發(fā)布時(shí)間：2018-05-24 01:35

  本文選題：小腸膠囊內(nèi)鏡 + 克羅恩病��； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景及目的:克羅恩病(Crohndisease,CD)是累及全消化道的慢性炎癥性疾病,約80%患者累及小腸,其中1/3患者小腸是唯一病灶。長(zhǎng)期以來(lái),人們無(wú)法直觀看到小腸內(nèi)部全景,直到小腸膠囊內(nèi)鏡(small bowel capsule endoscopy,SBCE)和小腸鏡的出現(xiàn)。SBCE是一種新型的內(nèi)鏡檢查技術(shù),現(xiàn)已經(jīng)成為臨床上小腸疾病的一線診斷技術(shù),然而SBCE對(duì)CD的診療價(jià)值目前仍存在爭(zhēng)議,本研究包括以下兩部分:1、探討SBCE對(duì)疑診CD患者的診斷價(jià)值;2、分析確診CD患者行SBCE檢查發(fā)生檢查未完成及膠囊滯留的危險(xiǎn)因素、探討SBCE在評(píng)估CD患者小腸黏膜愈合中的價(jià)值。研究方法1、小腸膠囊內(nèi)鏡在疑診克羅恩病患者中的應(yīng)用分析435例臨床懷疑CD且行SBCE檢查患者的臨床資料(其中23例患者同時(shí)行雙氣囊小腸鏡檢查、15例患者同時(shí)行CT小腸造影檢查)。分別統(tǒng)計(jì)三種檢查方法對(duì)疑診CD患者的診斷率、準(zhǔn)確率、靈敏度、特異度。2、小腸膠囊內(nèi)鏡在確診克羅恩病患者中的應(yīng)用2.1統(tǒng)計(jì)確診CD患者SBCE檢查未完成率和膠囊滯留率,并利用logistic回歸分析相關(guān)危險(xiǎn)因素。2.2觀察接受英夫利昔治療的小腸CD患者臨床療效,分析治療前和治療后第30周時(shí)患者小腸及結(jié)腸黏膜愈合情況。并利用spearman相關(guān)檢驗(yàn)分析Lewis評(píng)分與克羅恩病簡(jiǎn)化內(nèi)鏡評(píng)分(SES-CD)、克羅恩病活動(dòng)度指數(shù)(CDAI)、C反應(yīng)蛋白(CRP)的相關(guān)性。研究結(jié)果:1、小腸膠囊內(nèi)鏡在疑診克羅恩病患者中的應(yīng)用435例疑診CD患者中有267例患者最終確診為CD,其中三種方法的診斷率、'準(zhǔn)確率、靈敏度、特異度分別是小腸膠囊內(nèi)鏡為64.6%、89.4%、94.0%、82.1%;雙氣囊小腸鏡分別為78.2%、91.3%、94.4%、80%;CT小腸成像為73.3%、86.7%、90.9%、75%。2、小腸膠囊內(nèi)鏡在確診克羅恩病患者中的應(yīng)用2.1 302例確診CD中,SBCE檢查未完成率為33.44%,滯留率為5.6%,logistic回歸發(fā)現(xiàn)白蛋白降低是SBCE檢查未完成的危險(xiǎn)因素[OR=3.040;P=0.001],腹瀉是未完成的保護(hù)因素[OR=0.434;P=0.003]。CRP升高是膠囊滯留的危險(xiǎn)因素[OR=3.967;P=0.034]。2.2 36例接受英夫利昔治療的患者治療后第30周患者臨床緩解率為86.1%(31/36)結(jié)腸鏡下黏膜愈合率為72.2%(26/36),SBCE下小腸黏膜愈合率為30.6%(11/36),且11例小腸黏膜愈合的患者均同時(shí)取得了結(jié)腸鏡下黏膜愈合,有15例結(jié)腸鏡下黏膜愈合的患者未取得小腸黏膜愈合。Lewis評(píng)分與CRP呈中度相關(guān)[r=0.564,P0.001];與 CDAI 成低度相關(guān)[r=0.435,P0.001],與 SES-CD 評(píng)分無(wú)相關(guān)性[r=0.153,P=0.117]。研究結(jié)論:SBCE對(duì)疑診CD患者有較好的應(yīng)用價(jià)值。白蛋白降低增加CD患者SBCE檢查未完成風(fēng)險(xiǎn),腹瀉降低SBCE檢查未完成風(fēng)險(xiǎn);CRP升高增加膠囊滯留風(fēng)險(xiǎn)。英夫利昔可以有效誘導(dǎo)小腸受累的CD患者實(shí)現(xiàn)臨床緩解和黏膜愈合。SBCE下lewis評(píng)分可用來(lái)評(píng)估小腸黏膜愈合情況,CD患者中回腸末端同小腸其他部位愈合情況并不同步,小腸和結(jié)腸均受累的CD患者評(píng)估療效和黏膜愈合情況時(shí),有必要聯(lián)合SBCE和結(jié)腸鏡進(jìn)行評(píng)估。
[Abstract]:Background and purpose: Crohndisease (CD) is a chronic inflammatory disease involving the whole digestive tract. About 80% of the patients are involved in the small intestine, and the small intestine of the 1/3 patients is the only focus. For a long time, people can not see the whole small intestine in the small intestine until the small intestine capsule endoscopy (small bowel capsule endoscopy, SBCE) and small enteroscopy.SB appear in.SB. CE is a new type of endoscopic examination technology, which has become a diagnostic technique for clinical small intestinal diseases. However, the value of SBCE for diagnosis and treatment of CD is still controversial. This study includes two parts: 1, to explore the diagnostic value of SBCE for suspected CD patients; 2, the analysis of CD patients who did not complete the examination of SBCE examination and the retention of the capsule. Risk factors, the value of SBCE in evaluating the healing of small intestinal mucosa in CD patients. Method 1, the application of small intestinal capsule endoscopy in suspected Crohn's disease patients, 435 cases of clinically suspected CD and SBCE examination (of which 23 patients