中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2012年
12期
1240-1243
,共4页
克罗恩病%克罗恩病活动指数%症状复发%内镜复发
剋囉恩病%剋囉恩病活動指數%癥狀複髮%內鏡複髮
극라은병%극라은병활동지수%증상복발%내경복발
Crohn disease%Crohn disease activity indices%Symptomatic recurrence%Endoscopic recurrence
目的 探讨克罗恩病活动指数(CDAI)对克罗恩病患者肠切除术后症状复发的诊断价值.方法 将2003年3月至2010年3月间在浙江省丽水市人民医院施行初次肠切除手术的85例克罗恩病患者纳入研究.术后12个月,所有患者均接受肠镜检查并进行CDAI评分.将Rutgeerts内镜评分大于或等于i2定义为内镜复发；内镜复发的同时,出现需药物控制的症状,视为症状复发.采用受试者工作特征(ROC)曲线来评价单独应用CDAI及CDAI联合内镜评估对术后症状复发的诊断价值.结果 术后12个月,85例患者中有19例出现症状复发,其CDAI值为205 ±93,明显高于持续缓解的患者(97±44,P＜0.01).ROC曲线显示,CDAI判断术后症状复发的曲线下面积为0.786;取CDAI最佳截点(150),其敏感度、特异度和准确率分别为73.7％、81.8％和80.0％.当CDAI联合内镜评估,其判断术后症状复发的特异度和准确率分别提高至95.5％和90.6％.一致性检验显示,CDAI联合内镜评估的诊断价值(Kappa=0.718)明显高于单独采用CDAI (Kapp a=0.462).结论 CDAI能较好地判断克罗恩病术后症状复发情况；将CDAI与内镜评估相结合能进一步提高诊断的准确性.
目的 探討剋囉恩病活動指數(CDAI)對剋囉恩病患者腸切除術後癥狀複髮的診斷價值.方法 將2003年3月至2010年3月間在浙江省麗水市人民醫院施行初次腸切除手術的85例剋囉恩病患者納入研究.術後12箇月,所有患者均接受腸鏡檢查併進行CDAI評分.將Rutgeerts內鏡評分大于或等于i2定義為內鏡複髮；內鏡複髮的同時,齣現需藥物控製的癥狀,視為癥狀複髮.採用受試者工作特徵(ROC)麯線來評價單獨應用CDAI及CDAI聯閤內鏡評估對術後癥狀複髮的診斷價值.結果 術後12箇月,85例患者中有19例齣現癥狀複髮,其CDAI值為205 ±93,明顯高于持續緩解的患者(97±44,P＜0.01).ROC麯線顯示,CDAI判斷術後癥狀複髮的麯線下麵積為0.786;取CDAI最佳截點(150),其敏感度、特異度和準確率分彆為73.7％、81.8％和80.0％.噹CDAI聯閤內鏡評估,其判斷術後癥狀複髮的特異度和準確率分彆提高至95.5％和90.6％.一緻性檢驗顯示,CDAI聯閤內鏡評估的診斷價值(Kappa=0.718)明顯高于單獨採用CDAI (Kapp a=0.462).結論 CDAI能較好地判斷剋囉恩病術後癥狀複髮情況；將CDAI與內鏡評估相結閤能進一步提高診斷的準確性.
목적 탐토극라은병활동지수(CDAI)대극라은병환자장절제술후증상복발적진단개치.방법 장2003년3월지2010년3월간재절강성려수시인민의원시행초차장절제수술적85례극라은병환자납입연구.술후12개월,소유환자균접수장경검사병진행CDAI평분.장Rutgeerts내경평분대우혹등우i2정의위내경복발；내경복발적동시,출현수약물공제적증상,시위증상복발.채용수시자공작특정(ROC)곡선래평개단독응용CDAI급CDAI연합내경평고대술후증상복발적진단개치.결과 술후12개월,85례환자중유19례출현증상복발,기CDAI치위205 ±93,명현고우지속완해적환자(97±44,P＜0.01).ROC곡선현시,CDAI판단술후증상복발적곡선하면적위0.786;취CDAI최가절점(150),기민감도、특이도화준학솔분별위73.7％、81.8％화80.0％.당CDAI연합내경평고,기판단술후증상복발적특이도화준학솔분별제고지95.5％화90.6％.일치성검험현시,CDAI연합내경평고적진단개치(Kappa=0.718)명현고우단독채용CDAI (Kapp a=0.462).결론 CDAI능교호지판단극라은병술후증상복발정황；장CDAI여내경평고상결합능진일보제고진단적준학성.
Objective To evaluate the diagnostic value of Crohn disease activity indices (CDAI) in assessing symptomatic recurrence following ileocolic resection for Crohn disease.Methods A total of 85 patients who underwent ileocolic resection between March 2003 and March 2010 were included.Clinical and endoscopic evaluation were performed within 12 months after operation.Endoscopic appearance was assessed using Rutgeers score and endoscopic recurrence was defined as endoscopic score ≥i2.Symptomatic recurrence was defined by the composite of symptom severity warranting medical therapy and endoscopic recurrence.The receiver operator characteristic (ROC) curve was used to explore the utility of CDAI in determining the presence or absence of symptomatic disease.Results Nineteen patients had symptomatic recurrence within 12 months postoperatively.The mean CDAI of patients with symptomatic recurrence was 205±93,significantly higher than those with sustained remission (97±44,P＜0.01).The area under the ROC curve for symptomatic recurrence and CDAI was.0.786.Symptomatic recurrence was best predicted by a CDAI cutoff of 150 and the sensitivity,specificity,and accuracy was 73.7％,81.8％ and 80.0％ respectively.When a combined endoscopic and CDAI was applied,the specificity and accuracy was markedly improved to 95.5％ and 90.6％.In comparison to CDAI alone,the combined use of CDAI and endoscopic evaluation had a higher level of agreement on symptomatic recurrence(Kappa value,0.718 vs.0.462).Conclusions CDAI is effective to predict symptomatic recurrence.A combination of CDAI and endoscopic evaluation can further improve the accuracy of assessing symptomatic recurrence.
