Assessment of perianal fistulizing Crohn’s disease activity with endoanal ultrasound: A retrospective cohort study

BACKGROUND Perianal fistulas pose dual challenges to Crohn's disease(CD)patients.Low patient compliance due to the complexity of existing examination methods plagues the treatment and follow-up management of perianal CD.AIM To determine the accuracy of endoanal ultrasound(EUS)and shear wave elastography(SWE)for evaluating perianal fistulizing CD(PFCD)activity.METHODS This was a retrospective cohort study.A total of 67 patients from August 2022 to December 2023 diagnosed with CD were divided into three groups:Non-anal fistula group(n=23),low-activity perianal fistulas[n=19,perianal disease activity index(PDAI)≤4],high-activity perianal fistulas(n=25,PDAI>4)based on the PDAI.All patients underwent assessments including EUS+SWE,pelvic magnetic resonance[pelvic magnetic resonance imaging(MRI)],C-reactive protein,fecal calprotectin,CD activity index,PDAI.RESULTS The percentage of fistulas indicated by pelvic MRI and EUS was consistent at 82%,and there was good consistency in the classification of perianal fistulas(Kappa=0.752,P<0.001).Significant differences were observed in the blood flow Limberg score(χ^(2)=8.903,P<0.05)and shear wave velocity(t=2.467,P<0.05)between group 2 and 3.Shear wave velocity showed a strong negative correlation with magnetic resonance novel index for fistula imaging in CD(Magnifi-CD)score(r=-0.676,P<0.001),a weak negative correlation with the PDAI score(r=-0.386,P<0.05),and a weak correlation between the Limberg score and the PDAI score(r=0.368,P<0.05).CONCLUSION EUS combined with SWE offers a superior method for detecting and quantitating the activity of perianal fistulas in CD patients.It may be the ideal tool to assess PFCD activity objectively for management strategies.

Use of the Crohn's disease activity index in clinical trials of biological agents

The Crohn＇s disease activity index （CDAI） has been commonly used to assess the effects of treatment with different agents in Crohn＇s disease （CD）. However, these studies may be compromised, if the results compared to a placebo or standard therapy group （in the absence of a placebo） substantially differ from the expected response. In addition, significant concerns have been raised regarding the reliability and validity of the CDAI. Reproducibility of the CDAI may be limited as significant inter-observer error has been recorded, even if measurements are done by experienced clinicians with expertise in the diagnosis and treatment of CD. Finally, many CDAI endpoints are open to subjective interpretation and have the potential for manipulation. This is worrisome as there is the potential for significant financial gain, if the results of a clinical trial appear to provide a positive result. Physicians caring for patients should be concerned about the positive results in clinical trials that are sponsored by industry, even if the trials involve respected centers and the results appear in highly ranked medical journals.

Assessing disease activity using the pediatric Crohn’s disease activity index:Can we use subjective or objective parameters alone?

BACKGROUND The pediatric Crohn’s disease activity index(PCDAI)is used as a standard tool to assess disease activity in clinical trials for pediatric Crohn’s disease.AIM To examine which items on the PCDAI drive assessment of disease activity,and how subgroups of subjective and objective items reflect change in disease state over time.METHODS Selective raw data from three prospectively collected datasets were combined,including 703 children with full PCDAI data at baseline,at 3-mo(Q1,n=670),and 1-year(Q4,n=474).Change in individual PCDAI scores from baseline to Q1 and to Q4 were examined using the non-weighted PCDAI.RESULTS Abdominal pain,well-being,weight,and stooling had the highest change scores over time.Objective indicators including albumin,abdominal exam,and height velocity followed.Change scores for well-being and abdominal exam did not explain significant variance at Q1 but were significant predictors at Q4(P<0.001 and P<0.05).Subjective and objective subgroups of items predicted less variance(18%and 22%)on total PCDAI scores at Q1 and Q4 compared to the full PCDAI,or a composite scale(both 32%)containing significant predictors.CONCLUSION Although subjective items on the PCDAI change the most over time,the full PCDAI or a smaller composite of items including a combination of subjective and objective components classifies disease activity better than a subgroup of either subjective or objective items alone.Reliance on subjective or objective items as stand-alone proxies for disease activity measurement could result in misclassification of disease state.