underwent double balloon enteroscopy at the same time and 15 patients at the same time with CT small bowel contrast examination). The rate of diagnosis, accuracy, sensitivity, specificity,.2, and the application of small intestine capsule endoscopy in the diagnosis of Crohn's disease were statistically analyzed by three methods of examination, respectively, and 2.1 of the patients with Crohn's disease diagnosed by small intestine capsules were statistically diagnosed with CD, and the uncompleted and capsule retention rates of the CD patients were examined by the logistic regression analysis of the risk factors.2.2 for inflixime treatment. The clinical efficacy of small intestinal CD patients was analyzed before and thirtieth weeks after treatment. Spearman correlation test was used to analyze the correlation between Lewis score and the simplified endoscopic score (SES-CD), Crohn's disease activity index (CDAI), and C reactive protein (CRP). The results were as follows: 1, small intestinal capsule endoscopy was suspected Of the 435 patients with Crohn's disease, 267 of the 435 suspected patients were finally diagnosed with CD, of which three methods were diagnosed as' accuracy, sensitivity, and specificity were 64.6%, 89.4%, 94%, 82.1% of small intestinal capsule, respectively, 78.2%, 91.3%, 94.4%, 80%, respectively, and CT small intestine imaging for 73.3%, 86.7%, 86.7%, 90.9%, 75%.2, small. In the diagnosis of Crohn's disease, intestinal capsule endoscopy was used in the diagnosis of 2.1302 cases of CD. The failure rate of SBCE examination was 33.44%, the retention rate was 5.6%. Logistic regression found that the decrease of albumin was the risk factor of unfinished SBCE examination [OR=3.040; P=0.001], diarrhea was the unfinished protective factor [OR=0.434; P=0.003].CRP rise was the risk of capsule retention. The risk factor [OR=3.967, P=0.034].2.2 36 cases of patients receiving inflixime treatment, thirtieth weeks after treatment, the rate of clinical remission was 86.1% (31/36), the healing rate of mucosa was 72.2% (26/36), the healing rate of small intestinal mucosa was 30.6% (11/36) under SBCE, and 11 cases of small intestinal mucosa healed at the same time, and there were 15 cases in 15 cases. .Lewis score of non intestinal mucosa healing in patients with intestinal mucosa healing under enteroscopy was moderately associated with CRP, [r=0.564, P0.001], [r=0.435 in low degree of CDAI and P0.001], and no correlation with SES-CD score. P=0.117]. study concluded that SBCE was of good application value for suspected CD patients. Risk, diarrhea reduced SBCE examination uncompleted risk, CRP increased the risk of capsule retention. Inflixime can effectively induce CD patients with small intestinal involvement in clinical remission and mucosal healing.SBCE Lewis score can be used to evaluate the healing of small intestinal mucosa, in CD patients, the end of the ileum and the other parts of the small intestine are not synchronized, small It is necessary to combine SBCE and colonoscopy to assess the efficacy and mucosal healing of CD patients with intestinal and colonic involvement.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R574.62

