经多普勒超声评估的克罗恩病活动：主动脉血流参数的作用。
Crohn's disease activity assessed by Doppler sonography: the role of aortic flow parameters.
机构信息
Universidade Federal do Rio de Janeiro, Hospital Universitário, Serviço de Gastroenterologia and Laboratório Multidisciplinar de Pesquisa, Rio de Janeiro/RJ, Brazil.
出版信息
Clinics (Sao Paulo). 2013 Apr;68(4):457-62. doi: 10.6061/clinics/2013(04)04.
OBJECTIVES
Intestinal neovascularization and abnormal abdominal arterial flow rates have been reported in Crohn's disease. The aim of this study was to evaluate Doppler sonography as a method for assessing Crohn's disease activity based on changes in splanchnic hemodynamics.
METHODS
Forty-eight patients with Crohn's disease, 22 healthy volunteers and 12 patients with irritable bowel syndrome were evaluated by Doppler ultrasound for flow parameters of the aorta and superior mesenteric artery. This evaluation included the cross-sectional area, maximum flow volume, peak systolic velocity, end diastolic velocity, resistance and the pulsatility index. Disease activity was classified according to the Crohn's disease activity index.
RESULTS
Most measurements in the aorta and superior mesenteric artery were significantly different between Crohn's disease patients and both control groups. Only the aortic maximum flow volume (CC = 0.37, p = 0.009) and aortic peak systolic velocity (CC = 0.30, p = 0.035) showed a significant positive correlation with the Crohn's disease activity index. The determination of cut-off points for the aortic maximum flow volume and peak systolic velocity measurements increased the sensitivity (80 and 75% for flow volume and velocity, respectively), specificity (57 and 75%), accuracy (67 and 75%) and positive (57 and 68%) and negative (80 and 81%) predictive values. These cut-off values permitted the correct classification of most of the patients with Crohn's disease with respect to disease activity. None of the superior mesenteric artery measurements were able to discriminate patients in relation to disease activity.
CONCLUSION
The aortic maximum flow volume and peak systolic velocity levels estimated by Doppler sonography reflected disease activity in Crohn's disease. Doppler sonography of the aorta is therefore a novel noninvasive adjunct method that may be useful in the clinical follow-up of patients with Crohn's disease.
目的
已有研究报道，克罗恩病（Crohn's disease）存在肠道新生血管形成和腹部动脉血流速率异常。本研究旨在评估基于内脏血流动力学变化的多普勒超声检查对克罗恩病活动度的评估价值。
方法
采用多普勒超声检测 48 例克罗恩病患者、22 名健康志愿者和 12 例肠易激综合征患者的腹主动脉和肠系膜上动脉血流参数，包括横截面积、最大血流容积、收缩期峰值流速、舒张末期流速、阻力指数和搏动指数。根据克罗恩病活动指数（Crohn's disease activity index）对疾病活动度进行分类。
结果
腹主动脉和肠系膜上动脉的大多数测量值在克罗恩病患者与两个对照组之间存在显著差异。仅腹主动脉最大血流容积（CC = 0.37，p = 0.009）和腹主动脉收缩期峰值流速（CC = 0.30，p = 0.035）与克罗恩病活动指数呈显著正相关。腹主动脉最大血流容积和收缩期峰值流速测量的截断值的确定提高了敏感性（分别为 80%和 75%）、特异性（分别为 57%和 75%）、准确性（分别为 67%和 75%）和阳性预测值（分别为 57%和 68%）及阴性预测值（分别为 80%和 81%）。这些截断值可正确分类大多数克罗恩病患者的疾病活动度。肠系膜上动脉的测量值均无法区分活动期与缓解期患者。
结论
多普勒超声检查估测的腹主动脉最大血流容积和收缩期峰值流速水平可反映克罗恩病的疾病活动度。因此，腹主动脉多普勒超声检查是一种新的非侵入性辅助方法，可能有助于克罗恩病患者的临床随访。
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