Intestinal permeability and its association with the patient and disease characteristics in Crohn's disease

AIM:To assess the intestinal permeability (IP) in patients with Crohn's disease (CD) and study the association of IP with the patient and disease characteristics. METHODS: One hundred and twenty five consecutive patients of CD (Males: 66) were diagnosed on the basis of a combination of standard clinical, endoscopic, imaging and histological features. CD activity index (CDAI) was used to calculate the activity of the disease while the behavior of the disease was assessed by the modified Montreal classification. IP was measured by the ratio of the percentage excretion of ingested doses of lactulose and mannitol in urine (LMR). The upper limit of normality of LMR (0.037) was derived from 22 healthy controls. RESULTS: Thirty six percent of patients with CD had increased IP. There was no significant difference in mannitol excretion (patients vs controls = 12.5% vs 14.2%, P = 0.4652), but lactulose excretion was significantly higher in patients compared to healthy controls (patients vs controls = 0.326% vs 0.293%, P = 0.0391). The mean LMR was also significantly higher in the patients as compared to healthy controls [0.027 (0.0029-0.278) vs 0.0164 (0.0018-0.0548), P = 0.0044]. Male patients had a higher LMR compared to females [0.036 (95% CI 0.029, 0.046) vs 0.022 (95% CI 0.0178, 0.028) (P = 0.0024), though there was no difference in the number of patients with abnormal IP in boththe sexes. Patients with an ileo-colonic disease had a higher LMR than those with only colonic disease [0.045 (95% CI 0.033, 0.06) vs 0.021 (95% CI 0.017, 0.025) (P < 0.001)]. Of patients with ileo-colonic disease, 57.8% had an abnormal IP, compared to 26.7% with colonic and 15.6% with small intestinal disease. Patients with a stricturing disease had significantly higher LMR compared to non-fistulising non-stricturing disease [0.043 (95% CI 0.032, 0.058) vs 0.024 (95% CI 0.019, 0.029) (P = 0.0062)]. There was no correlation of IP with age, disease activity, duration of illness, D-xylose absorption, upper GI involvement, perianal disease, and extra- intestinal manifestations. On multiple regression analysis, male gender and ileo-colonic disease were independent factors associated with increased IP. Gender, location, behavior of the disease and upper GI involvement could explain up to 23% of variability in IP (R2 = 0.23). CONCLUSION: IP was increased in 36% of patients with CD. Male gender and an ileo-colonic disease were the independent factors associated with increased IP.

Faecal calprotectin and magnetic resonance imaging in detecting Crohn's disease endoscopic postoperative recurrence

AIM To assess magnetic resonance imaging(MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers, all patients with CD who underwent ileocolonic resection were consecutively and prospectively included. All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity [median = 6 mo(5.0-9.3)]. The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level. Endoscopic postoperative recurrence(POR) was defined as Rutgeerts' index ≥ i2b. The MRI was analyzed independently by two radiologists blinded from clinical data.RESULTS Apparent diffusion coefficient(ADC) was lower in patients with endoscopic POR compared to those with no recurrence(2.03 ± 0.32 vs 2.27 ± 0.38 × 10^(-3) mm^2/s, P = 0.032). Clermont score(10.4 ± 5.8 vs 7.4 ± 4.5, P = 0.038) and relative contrast enhancement(RCE)(129.4% ± 62.8% vs 76.4% ± 32.6%, P = 0.007) were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity(Ma RIA)(7.3 ± 4.5 vs 4.8 ± 3.7; P = 0.15) and MR scoring system(P = 0.056). ADC < 2.35 × 10^(-3) mm^2/s [sensitivity = 0.85, specificity = 0.65, positive predictive value(PPV) = 0.85, negative predictive value(NPV) = 0.65] and RCE > 100%(sensitivity = 0.75, specificity = 0.81, PPV = 0.75, NPV = 0.81) were the best cutoff values to identify endoscopic POR. Clermont score > 6.4(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74), Ma RIA > 3.76(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74) and a MR scoring system ≥ MR1(sensitivity = 0.54, specificity = 0.82, PPV = 0.70, and NPV = 0.70) demonstrated interesting performances to detect endoscopic POR. Faecal calprotectin values were significantly higher in patients with endoscopic POR(114 ± 54.5 μg/g vs 354.8 ± 432.5 μg/g; P = 0.0075). Faecal calprotectin > 100 μg/g demonstrated high performances to detect endoscopic POR(sensitivity = 0.67, specificity = 0.93, PPV = 0.89 and NPV = 0.77).CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.