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 Sara Monteiro;Francisca Dias de Castro;Pedro Boal Carvalho;Bruno Rosa;Maria Jo?o Moreira;Rolando Pinho;Miguel Mascarenhas Saraiva;José Cotter;;Essential role of small bowel capsule endoscopy in reclassification of colonic inflammatory bowel disease type unclassified[J];World Journal of Gastrointestinal Endoscopy;2017年01期

2 Ahilan Arulanandan;Parambir S Dulai;Siddharth Singh;William J Sandborn;Denise Kalmaz;;Systematic review: Safety of balloon assisted enteroscopy in Crohn's disease[J];World Journal of Gastroenterology;2016年40期

3 Jo?o Santos-Antunes;Hélder Cardoso;Susana Lopes;Margarida Marques;Amadeu CR Nunes;Guilherme Macedo;;Capsule enteroscopy is useful for the therapeutic management of Crohn's disease[J];World Journal of Gastroenterology;2015年44期

4 José Manuel Benítez;Valle García-Sánchez;;Faecal calprotectin: Management in inflammatory bowel disease[J];World Journal of Gastrointestinal Pathophysiology;2015年04期

5 Cedric Van de Bruaene;Danny De Looze;Pieter Hindryckx;;Small bowel capsule endoscopy:Where are we after almost 15 years of use?[J];World Journal of Gastrointestinal Endoscopy;2015年01期

6 ;中國(guó)膠囊內(nèi)鏡臨床應(yīng)用指南[J];中華消化內(nèi)鏡雜志;2014年10期

7 Tomoaki Kono;Nobuyuki Hida;Koji Nogami;Masaki Iimuro;Yoshio Ohda;Yoko Yokoyama;Koji Kamikozuru;Katsuyuki Tozawa;Mikio Kawai;Tomohiro Ogawa;Kazutoshi Hori;Hiroki Ikeuchi;Hiroto Miwa;Shiro Nakamura;Takayuki Matsumoto;;Prospective postsurgical capsule endoscopy in patients with Crohn's disease[J];World Journal of Gastrointestinal Endoscopy;2014年03期

8 Anastasios Koulaouzidis;Emanuele Rondonotti;Alexandros Karargyris;;Small-bowel capsule endoscopy: A ten-point contemporary review[J];World Journal of Gastroenterology;2013年24期

9 István Rácz;Milán Szalai;Valéria Kovács;Henriett Regczi;Gyngyi Kiss;Zoltán Horváth;;Mucosal healing effect of mesalazine granules in naproxen-induced small bowel enteropathy[J];World Journal of Gastroenterology;2013年06期

10 楊黎;戈之錚;高云杰;李曉波;戴軍;張堯;薛寒冰;趙韞嘉;;膠囊內(nèi)鏡評(píng)分指數(shù)與簡(jiǎn)化克羅恩病活動(dòng)指數(shù)、血清C反應(yīng)蛋白評(píng)估小腸克羅恩病病變活動(dòng)程度的相關(guān)性分析[J];中華消化內(nèi)鏡雜志;2012年03期

，

本文編號(hào)：1927180