肠镜与多层螺旋CT小肠造影对炎症性肠病的诊断价值评估

Clinical value of enteroscopy and multislice spiral CT enterography in inflammatory bowel disease

摘要:

目的 探讨肠镜与多层螺旋CT小肠造影（MSCTE）对炎症性肠病（IBD）的诊断效能。方法 回顾性分析2018年5月13日－2019年6月13日该院消化科76例经病理确诊为IBD患者的肠镜和MSCTE影像学检查资料，观察分析肠黏膜溃疡、多节段性病变、鹅卵石征、肠息肉、肠壁强化、肠壁增厚、结肠带消失、瘘管形成与腹腔脓肿的情况，并利用统计学方法对两项检查进行诊断效能的评估和分析。结果 肠镜对IBD的诊断敏感性、特异性分别为98.68%和90.00%，肠镜和病理诊断结果的一致性较好（Kappa = 0.77）；MSCTE对IBD的诊断敏感性、特异性分别为88.16%和25.00%，MSCTE和病理诊断结果的一致性一般（Kappa = 0.50）。MSCTE对IBD的诊断敏感性、特异性均明显低于肠镜，差异均有统计学意义（P < 0.05）。肠镜+MSCTE对IBD的诊断敏感性、特异性分别为100.00%和95.00%，其与病理诊断结果的一致性较好（Kappa = 0.84）。肠镜对于诊断IBD患者中肠壁溃疡、肠息肉、瘘管形成、鹅卵石征和结肠带消失有较高的诊断敏感性，但对瘘管形成的诊断特异性极低，MSCTE对肠壁增厚、肠壁强化和瘘管形成的敏感性均为100.00%，但对肠息肉、多节段病变的诊断特异性极低。结论 肠镜仍是目前临床上诊断IBD的首选方式，对于身体状况不耐受和合并肠壁増厚、瘘管形成和腹腔脓肿等并发症的患者，则需要MSCTE才能获得全面、准确的诊断。肠镜和MSCTE的联合检查方式，对于IBD的诊断具有更高的临床价值。

Abstract:

Objective To evaluate the value of enteroscopy and multislice computed tomography enterography(MSCTE) in diagnosis of inflammatory bowel disease.Methods A retrospectively analysis was performed on the colonoscopy and MSCTE imaging data of 76 patients were diagnosed with IBD by pathology from 13th May 2018 to 13th June 2019. Then observe and analyze the intestinal ulcer, multiple segmental lesions, cobble stone sign, intestinal polyp, intestinal wall strengthening and abnormal thickening, loss of colon band, formation of fistula and abdominal abscess. The diagnostic efficiency of the two tests was evaluated and analyzed by statistical method.Results The sensitivity and specificity of colonoscopy in the diagnosis of IBD were 98.68% and 90.00%, respectively, and the results of colonoscopy and pathology had good consistency (Kappa = 0.77); the sensitivity and specificity of MSCTE for IBD were 88.16% and 25.00%, respectively, and the consistency of MSCTE and pathological diagnosis was general (Kappa = 0.50). The sensitivity and specificity of MSCTE in the diagnosis of IBD were significantly lower than those of colonoscopy (P < 0.05). The sensitivity and specificity of colonoscopy + MSCTE in the diagnosis of IBD were 100.00% and 95.00%, respectively, and the results were consistent with pathological diagnosis (Kappa = 0.84). The colonoscopy had high diagnostic sensitivity in the diagnosis of IBD patients with intestinal wall ulcer, intestinal polyps, fistula formation, cobble stone sign, loss of colon band, but the specificity for fistula formation was very low. The sensitivity of MSCTE to intestinal wall thickening, intestinal wall enhancement and fistula formation was 100.00%, but the specificity of intestinal polyps and multi segment lesions was very low.Conclusion Enteroscopy is still the first choice in the clinical diagnosis of IBD. Patients with physical intolerance and complications such as intestinal wall thickening, fistula formation and abdominal abscess, MSCTE is needed to obtain a comprehensive and accurate diagnosis. The combined examination of enteroscopy and MSCTE has higher clinical value for the diagnosis of IBD.