CAJ | 학술논문

目的：分析克罗恩病患者超声声像图特征，探讨超声检查评估克罗恩病活动性的价值。方法2011年8月至2012年8月上海第十人民医院收治的克罗恩病患者25例。其中克罗恩病活动指数（ CDAI）评分＜150分（缓解期）12例，150～450分（活动期）13例。每例患者均行内镜（结肠镜或小肠镜）检查、腹部超声检查。非炎性病变（缓解期）和炎症（活动期）肠段肠壁厚度比较采用两独立样本t检验。以内镜检查结果作为金标准，能量多普勒超声判断克罗恩病活动性与CDAI评分判断克罗恩病活动性的符合率比较采用χ2检验。结果25例克罗恩病患者经内镜检查判断活动期20例，缓解期5例。所有患者均能获得满意的超声图像。本组超声诊断克罗恩病22例，诊断准确率为88％（22/25）。超声检测非炎性病变（缓解期）肠段肠壁厚度为（2.06±0.62） mm，低于炎症（活动期）肠段肠壁厚度（7.90±2.90） mm，且差异有统计学意义（t＝2.53，P＜0.05）。本组25例克罗恩病患者能量多普勒超声判断缓解期7例，活动期18例。能量多普勒超声判断克罗恩病活动性的符合率为92％（23/25）；而根据CDAI评分判断克罗恩病活动性的符合率仅为64％（16/25），低于能量多普勒超声判断克罗恩病活动性的符合率，且差异有统计学意义（χ2＝9.39，P＜0.05）。超声检查发现腹腔脓肿1例，腹腔淋巴结肿大7例，腹腔积液2例。结论超声检查对肠壁厚度、结构层次、回声及肠外并发症的观察具有一定的优势，能准确评估克罗恩病活动性，对克罗恩病的诊治具有指导意义。
목적：분석극라은병환자초성성상도특정，탐토초성검사평고극라은병활동성적개치。방법2011년8월지2012년8월상해제십인민의원수치적극라은병환자25례。기중극라은병활동지수（ CDAI）평분＜150분（완해기）12례，150～450분（활동기）13례。매례환자균행내경（결장경혹소장경）검사、복부초성검사。비염성병변（완해기）화염증（활동기）장단장벽후도비교채용량독립양본t검험。이내경검사결과작위금표준，능량다보륵초성판단극라은병활동성여CDAI평분판단극라은병활동성적부합솔비교채용χ2검험。결과25례극라은병환자경내경검사판단활동기20례，완해기5례。소유환자균능획득만의적초성도상。본조초성진단극라은병22례，진단준학솔위88％（22/25）。초성검측비염성병변（완해기）장단장벽후도위（2.06±0.62） mm，저우염증（활동기）장단장벽후도（7.90±2.90） mm，차차이유통계학의의（t＝2.53，P＜0.05）。본조25례극라은병환자능량다보륵초성판단완해기7례，활동기18례。능량다보륵초성판단극라은병활동성적부합솔위92％（23/25）；이근거CDAI평분판단극라은병활동성적부합솔부위64％（16/25），저우능량다보륵초성판단극라은병활동성적부합솔，차차이유통계학의의（χ2＝9.39，P＜0.05）。초성검사발현복강농종1례，복강림파결종대7례，복강적액2례。결론초성검사대장벽후도、결구층차、회성급장외병발증적관찰구유일정적우세，능준학평고극라은병활동성，대극라은병적진치구유지도의의。
Objective To analyze the ultrasonographic features of Crohn ′s disease and to evaluate its role in the assessment of Crohn′s disease activity .Methods Twenty-five Crohn′s disease patients who treated from August 2011 to August 2012 in Shanghai Tenth People′s Hospital were enrolled in the study . Twelve cases were with Crohn′s disease activity index(CDAI)score<150 scores(catabasis stage) and other 13 cases with CDAI score from 150 to 450 scores ( active stage ) .Each patient underwent endoscopy ( colonoscopy or enteroscopy ) and abdominal ultrasound .Bowel wall thickness ( BWT ) of non-inflammatory segments(catabasis stage)and inflamed segments(active stage)were compared with two independent t test. Using colonoscopy/enteroscopy as the gold reference standard , the consistent rates of power Doppler ultrasound and CDAI score for the assessment of Crohn′s disease activity were evaluated withχ2 test. Results Among 25 Crohn′s disease patients,20 cases were in endoscopic active stage ,other 5 cases in endoscopic remission .Satisfactory ultrasound images were obtained in all patients .Twentyt-wo cases were diagnosed as Crohn′s disease with ultrasonography and the diagnostic accuracy was 88%(22/25).BWT in the inflammatory lesions was ( 7.90 ±2.90 ) mm, which was significantly greater than that in non-inflammatory segments (2.06 ±0.62) mm(t=2.53,P<0.05).Power Doppler ultrasound showed that 18 cases were in active stage and 7 in remission phase,the consistent rate was 92% (23/25),which was significantly higher than that of CDAI score (64%,16/25)(χ2 =9.39,P<0.05).The extra-intestinal manifestations detected with ultrasound included abdominal abscess in 1 case,enlarged celiac lymph nodes in 7 cases and seroperitoneum in 2 cases.Conclusions Abdominal ultrasound has certain advantages to evaluate the BWT , structure and ultrasonic echo of bowel wall and perienteric complications .Ultrasound can evaluate the activity of Crohn′s disease and has guiding significance for the diagnosis and treatment of Crohn ′s disease .