Combined evaluation of biomarkers as predictor of maintained remission in Crohn's disease

BACKGROUND The individual performances and the complementarity of Crohn's disease(CD)activity index(CDAI), C-reactive protein(CRP) and faecal calprotectin(Fcal) to monitor patients with CD remain poorly inves-tigated in the era of "tight control"and "treat to target" strategies.AIM To assess CDAI, CRP and Fcal variation, alone or combined, after 12 wk(W12) of anti-tumor necrosis factor(TNF) therapy to predict corticosteroids-free remission(CFREM = CDAI < 150, CRP < 2.9 mg/L and Fcal < 250 μg/g with no therapeutic intensification and no surgery) at W52.METHODS CD adult patients needing anti-TNF therapy with CDAI > 150 and either CRP >2.9 mg/L or Fcal > 250 μg/g were prospectively enrolled.RESULTS Among the 40 included patients, 13 patients(32.5%) achieved CFREM at W52. In univariable analysis, CDAI < 150 at W12(P = 0.012), CRP level < 2.9 mg/L at W12(P = 0.001) and Fcal improvement at W12(Fcal < 300 μg/g; or, for patients with initial Fcal < 300 μg/g, at least 50% decrease of Fcal or normalization of Fcal(< 100 μg/g)(P = 0.001) were predictive of CFREM at W52. Combined endpoint(CDAI < 150 and CRP ≤ 2.9 mg/L and FCal improvement) at W12 was the best predictor of CFREM at W52 with positive predictive value = 100.0%(100.0-100.0)and negative predictive value = 87.1%(75.3-98.9). In multivariable analysis, Fcal improvement at W12 [odd ratio(OR) = 45.1(2.96-687.9); P = 0.03] was a better predictor of CFREM at W52 than CDAI < 150 [OR = 9.3(0.36-237.1); P = 0.145]and CRP < 2.9 mg/L(0.77-278.0; P = 0.073).CONCLUSION The combined monitoring of CDAI, CRP and Fcal after anti-TNF induction therapy is able to predict favorable outcome within one year in patients with CD.

Altered pattern of tumor necrosis factor-alpha production in peripheral blood monocytes from Crohn's disease

AIM To evaluate the inflammatory state in Crohn's disease(CD) patients and correlate it with genetic background and microbial spreading.METHODS By means of flow cytometry, production of tumor necrosis factor-alpha(TNF-α) was measured in peripheral blood monocytes from patients suffering from CD, ulcerative colitis(UC) and in healthy subjects after stimulation of the NOD2 and TLR pathways. CD patients were genotyped for the three most common NOD2 variants(R702W, G908 R and L1007Pfs*2) and basal production of TNF-α was correlated to NOD2 genotype. Also, production of TNF-α was correlated to plasmatic levels of LPS Binding Protein(LBP), soluble(s) CD14 and to the activity state of the disease.RESULTS The patients with CD were characterized by a significantly higher monocyte basal expression of TNF-αcompared with healthy subjects and UC patients, and after stimulation with Pam3CSK4(ligand of TLR2/1) and MDP-L18(ligand of NOD2) this difference was maintained, while other microbial stimuli(LPS, ligand of TLR4 and Poly I:C, ligand of TLR3) induced massive activation in CD monocytes as well as in UC and in healthy control cells. There was no significant difference in the production of TNF- α between patients who carried CD-associated heterozygous or homozygous variants in NOD2 and patients with wild type NOD2 genotype. Although serum LBP levels have been shown to correlate positively with the state of activity of the disease, TNF-α production did not show a clear correlation with either LBP or s CD14 levels in plasma. Moreover, no clear correlation was seen between TNF-α production and activity indices in either CD or UC.CONCLUSION Peripheral monocytes from CD express higher basal and stimulated TNF-α than controls, regardless of NOD2 genotype and without a clear correlation with disease activity.

