CAJ | 학술논문

目的探讨对比增强超声定量检测对克罗恩病患者内镜下疾病活动度的评估价值.方法前瞻性入组2009年1月至2010年12月间在浙江省丽水市人民医院就诊或随访的59例克罗恩病患者,分别进行结肠镜检查和对比增强超声检查.采用克罗恩病简单内镜下评分将疾病分为非活动性病变和活动性病变.定量分析对比增强超声检查中的对比剂摄入情况,用以评估结直肠环(回肠末段至直肠)中病变肠段的血流状况,结果以感兴趣区(ROI)灰度值上升百分比表示.采用受试者工作特征曲线来评估DOI灰度值上升百分比对内镜下疾病活动度的判断价值.结果内镜评估结果显示,59例克罗恩病患者活动性病变45例,非活动性病变14例,其ROI灰度值上升百分比分别(90±32)％和(41±29)％,差异有统计学意义(P＜0.01).取最佳截点45％,ROI灰度值上升百分比预测内镜下疾病活动度的敏感度、特异度和准确度分别为95.6％、78.6％和91.5％,Youden指数为0.74,曲线下面积为0.846.结论对比增强超声的定量检测能够有效地将肠镜下不同活动度的克罗恩病区别开来,可作为评估克罗恩病患者疾病活动度的理想方法.
목적 탐토대비증강초성정량검측대극라은병환자내경하질병활동도적평고개치.방법 전첨성입조2009년1월지2010년12월간재절강성려수시인민의원취진혹수방적59례극라은병환자,분별진행결장경검사화대비증강초성검사.채용극라은병간단내경하평분장질병분위비활동성병변화활동성병변.정량분석대비증강초성검사중적대비제섭입정황,용이평고결직장배(회장말단지직장)중병변장단적혈류상황,결과 이감흥취구(ROI)회도치상승백분비표시.채용수시자공작특정곡선래평고DOI회도치상승백분비대내경하질병활동도적판단개치.결과내경평고결과현시,59례극라은병환자활동성병변45례,비활동성병변14례,기ROI회도치상승백분비분별(90±32)％화(41±29)％,차이유통계학의의(P＜0.01).취최가절점45％,ROI회도치상승백분비예측내경하질병활동도적민감도、특이도화준학도분별위95.6％、78.6％화91.5％,Youden지수위0.74,곡선하면적위0.846.결론 대비증강초성적정량검측능구유효지장장경하불동활동도적극라은병구별개래,가작위평고극라은병환자질병활동도적이상방법.
Objective To evaluate the predictive value of quantitative examination via contrastenhanced ultrasonography on the activity of Crohn disease at endoscopy.Methods A total of 59 cases with Crohn disease in People's Hospital of Lishui City between January 2009 and December 2010 were collected prospectively and underwent both colonoscopy and contrast-enhanced ultrasonography.According to the Simple Endoscopic Score,Crohn disease was divided into inactive and active disease by colonoscopy.To assess the vascularization of the involved bowel loop in a region expected to be seen at colonoscopy,the contrast agent uptake was measured by using quantitative analysis.Measurement of contrast enhancement was assessed as the percentage of increase in wall brightness in regions of interest (ROI).The receiver operating characteristic curve was used to evaluate the value of contrast agent uptake in predicting the severity determined at endoscopy.Results Colonoscopy showed active lesions in 45 cases and inactive lesions in 14 cases,in whom the percentages of increase of brightness were (90±32)％ and (41±29)％ respectively.At a threshold value of 45％ for the percentage of increase of brightness,sensitivity,specificity and accuracy of predicting the severity at endoscopy were 95.6％,78.6％ and 91.5％,the Youden index was 0.74,and area under curve was 0.846.Conclusions Quantitative measurement of bowel enhancement by using contrast-enhanced ultrasonography can discriminate between active and inactive Crohn disease at endoscopy.Contrast-enhanced ultrasonography may be a useful technique to monitor the activity of Crohn disease.