南通大学学报(医学版)

目的：探究经腹肠道超声(transabdominal bowel ultrasonography, TBUS)对克罗恩病患者疾病活动度的评估价值，并分析其作为独立的影像学检查在克罗恩病随访检查中的可能性。方法：收集2022年1月—2024年6月就诊于南通大学附属南通第三医院诊断明确、资料完整的克罗恩病患者42例，根据克罗恩病活动指数将其分为临床活动期(n=27)、临床缓解期(n=15)两组。收集的患者资料包括克罗恩病活动指数(Crohn,s disease activity index, CDAI)，实验室指标(血常规、红细胞沉降率、CRP、粪便钙卫蛋白)，结肠镜图像及克罗恩病简化内镜评分(Crohn,s disease simplified endoscopic score, SES-CD)。比较临床活动期和临床缓解期两组患者的实验室指标及SES-CD差异。通过TBUS观察患者肠道的肠壁分层、测量肠壁厚度(bowel wall thickening, BWT)，比较内镜活动期和内镜缓解期两组患者BWT的差异；评估肠壁血流情况(通过Limberg分级法半定量评估，分为Ⅰ～Ⅳ级)，比较临床活动期和临床缓解期两组患者血流分级的差异。通过绘制ROC曲线比较内镜评分、实验室指标、BWT评估克罗恩病病情活动的效能，并根据约登指数寻找BWT的最佳阈值。进一步采用Spearman相关性检验分析肠壁增厚的程度与SES-CD评分、红细胞沉降率、CRP、粪便钙卫蛋白的相关性。结果：克罗恩病患者的BWT、血流分级与疾病活动度呈正相关。内镜活动期患者的病变处BWT明显大于内镜缓解期患者(P<0.000 1)。临床活动期患者肠壁血流Limberg分级高于临床缓解期(P<0.000 1)。通过BWT评估克罗恩病活动性的效能虽弱于观察最直观的肠镜检查，但优于血液以及粪便的实验室检查，最佳阈值为5.65 mm。并且BWT的程度与SESCD评分、红细胞沉降率、CRP、粪便钙卫蛋白均呈正相关(r=0.814 8、0.330 5、0.516 5、0.315 6,均P<0.05)。结论 ：TBUS测量BWT及Limberg分级对评估克罗恩病的活动度有判断价值，超声能作为独立的无创影像学检查用于克罗恩病患者的随访复查。

Objective: To investigate the value of transabdominal bowel ultrasonography(TBUS) in evaluating disease activity in patients with Crohn,s disease and to evaluate its possibility as an independent imaging ultrasonograply in follow-up examination of Crohn,s disease. Methods: 42 patients with Crohn,s disease who were admitted to the Nantong Hospital 3 of from January 2022 to June 2024 with clear diagnosis and complete data were collected and divided into two groups: clinical active period(n=27) and clinical remission period(n=15), according to the Crohn,s disease activity index. Patient data collected included Crohn,s disease activity index(CDAI score), laboratory indicators(blood routine, erythrocyte deposition rate, CRP, fecal calprotron),colonoscopy images, and Crohn,s disease simplified endoscopic score(SES-CD). The differences of laboratory indexes and SESCD scores between the clinical active period group and clinical remission period group were compared. TBUS was used to observe the intestinal wall stratification of the patients, measure the bowel wall thickening(BWT), compare the differences in BWT between the endoscopic active period group and endoscopic remission period group, to evaluate the intestinal wall blood flow(semiquantitative evaluation by Limberg grading, divided into grades Ⅰ to Ⅳ), and compare the differences in blood flow grading between the clinical active period group and clinical remission period group. The efficacy of endoscopic score, laboratory indicators and BWT in evaluating the disease activity of Crohn,s disease was compared by drawing ROC curve, and the optimal threshold of BWT was found according to Jorden index. Spearman correlation test was used to analyze the correlation between BWT and SES-CD score, erythrocyte sedimentation rate, CRP and fecal calprotectin. Results: BWT and blood flow grade were positively correlated with disease activity in Crohn,s patients. The BWT in endoscopic active patients was significantly greater than that in endoscopic remission patients(P<0.000 1). At the same time, the Limberg grade of intestinal wall blood flow in clinical active patients was higher than that in clinical remission patients(P<0.000 1). The assessment of Crohn,s disease activity by BWT was less effective than the most visible colonoscopy, but superior to laboratory tests of blood and stool, with an optimal threshold of 5.65 mm. Moreover, the degree of BWT was positively correlated with SES-CD score, erythrocyte sedimentation rate, CRP, and fecal calprotectin(r=0.814 8, 0.330 5, 0.516 5, 0.315 6, all P<0.05). Conclusion: TBUS measurement of BWT and Limberg grades is valuable for evaluating the activity of Crohn,s disease, and ultrasound can be used as an independent noninvasive imaging examination for follow-up review of Crohn,s disease patients.