克罗恩病患者血清CCL11及I-FABP的表达水平与疾病活动指数的相关性研究

目的探究克罗恩病(CD)患者血清嗜酸性粒细胞趋化因子(CCL11)及肠脂肪酸结合蛋白(I-FABP)水平表达与疾病活动指数的相关性。方法选取2021年2月至2023年2月于上海市杨浦区中心医院就诊的98例CD患者进行研究(CD组),根据疾病活动指数(CDAI)评分将患者分为缓解期21例、轻度活动期31例、中度活动期28例和重度活动期18例,另选取同期健康者100例作为对照组,采用酶联免疫吸附法检测血清CCL11、I-FABP水平,采用Spearman法分析血清CCL11、I-FABP水平与CDAI评分的相关性,采用受试者工作特征曲线(ROC)分析血清CCL11、I-FABP水平对CD患者疾病活动度的评估价值。结果CD组患者的血清CCL11、I-FABP水平分别为(51.33±7.14)pg/mL、(64.85±11.56)ng/mL,明显高于对照组的(28.56±6.61)pg/mL、(31.38±10.35)ng/mL,差异均有统计学意义(P<0.05);缓解期、轻度、中度、重度活动期CD患者血清CCL11水平分别为(31.47±7.02)pg/mL、(45.52±7.08)pg/mL、(57.83±7.12)pg/mL、(74.41±7.43)pg/mL,I-FABP水平分别为(48.13±10.79)ng/mL、(59.97±11.32)ng/mL、(70.76±11.75)ng/mL、(83.58±12.58)ng/mL,缓解期、轻度活动期、中度活动期、重度活动期CD患者血清CCL11、I-FABP水平依次升高,差异均有统计学意义(P<0.05)。Spearman相关性分析结果显示,血清CCL11、I-FABP水平均与CDAI评分呈正相关(r=0.834、0.620,P<0.01);ROC分析结果显示,血清CCL11、I-FABP水平评估CD患者疾病活动度的AUC分别为0.882、0.889,敏感性为81.82%、80.52%,特异性为85.71%、85.71%。两者联合评估疾病活动度的AUC为0.938,显著高于单项检测(P<0.05),联合检测的敏感性和特异性为93.51%、85.71%。结论CD患者血清CCL11、I-FABP水平升高,与疾病活动指数密切相关,且两者联合评估CD患者疾病活动度具有较高效能。

Role of capsule endoscopy in inflammatory bowel disease:Anything new?

Capsule endoscopy(CE)is a recently developed diagnostic method for diseases of the small bowel that is non-invasive,safe,and highly tolerable.Its role in patients with inflammatory bowel disease has been widely validated in suspected and established Crohn’s disease(CD)due to its ability to assess superficial lesions not detected by cross-sectional imaging and proximal lesions of the small bowel not evaluable by ileocolonoscopy.Because CE is a highly sensitive but less specific technique,differential diagnoses that can simulate CD must be considered,and its interpretation should be supported by other clinical and laboratory indicators.The use of validated scoring systems to characterize and estimate lesion severity(Lewis score,Capsule Endoscopy Crohn’s Disease Activity Index),as well as the standardization of the language used to define the lesions(Delphi Consensus),have reduced the interobserver variability in CE reading observed in clinical practice,allowing for the optimization of diagnoses and clinical management strategies.The appearance of the panenteric CE,the incorporation of artificial intelligence,magnetically-guided capsules,and tissue biopsies are elements that contribute to CE being a promising,unique diagnostic tool in digestive tract diseases.

