多层螺旋ＣＴ 小肠造影在结肠受累克罗恩病患者诊断中的价值

目的：分析结肠受累克罗恩病（CD）的临床、内镜、病理及多层螺旋CT小肠造影（MSCTE）特征，探讨MSCTE在CD诊断中的临床价值。方法选择结肠受累CD住院患者71例，选取同期28例肠结核（ITB）患者的临床、内镜、病理及MSCTE资料作为对照，采用单因素及多因素logistic回归分析的方法筛选诊断CD的相关特征。结果 CD组腹泻及肛周病变发生率、CRP升高比例均高于ITB组；肠外结核史、PPD强阳性及T-SPOT阳性率低于ITB组（P＜0．05）。结肠镜特征分析显示CD组病变≥4个肠段和纵形溃疡高于ITB组，环形溃疡低于ITB组（P＜0．05）。病理学特征分析显示两组非干酪样肉芽肿、裂隙样溃疡、隐窝脓肿及干酪样肉芽肿的检出率差异无统计学意义（P＞0．05）。MSCTE特征单因素分析显示CD组肠壁分层强化、肠系膜侧管壁增厚及梳状征较ITB组多见，腹腔淋巴结钙化或中心性坏死较ITB组少见（P＜0．05）；多因素logistic回归分析显示，肠系膜侧管壁增厚（OR＝5．140，95％CI：1．053～25．087）是CD的独立预测因素。结论 CD的临床、内镜及病理特征诊断价值有限，综合判断时难以满足临床诊断需求，MSCTE的应用有助于提高CD的临床诊断水平。

The clinical value of multi-slice CT enterography in diagnosis of Crohn disease involving colon

Objective To analyze the clinical,endoscopic,histological and multi-slice CT enterography(MSCTE)characteristics of Crohn disease(CD),and to explore the value of MSCTE in the diagnosis of CD involving the colon. Methods Clinical,endoscopic,histo-logical and MSCTE data of 71 patients with CD attending in our hospital from January 2009 to September 2013 were analyzed,and the data of 28 patients with ITB as a control at the same period were studied. The parameters for diagnosis of CD were screened by logistic regression a-nalysis. Results The incidence rates of diarrhea,perianal disease and C-reaction protein elevated in CD were higher than those in intestinal tuberculosis(ITB);the occurrence rate of history of abenteric tuberculosis,and the positive rates of PPD and T-SPOT were lesser than those of ITB(P<0. 05). The endoscopic findings showed that involvement of more than four intestinal segments and longitudinal ulcers were signif-icantly more common in CD than in ITB and transverse ulcers were more common in ITB(P<0. 05). There was no significant deviation of histological characteristics(P>0. 05). The pathological analysis showed that non-caseous granulomas,fissure-like ulcers,crypt abscess and caseous granulomas between the two groups had no statistically significant difference (P>0. 05 ). The analysis of MSCTE imaging showed that mural stratification enhancement,thickening obviously of the membrane margin and comb sign occurred more frequently in CD than in ITB and that Lymph node calcification or central necrosis was more frequently found in ITB than in CD. The results of logistic regression anal-ysis showed that thickening obviously of the membrane margin(OR=5. 140,95%CI:1. 053~25. 087)was an independent predictor for the diagnosis of CD. Conclusion CD has clinical,colonoscopic and pathological characteristics,but the diagnostic value of these characteristics is limited,and the comprehensive judgment can not meet the demand of clinical diagnosis. Application of MSCTE is helpful to improve the level of diagnosis of CD.