Civitelli Fortunata, Di Nardo Giovanni, Oliva Salvatore, Nuti Federica, Ferrari Federica, Dilillo Anna, Viola Franca, Pallotta Nadia, Cucchiara Salvatore, Aloi Marina
Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
J Pediatr. 2014 Jul;165(1):78-84.e2. doi: 10.1016/j.jpeds.2014.02.055. Epub 2014 Apr 13.
To evaluate the usefulness of colonic ultrasonography (US) in assessing the extent and activity of disease in pediatric ulcerative colitis (UC) and to compare US findings with clinical and endoscopic features.
Consecutive pediatric patients (n = 60) with a diagnosis of UC and suspected disease flare-up were prospectively enrolled; of these, 50 patients were eligible for the study. All underwent clinical evaluation, bowel US with color Doppler examination and colonoscopy. Blind US was performed the day before endoscopy in all patients. The US assessed variables were bowel wall thickness >3 mm, bowel wall stratification, vascularity, presence of haustra coli, and enlarged mesenteric lymph nodes.
The endoscopic extent of disease was independently confirmed in 47 patients by US that yielded a 90% concordance with endoscopy (95% CI 0.82-0.96). Multiple regression analysis showed that US measurements with an independent predictive value of severity at endoscopy were increased bowel wall thickness (P < .0008), increased vascularity (P < .002), loss of haustra (P = .031), and loss of stratification of the bowel wall (P = .021). Each variable was assigned a value of 1 if present. The US score strongly correlated with clinical (r = 0.94) and endoscopic activity (r = 0.90) of disease (P < .0001).
Colonic US is a useful first line noninvasive tool to assess the extent and activity of disease in children with UC and to estimate the severity of a flare-up, prior to further invasive tests.
评估结肠超声（US）在评估小儿溃疡性结肠炎（UC）疾病范围和活动度方面的实用性，并将超声检查结果与临床及内镜特征进行比较。
前瞻性纳入连续60例诊断为UC且疑似疾病复发的儿科患者；其中50例患者符合研究条件。所有患者均接受临床评估、彩色多普勒肠超声检查及结肠镜检查。所有患者在结肠镜检查前一天进行盲法超声检查。超声评估的变量包括肠壁厚度>3 mm、肠壁分层、血管分布、结肠袋存在情况及肠系膜淋巴结肿大。
47例患者的疾病内镜范围通过超声得到独立确认，超声与内镜检查的一致性为90%（95%CI 0.82 - 0.96）。多元回归分析显示，在内镜检查中具有独立预测严重程度价值的超声测量指标包括肠壁厚度增加（P < .0008）、血管分布增加（P < .002）、结肠袋消失（P = .031）及肠壁分层消失（P = .021）。若存在上述每个变量，则赋值为1。超声评分与疾病的临床活动度（r = 0.94）和内镜活动度（r = 0.90）密切相关（P < .0001）。
结肠超声是一种有用的一线非侵入性工具，可在进一步进行侵入性检查之前，评估小儿UC患者的疾病范围和活动度，并估计疾病复发的严重程度。