补中益气汤联合英夫利西单抗治疗活动性克罗恩病临床研究

目的:观察补中益气汤联合英夫利西单抗治疗活动性克罗恩病的临床疗效,以及对患者免疫功能的影响。方法:按随机数字表法将86例活动性克罗恩病患者分为对照组和观察组,每组43例。对照组予以英夫利西单抗治疗,观察组在对照组基础上予以补中益气汤治疗。对比2组临床疗效、黏膜愈合率、复发率及不良反应发生率,观察2组治疗前后克罗恩病活动指数(CDAI)、克罗恩病内镜下严重指数(CDEIS)、免疫功能指标的变化。结果:观察组总有效率95.35%,高于对照组79.07%(P<0.05)。观察组黏膜愈合率88.37%,高于对照组69.77%(P<0.05)。观察组复发率5.56%,低于对照组35.71%(P<0.05)。治疗后,2组CDAI、CDEIS评分均较治疗前降低(P<0.05),观察组CDAI、CDEIS评分均低于对照组(P<0.05)。治疗后,2组血清CD3^(+)、CD4^(+)水平均较治疗前降低(P<0.05),血清CD4^(+)/CD25^(+)调节性T细胞(Treg)水平均较治疗前升高(P<0.05);观察组血清CD3^(+)、CD4^(+)水平均低于对照组(P<0.05),血清CD4^(+)/CD25^(+)Treg水平高于对照组(P<0.05)。观察组不良反应发生率9.30%,与对照组4.65%比较,差异无统计学意义(P>0.05)。结论:补中益气汤联合英夫利西单抗治疗活动性克罗恩病,可增强疗效、减少复发,并能改善患者的免疫功能,安全性高。

MRI在克罗恩病肛瘘活动性评价与随诊中的研究进展

克罗恩病(Crohn’s disease, CD)是一种病因不明的慢性非特异性炎症性肠病。CD肛瘘(perianal fistulizing CD,pfCD)作为CD最常见的并发症,常发生在成人和儿童CD中。随着医学技术的不断发展,多种辅助检查方法应运而生,如内镜、瘘管造影、麻醉下探查、腔内超声、MRI等皆可辅助诊断。其中MRI具有无创、快速、准确等特点,已经成为pfCD影像学诊断的金标准。本文就盆腔MRI在pfCD的诊断价值、鉴别诊断与疗效评估进行综述。同时考虑到pfCD的复杂性,本文还探讨了CD的MRI炎症活动评分、影像学指标和基于MRI的新技术,以期为pfCD患者诊治策略的进一步优化提供理论依据。

影像组学及MaRIA对克罗恩病小肠黏膜愈合的诊断效能

目的探讨影像组学在临床缓解的克罗恩病(Crohn's disease,CD)患者小肠黏膜愈合的诊断效能,并与磁共振活度指数(magnetic resonance index of activity,MaRIA)的诊断效能进行比较。方法收集2019年1月至2020年1月80例临床缓解的CD患者临床资料。临床缓解依据克罗恩活动度指数(Crohn's disease activity index,CDAI),CDAI<150分为缓解期。CD患者在入组时均行常规血液检测、结肠镜和小肠磁共振检查,并留取粪便测定FC浓度。内镜评分为克罗恩内镜活动度(Crohn's disease index of severity,CDEIS)。MaRIA根据MRI图像计算所得。通过K-近邻算法(K-Nearest Neighbor,KNN)建立KNN模型。分析两者特异度及敏感度,绘制受试者操作特征曲线(ROC),计算曲线下面积(AUC)。结果临床缓解的CD患者中MaRIA诊断小肠黏膜愈合的敏感度为0.802,特异度为0.775,AUC为0.804(P<0.05)。根据训练组建立影像组学KNN模型,其诊断小肠黏膜愈合的敏感度为0.865,特异度为0.6,AUC为0.801(P<0.05)。将KNN模型进行验证,验证组中KNN模型诊断敏感度0.727,特异度0.733,AUC为0.719(P<0.05)。结论影像组学模型和MaRIA均可较好诊断临床缓解的克罗恩病患者小肠黏膜愈合情况。

