Mirk P, Palazzoni G, Gimondo P
Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia.
AJR Am J Roentgenol. 1999 Aug;173(2):381-7. doi: 10.2214/ajr.173.2.10430141.
To our knowledge, Doppler data for the inferior mesenteric artery are currently restricted to healthy patients. The present study was conducted to evaluate changes in inferior mesenteric artery flow in patients with inflammatory bowel disease.
Doppler sonography of the inferior mesenteric artery was prospectively performed in 24 patients with Crohn's disease (active, n = 15; inactive, n = 9), in 22 patients with ulcerative colitis (active, n = 14; inactive, n = 8), and in 40 healthy controls. Disease activity was determined with clinical and laboratory indicators (medical history, physical examination, laboratory data, and endoscopy with histology). Flow velocity, pulsatility index, and estimated flow volume were measured in all patients and compared with the corresponding values for control subjects. Hemodynamic parameters were then correlated with location of disease (small bowel and right and proximal transverse colon versus distal transverse and left colon) and disease activity or inactivity.
Among patients with active disease, inferior mesenteric artery flow was significantly greater in those with left colon involvement (group 1, 20 patients) than in patients with involvement of the small bowel or right colon (group 2, nine patients) and in control subjects. Median flow values for group 1 were peak systolic velocity, 1.96+/-0.57 m/sec; mean velocity, 0.63+/-0.25 m/sec; minimum velocity, 0.17+/-0.20 m/sec; pulsatility index, 3.07+/-1.24; and estimated flow volume, 0.40+/-0.17 l/min. Median flow values for group 2 were peak systolic velocity, 1.27+/-0.56 m/sec; mean velocity, 0.29+/-0.14 m/sec; minimum velocity, 0.06+/-0.10 m/sec; pulsatility index, 4.71+/-0.98; and estimated flow volume, 0.14+/-0.11 l/min. Median flow values for control subjects were peak systolic velocity, 1.41+/-0.48 m/sec; mean velocity, 0.43+/-0.19 m/sec; minimum velocity, 0.10+/-0.16 m/sec; pulsatility index, 3.49+/-0.49; and estimated flow volume, 0.13+/-0.06 l/min. Compared with control subjects, patients with acute disease involving the left colon (group 1) presented increases in flow velocity (systolic velocity, p < .001; minimum velocity, p = .01; mean velocity, p < .001) and estimated flow volume (p < .001) and a decreased pulsatility index (p = .01). A significant increase in inferior mesenteric artery flow was also found when group 1 patients were compared with those of group 2 (active disease affecting the small bowel and right colon) and group 3 (13 patients with quiescent disease of the left colon).
In this preliminary study, active inflammation of the left colon in patients with Crohn's disease or with ulcerative colitis was associated with a substantial increase in inferior mesenteric artery flow that could be seen on Doppler sonography.
据我们所知，目前关于肠系膜下动脉的多普勒数据仅限于健康患者。本研究旨在评估炎症性肠病患者肠系膜下动脉血流的变化。
对24例克罗恩病患者（活动期，n = 15；非活动期，n = 9）、22例溃疡性结肠炎患者（活动期，n = 14；非活动期，n = 8）以及40名健康对照者进行肠系膜下动脉的多普勒超声检查。通过临床和实验室指标（病史、体格检查、实验室数据以及组织学检查的内镜检查）确定疾病活动度。测量所有患者的血流速度、搏动指数和估计血流量，并与对照者的相应值进行比较。然后将血流动力学参数与疾病部位（小肠、右半结肠和近端横结肠与远端横结肠和左半结肠）以及疾病活动或非活动状态进行关联分析。
在活动期疾病患者中，左半结肠受累患者（第1组，20例）的肠系膜下动脉血流显著高于小肠或右半结肠受累患者（第2组，9例）以及对照者。第1组的血流中位数为：收缩期峰值速度1.96±0.57米/秒；平均速度0.63±0.25米/秒；最小速度0.17±0.20米/秒；搏动指数3.07±1.24；估计血流量0.40±0.17升/分钟。第2组的血流中位数为：收缩期峰值速度1.27±0.56米/秒；平均速度0.29±0.14米/秒；最小速度0.06±0.10米/秒；搏动指数4.71±0.98；估计血流量0.14±0.11升/分钟。对照者的血流中位数为：收缩期峰值速度1.41±0.48米/秒；平均速度0.43±0.19米/秒；最小速度0.10±0.16米/秒；搏动指数3.49±0.49；估计血流量0.13±0.06升/分钟。与对照者相比，左半结肠急性疾病患者（第1组）的血流速度（收缩期速度，p < 0.001；最小速度，p = 0.01；平均速度，p < 0.001）和估计血流量（p < 0.001）增加，搏动指数降低（p = 0.01）。当将第1组患者与第2组（影响小肠和右半结肠的活动期疾病）和第3组（13例左半结肠静止期疾病患者）进行比较时，还发现肠系膜下动脉血流显著增加。
在这项初步研究中，克罗恩病或溃疡性结肠炎患者左半结肠的活动性炎症与肠系膜下动脉血流的显著增加相关，这在多普勒超声检查中可以看到。
