠造影检查,记录肠壁厚度、肠壁强化△Ct值、强化方式、梳征及肠系膜脂肪浸润发生肠段数量、肠系膜淋巴结数量并评分,计算6项评分之和为CT小肠造影征象评分。比较2组不同肠壁厚度、肠壁强化△Ct值、强化方式、梳征、肠系膜脂肪浸润、肠系膜淋巴结数量评分比率及CT小肠造影征象评分;采用Pearson相关分析活动期CD患儿CT小肠造影征象评分与PCDAI评分的相关性;绘制ROC曲线,评估CT小肠造影征象评分诊断中重度活动期CD的效能。结果(1)中重度组肠壁厚度评分3分(66.67%)、梳征评分2分(75.00%)、肠系膜脂肪浸润评分2分(33.33%)比率均大于轻度组(13.33%、6.67%、0)(χ^(2)=-2.779,P=0.005;χ^(2)=14.243,P=0.001;χ^(2)=16.200,P<0.001),CT小肠造影征象评分[(11.75±1.87)分]高于轻度组[(7.73±1.91)分](t=-5.490,P<0.001),不同肠壁强化△Ct值评分、强化方式评分、肠系膜淋巴结数量评分比率与轻度组比较差异均无统计学意义(P>0.05)。(2)轻度组PCDAI评分为(17.87±5.98)分,中重度组PCDAI评分为(41.17±7.42)分。Pearson相关分析结果显示,轻度组CT小肠造影征象评分与PCDAI评分无相关性(r=0.216,P=0.440),中重度组CT小肠造影征象评分与PCDAI评分呈正相关(r=0.742,P=0.006)。(3)CT小肠造影征象评分以9.5分为最佳截断值,诊断中重度活动期CD的AUC为0.933(95%CI:0.835~1.000,P<0.05),灵敏度为91.7%,特异度为86.7%,准确率为88.9%。结论中重度活动期CD患儿CT小肠造影主要表现为肠壁增厚、2段及以上梳征和肠系膜脂肪浸润,CT小肠造影征象评分可定量评估活动期CD患儿病情严重程度,对中重度活动期CD患儿的诊断价值较高。

Objective To observe the features of CT enterography(CTE)of active pediatric Crohn's disease(PCD),and to investigate the value of CTE to the evaluation of the severity of active PCD.Methods Twenty-seven children with active PCD were diagnosed and treated in Xi'an Children's Hospital from January 2020 to February 2023.All children were evaluated the PCD activity index(PCDAI)on admission and were divided into 15 children with PCDAI 11-30(mild group),and 12 children with PCDAI 30(moderate to severe group).GTE was performed after PCDAI scoring to record and score the intestinal wall thickness,intestinal wall enhancement△Ct value,enhancement mode,numbers of intestinal segments involved in comb sign and mesenteric fat infiltration,and number of mesenteric lymph nodes.The sum of these 6 scores was regarded as the CTE score.The rates of intestinal wall thickness,intestinal wall enhancement△Ct value,enhancement mode,comb sign,mesenteric fat infiltration and mesenteric lymph node number scores as well as CTE score were compared between two groups.Pearson correlation analysis was done to assess the correlation between CTE scores and PCDAI scores of active PCD.ROC curve was plotted to evaluate the efficiency of CTE score on the diagnosis of moderate to severe active PCD.Results(1)The proportions of intestinal wall thickness score 3,comb sign score 2 and mesenteric fat infiltration score 2 were higher in moderate to severe group(66.67%,75.00%,33.33%)than those in mild group(13.33%,6.67%,0)(χ^(2)=-2.779,P=0.005;χ^(2)=14.243,P=0.001;χ^(2)=16.200,P<0.001),the CTE score was higher in moderate to severe group(11.75±1.87)than that in mild group(7.73±1.91)(t=-5.490,P<0.001),and there were no significant differences in the proportions of△Ct value,enhancement mode score and mesenteric lymph node number score between two groups(P>0.05).(2)The PCDAI score was 17.87±5.98in mild group and 41.17±7.42 in moderate to severe group.Pearson correlation analysis showed that CTE score was not correlated with PCDAI score in mild group(r=0.216,P=0.440),and was positively correlated with PCDAI score in moderate to severe group(r=0.742,P=0.006).(3)When the optimal cut-off value of CTE score was 9.5.the AUC for predicting moderate to severe active PCD was 0.933(95%CI:0.835-1.000,P<0.05),with a sensitivity of 91.7%,a specificity of 86.7%and an accuracy rate of 88.9%.Conclusions The CTE of moderate to severe active PCD are mainly demonstrated by intestinal wall thickening,comb sign and mesenteric fat infiltration involving two or more segments of intestinal canal.The CTE score can quantitatively evaluate the severity of active PCD,and has a high diagnostic value for moderate to severe active PCD.