克罗恩病患者血清总25羟维生素D及细胞因子水平表达与疾病活动指数的相关性研究

目的探讨克罗恩病患者血清总25羟基维生素D、细胞因子白介素6(IL-6)、白介素8(IL-8)和肿瘤坏死因子α(TNF-α)在克罗恩病不同时期的表达水平以及其与疾病活动指数(CDAI)的相关性。方法选取2018年1月~2020年12月在北京大学深圳医院就诊的克罗恩病患者共100例纳入研究。收集患者的空腹静脉血,检测总25羟基维生素D,IL-6,IL-8和TNF-α水平;采用CDAI评估患者疾病活动情况,并根据CDAI评分将患者分为四组,缓解期21例,轻度活动期32例,中度活动期29例和重度活动期18例。比较CDAI评分不同分期患者的血清总25-羟基维生素D,IL-6,IL-8和TNF-α的表达水平。并进一步分析比较患者CDAI与血清总25-羟基维生素D水平及细胞因子IL-6,IL-8及TNF-α表达水平之间的相关性。结果四组患者血清总25-羟基维生素D及细胞因子IL-6,IL-8和TNF-α的差异均存在统计学意义(F=34.281~128.53,均P<0.05)。缓解期患者血清总25-羟基维生素D(23.49±3.46μg/L),IL-8(86.39±11.23ng/L)和TNF-α(24.05±2.12ng/L)水平高于其他三组(轻度活动期分别为19.47±2.83μg/L,70.48±9.48ng/L,20.59±3.22ng/L;中度活动期14.30±2.64μg/L,65.38±10.91ng/L,17.48±4.12ng/L;重度活动期11.39±3.93μg/L,46.58±12.32ng/L,13.44±3.98ng/L),但IL-6水平(4.37±0.78ng/L)明显低于其他三组(轻度活动期6.48±1.12 ng/L,中度活动期65.38±10.91 ng/L,重度活动期46.58±12.32 ng/L),差异均具有统计学意义(均P<0.05)。采用Spearman相关性分析发现克罗恩病患者CDAI与血清总25-羟基维生素D水平呈负相关(r=-0.691,P<0.05),与细胞因子IL-6水平呈正相关(r=0.889,P<0.05),与IL-8和TNF-α均呈负相关(r=-0.675,-0.658,均P<0.05)。结论不同疾病活动期的克罗恩病患者总25-羟基维生素D和细胞因子水平存在明显差异,患者血清IL-6水平与疾病活动性呈正相关,而总25-羟基维生素D,IL-8和TNF-α水平与疾病活动性呈负相关。

CESI、简化CDAI和CRP在评估小肠克罗恩病病变范围和活动程度中的应用价值

背景:小肠克罗恩病(CD)是一种慢性、反复发作性疾病。目前胶囊内镜评分指数(CESI)、简化CDAI和CRP在评估小肠CD病变范围和活动程度中的应用价值的研究甚少。目的:探讨CESI、简化CDAI和CRP在评估小肠CD病变范围和活动程度中的应用价值。方法:纳入行胶囊内镜检查并最终确诊为小肠CD的患者58例。分析简化CDAI和CRP与小肠病变范围的关系;评估小肠CD患者临床特征与CESI的相关性;计算简化CDAI和CRP判断胶囊内镜下炎症活动期的敏感性、特异性、阳性预测值、阴性预测值和准确性。对治疗后11例小肠CD患者行胶囊内镜复查,分析CESI改变与简化CDAI和CRP改变的相关性。结果:不同小肠病变范围的简化CDAI和CRP相比差异无统计学意义(P>0.05);小肠CD患者临床特征与CESI无关;简化CDAI和CRP判断胶囊内镜下炎症活动期的敏感性、特异性、阳性预测值、阴性预测值和准确性均较低。治疗后,CESI改变与简化CDAI和CRP改变无相关性(P>0.05)。结论:简化CDAI和CRP并不能反映胶囊内镜下小肠CD患者病变范围和活动程度;小肠CD的胶囊内镜下黏膜修复情况与临床症状和生化指标的改善不一致,胶囊内镜下病变好转迟滞于简化CDAI和CRP的改善。

