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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。
Objective To analyze the ultrasonographic features of Crohn’s disease patients and evaluate the value of ultrasound in assessing the activity of Crohn’s disease. Methods From August 2011 to August 2012, 25 cases of Crohn’s disease were treated in Shanghai Tenth People’s Hospital. Including Crohn’s disease activity index (CDAI) score <150 points (remission) in 12 cases, 150 ~ 450 points (active) in 13 cases. Each patient underwent endoscopy (colonoscopy or enteroscopy), abdominal ultrasound. Non-inflammatory lesions (remission) and inflammation (active) intestine intestinal wall thickness compared with two independent samples t test. The results of endoscopy as the gold standard, energy Doppler ultrasound to determine the activity of Crohn’s disease and CDAI score to determine the coincidence rate of activity of Crohn’s disease compared with χ2 test. Results 25 cases of Crohn disease patients by endoscopy to determine the active period of 20 cases, 5 cases of remission. All patients can get satisfactory ultrasound images. The group of 22 cases of Crohn’s disease ultrasound diagnosis, the diagnostic accuracy was 88% (22/25). The thickness of the intestinal wall in the non-inflammatory lesions (remission stage) was (2.06 ± 0.62) mm lower than that in the inflammatory stage (7.90 ± 2.90) mm, and the difference was statistically significant (t = 2.53, P <0.05). The 25 cases of Crohn’s disease in patients with energy Doppler ultrasound to determine the remission in 7 cases, 18 cases of active. The coincidence rate of energy Doppler ultrasound in judging the activity of Crohn’s disease was 92% (23/25). The coincidence rate of judging the activity of Crohn’s disease based on CDAI score was only 64% (16/25) Energy Doppler ultrasound to determine the coincidence rate of Crohn’s disease activity, and the difference was statistically significant (χ2 = 9.39, P <0.05). Ultrasound examination found abdominal abscess in 1 case, abdominal lymph node enlargement in 7 cases, ascites in 2 cases. Conclusion Ultrasonography has certain advantages in the observation of intestinal wall thickness, structure level, echogenicity and parenteral complications. It can accurately evaluate the activity of Crohn ’s disease and has guiding significance for the diagnosis and treatment of Crohn’ s disease.