本文選題：炎癥性腸病 + 結(jié)腸鏡��； 參考：《昆明醫(yī)科大學》2017年碩士論文

【摘要】：[目的]探討結(jié)腸鏡、超聲內(nèi)鏡(endoscopic ultrasonography,EUS)及CT小腸造影(computed tomographic enterography,CTE)在炎癥性腸病(inflammatory bowel disease, IBD)診斷和活動性評估中的價值,以指導臨床診治。[方法]選取2014年9月至2016年9月間在昆明醫(yī)科大學第一附屬醫(yī)院經(jīng)內(nèi)鏡、CT、MRI及病理確診的105例IBD患者,其中潰瘍性結(jié)腸炎((ulcerativecolitis,UC) 68例,克羅恩病(crohn's disease,CD) 37例,回顧性分析其結(jié)腸鏡、EUS及CTE的影像學表現(xiàn),探討IBD在這3種檢查下的表現(xiàn)特征和陽性檢出率,并比較該3種檢查在評估疾病活動性中的價值。[結(jié)果]1.結(jié)腸鏡可直觀觀察腸道病變,并可通過改進的Baron分級標準、SES-CD評分預測疾病活動性;2. EUS除了觀察消化道黏膜病變以外,還可觀察消化道管壁及管壁外病變,并通過測量UC管壁厚度評估疾病嚴重度:輕、中、重度UC患者EUS下的腸壁總厚度分別為3.59±0.69mm、4.54±0.96mm、5.99± 1.16mm,黏膜層厚度分別為 1.02±0.14mm、1.22±0.25mm、1.61±0.27mm,黏膜下層厚度分別為 1.41±0.36mm、2.07±0.70mm、2.67±0.51mm,差異均具有統(tǒng)計學意義;3. CTE觀察CD患者小腸病變具有明顯優(yōu)勢,本研究中檢出9例患者(30.00%)存在小腸病變,彌補了結(jié)腸鏡的不足;4.UC組,結(jié)腸鏡、EUS、CTE單獨檢查發(fā)現(xiàn)病變的陽性率分別是86.76%、77.94%、71.43%;結(jié)腸鏡聯(lián)合 CTE 為 92.86%高于單獨 CTE( χ2 =4.383, P=0.036),結(jié)腸鏡+EUS+CTE 為 92.86%高于單獨 CTE (χ2=4.383, P=0.036)。CD 組,結(jié)腸鏡、EUS、CTE單獨檢查發(fā)現(xiàn)病變的陽性率分別是62.16%、86.49%、76.67%;以下檢查陽性率均高于單獨結(jié)腸鏡,EUS為86.49% (χ2 =5.736, P=0.017),結(jié)腸鏡聯(lián)合 EUS 為 89.19%( χ2 =7.341,P=0.007),,結(jié)腸鏡聯(lián)合 CTE 為 90.00%( χ2 =6.780,P=0.009),結(jié)腸鏡+EUS+CTE 為 93.33% (χ2=8.856,P=0.003);5. UC組疾病活動性預測價值由高到低排列:改進的Baron分級標準(r=0.748,P0.001)、EUS 黏膜層厚度(r=0.720,P0.001)、EUS 管壁總厚度(r=0.671,P0.001)、EUS 黏膜下層厚度(r=0.628,P0.001) ; CD 組 SES-CD評分可預測疾病活動性(r=0.646,P0.001)。[結(jié)論]1.結(jié)腸鏡可直觀觀察腸道病變,并可通過改進的Baron分級標準、SES-CD評分預測疾病活動性;2. EUS可通過測量腸壁厚度評估UC活動性;3. CTE觀察CD患者小腸病變具有明顯優(yōu)勢;4.診斷IBD時聯(lián)合使用結(jié)腸鏡、EUS及CTE檢查,可提高病變檢出率;5.在IBD的診治中需密切結(jié)合臨床表現(xiàn)、結(jié)腸鏡、EUS及CTE的證據(jù)進行綜合判斷,預測疾病嚴重程度,選擇最佳治療方案。
[Abstract]:[objective] to evaluate the value of colonoscopy (EUS) and computed tomographic enterography (CTEUS) in the diagnosis and active evaluation of inflammatory bowel disease (IBD) in order to guide clinical diagnosis and treatment. [methods] from September 2014 to September 2016, 105 patients with IBD confirmed by endoscopy and pathology in the first affiliated Hospital of Kunming Medical University, including 68 cases of ulcerative colitis and 37 cases of Crohn's disease, were selected. The imaging findings of EUS and CTE in colonoscopy were retrospectively analyzed, and the characteristics and positive rate of IBD in these three examinations were discussed, and the value of these three examinations in evaluating disease activity was compared. [result] 1. Colonoscopy can directly observe intestinal lesions and predict disease activity by modified Baron grading criteria (SES-CD score). In addition to observing the mucosal lesions of the digestive tract, EUS can also observe the wall and extrawall lesions of the digestive tract, and evaluate the severity of the disease by measuring the thickness of the UC wall. The total thickness of intestinal wall under EUS was 3.59 鹵0.69mm / 4.54 鹵0.96mm / 5.99 鹵1.16mm, the thickness of mucosal layer was 1.02 鹵0.14mm / 1.22 鹵0.25mm / 1.61 鹵0.27mm, and the thickness of submucosal layer was 1.41 鹵0.36mm / 2.07 鹵0.70mm 2.67 鹵0.51mm, respectively. In this study, 9 cases of small intestine lesions were detected in 9 patients with CD, which made up for the deficiency of colonoscopy in the UC group. The positive rate of colonoscopy combined with CTE was 92.86% higher than that of CTE alone (蠂 2 4.383, P < 0.036), and the positive rate of colonoscopy EUS CTE was 92.86% higher than that of CTE alone (蠂 24.383, P=0.036).CD group), and the positive rate of colonoscopy alone was 86.76% and 77.94% respectively (蠂 24.383, P=0.036).CD group), and the positive rate of colonoscopy combined with CTE was 92.86% and 92.86% respectively (蠂 24.383, P=0.036).CD group). The positive rates were 62.16% and 86.49%, respectively, and the positive rates of the following examinations were 86.49% (蠂 2 / 5.736, P 0.017), 89.19% (蠂 ~ 2 7.341 1 P 0.007), 90.005% (蠂 ~ 2 6.780%) and 93.33% (蠂 ~ 2 8.856P0. 003P ~ 0. 003P ~ 0. 005), respectively (蠂 2 7. 34 1 P 0. 007), and the positive rates of colonoscopy combined with CTE were 90. 005% (蠂 2 6.780) and 93 33% (蠂 2 = 28. 856P 0. 003P 0. 003) respectively. The predictive value of disease activity in UC group ranged from high to low: the modified Baron grading standard was 0.748g / P0.001P0.001EUS mucosal thickness. The total thickness of EUS wall was 0.671g / P0.001EUS (r 0.628P0.001), and the SES-CD score of CD group could predict the activity of disease. [conclusion] 1. Colonoscopy can directly observe intestinal lesions and predict disease activity by modified Baron grading criteria (SES-CD score). EUS can evaluate UC activity by measuring the thickness of intestinal wall. CTE observation of small intestine lesions in CD patients has obvious advantages. In the diagnosis of IBD, the combined use of colonoscopy combined with EUS and CTE can increase the detection rate of lesions by 5. 5%. In the diagnosis and treatment of IBD, clinical manifestations should be closely combined, and the evidence of colonoscopy and CTE should be comprehensively judged to predict the severity of the disease and to select the best treatment plan.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R574

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