多普勒超声评价克罗恩病活动性的价值

目的探讨多普勒超声观察肠系膜上动脉及病变段肠壁内动脉在评估克罗恩病(CD)活动性中的价值。方法根据Harvey-Bradshaw指数(HBI)将33例CD患者分为活动组(n=16)和静止组(n=17),采用彩色脉冲多普勒超声定量测量肠系膜上动脉血流,能量多普勒超声对病变段肠壁内血流进行半定量Limberg评分,评价疾病活动性,比较两组间多普勒超声参数,并将其与相应C反应蛋白(CRP)及HBI进行相关分析。结果肠系膜上动脉舒张末期流速、阻力指数在活动组与静止组之间的差异有统计学意义(P均<0.05)。两组间病变段肠壁内血流Limberg评分差异有统计学意义(P<0.001)。舒张末期流速与CRP呈正相关(r=0.602,P<0.001),与HBI无显著相关性;阻力指数与CRP(r=-0.676,P<0.001)、HBI(r=-0.415,P=0.020)呈负相关;肠壁血流Limberg分级与CRP(r=0.587,P<0.001)、HBI(r=0.498,P=0.003)相关性较好。结论多普勒超声可作为评价CD活动性的可靠工具,指导临床采取合适的治疗措施,对病变随访和疗效监测也具有重要意义。

克罗恩病患者疾病活动指数应对方式与抑郁的相关性研究

目的调查分析克罗恩病患者的疾病活动指数、应对方式与抑郁的相关性,为制订针对性的干预措施提供依据。方法以Harvey简化CDAI计算法、抑郁自评量表(SDS)、应对方式量表(MCMQ)对100例克罗恩病患者进行调查。结果 62%的克罗恩病患者存在抑郁;克罗恩病患者疾病活动指数与抑郁呈正相关(r=0.556,P<0.01);面对与抑郁呈负相关(r=-0.578,P<0.01);回避与抑郁呈正相关(r=0.165,P<0.05);屈服与抑郁呈正相关(r=0.215,P<0.01)。结论克罗恩病患者多存在抑郁,与疾病程度和应对方式有一定相关性,护理人员应根据患者特点进行心理护理,减少患者抑郁。

MDCTE评分评价克罗恩病活度的临床应用

收集临床确诊并行CT小肠检查的活动期克罗恩病患者50例。回顾性分析患者的CT表现,将患者的CT所见赋予一定的分值并进行综合评分,根据活动度指数将患者分为轻度活动期、中度活动期和明显活动期,比较CT评分与患者的活动度指数之间的相关性,结果显示CT评分与患者活动度明显相关(r=0.825,P<0.001)。表明多排CT小肠成像评分可以用于临床评估克罗恩病患者的活动度。。

参苓白术散合附子理中丸联合西药治疗克罗恩病临床研究

目的:观察参苓白术散合附子理中丸加减联合西药治疗脾胃虚寒型克罗恩病(CD)的临床疗效。方法:将80例患者随机分为对照组和观察组各40例。2组中的轻度患者均服用美沙拉嗪肠溶片,中度患者加服泼尼松龙片,观察组同时予参苓白术散合附子理中丸加减治疗。2组均连续治疗12周。治疗前后和随访期(3个月)评定克罗恩病严重程度(CDAI)评分、中医症状评分和炎症性肠病生活质量问卷(IBDQ)评分,检测红细胞沉降率(ESR)和C-反应蛋白(CRP)水平,比较2组的临床疗效。结果:观察组临床缓解率为90.0%,高于对照组的70.0%(P<0.05);观察组有效率为97.5%,高于对照组的80.0%(P<0.05)。在3个月的随访期间,观察组复发率为12.5%,低于对照组的35.0%(P<0.05)。2组CDAI评分和中医症状积分均较治疗前下降(P<0.01),观察组2项分值均低于对照组(P<0.01)。2组IBDQ肠道症状、全身症状、情感功能、社会功能评分和IBDQ总分均较治疗前升高(P<0.01),观察组各个维度评分和IBDQ总分均高于对照组(P<0.01)。结论:参苓白术散合附子理中丸联合西药治疗脾胃虚寒型CD患者,能有效缓解临床症状,减轻炎症反应,促使病程进入缓解期,提高了治疗效果,改善了患者的生活质量,降低了疾病的近期复发率。

粒细胞和单核细胞吸附分离治疗中-重度炎症性肠病的有效性及安全性分析

目的:探讨粒细胞和单核细胞吸附分离治疗(granulocyte and monocyte apheresis,GMA)对中-重度炎症性肠病(inflammatory bowel disease,IBD)患者的有效性和安全性。方法:分析2013年5月至2021年9月于我院接受GMA治疗的38例中-重度IBD患者的临床资料,其中溃疡性结肠炎(ulcerative colitis,UC)28例、克罗恩病(Crohn disease,CD)10例。比较治疗前及治疗结束后第2周时患者疾病临床活动度评分[梅奥评分(Mayo score)、CD活动指数(CD activity index, CDAI)]、内镜下活动度评分[UC内镜下严重指数(UC endoscopic index of severity,UCEIS)、梅奥内镜评分(Mayo endoscopic score, MES)、Baron评分、CD内镜下严重指数(CD endoscopic index of severity,CDEIS)]、实验室指标变化及不良反应情况。结果:38例IBD患者总体临床有效率为79%,临床缓解率为42%。28例UC患者中23例(82%)GMA治疗后有效,10例(36%)达到临床缓解;10例CD患者中7例(70%)GMA治疗后有效,6例(60%)达到临床缓解。UC患者中,GMA显著降低梅奥、UCEIS、MES、Baron评分;CD患者中,GMA显著降低CDAI评分、CDEIS评分(均P<0.05)。所有IBD患者中,GMA显著升高血红蛋白、白蛋白水平,降低C反应蛋白(C-reactive protein,CRP)水平及减少大便次数(P<0.05);治疗前后的白细胞、中性粒细胞比例、淋巴细胞比例、单核细胞比例、血小板、红细胞沉降率(erythrocyte sedimentation rate,ESR)水平差异无统计学意义。未观察到GMA相关的严重不良事件。结论:GMA对中-重度IBD患者有效、安全性高,但考虑到病例数较少,仍需进行进一步更大样本及长期随访的随机对照研究。

CT肠道成像定量评分系统在回结肠克罗恩病活动性评估中的应用价值

目的:探讨CT肠道成像(CTE)在回结肠克罗恩病(CD)活动性评估中的应用价值。方法:搜集我院经内镜、病理及临床随访确诊的CD患者共110例。110例患者均行常规结肠镜及CTE标准化检查,两种检查时间间隔小于1周。CTE检查主要评价病变部位、肠壁厚度、肠黏膜ΔCT值(门静脉期黏膜CT值-增强前黏膜CT值)、病变肠段周围最大淋巴结短径,有无肠壁分层强化、肠腔狭窄、肠系膜血管增粗(梳征)及肠系膜纤维脂肪增生。结肠镜检查根据克罗恩病简化内镜活动性评分(SESCD)将CD患者分为非活动组、轻微活动组和中重度活动组。结果:110例CD患者共评估298个病变肠段,其中非活动组80个,轻微活动组142个,中重度活动组76个。单因素分析结果表明,各组间的肠壁厚度、ΔCT值、淋巴结短径、肠壁分层强化及肠腔狭窄的差异均有统计学意义(P值均<0.05);而各组间的肠系膜血管增粗、肠系膜纤维脂肪增生的差异均无统计学意义(P>0.05)。相关性分析结果显示,肠壁厚度、ΔCT值、肠壁分层强化与SES-CD均呈中度相关,r值分别为0.535、0.787、0.676(P值均<0.01);肠腔狭窄与SES-CD呈轻度相关,r值为0.480(P<0.01)。通过多分类有序logistic回归模型初步计算出一个CTE定量评分系统:简化CTE评分=0.2×肠壁厚度+0.3×ΔCT值+1.5×肠壁分层强化+2×肠腔狭窄。通过对之后新收集的30例(88个肠段)CD患者的验证分析表明,该评分系统与SES-CD高度相关(r=0.866,P<0.01)。ROC曲线分析结果表明,当CTE评分为13.3时,其在区分CD活动组与非活动组中的灵敏度和特异度分别为80.3%、95.5%,曲线下面积(AUC)=0.906;当CTE评分=16.5时,其在区分CD轻微活动组与中重度活动组中的灵敏度和特异度分别为96.3%、90.2%,AUC=0.961。结论:CTE定量评分系统可用于CD病变活动性及严重程度的评估。